Epinephrine For Anaphylaxis Research Articles

Evaluating Practice Patterns of Observation Periods Following Epinephrine Administration for Anaphylaxis Among Pediatric Patients.

Objective Current guidelines recommend that anaphylactic patients be observed for 4-6 hours following epinephrine administration to monitor for biphasic reactions. There is conflicting data regarding the efficacy of these guidelines and the prevalence of biphasic reactions among the pediatric population. This retrospective study aimed to investigate the appropriateness of these guidelines through evaluation of observation periods and patterns of biphasic reaction development among pediatric anaphylactic patients at a single-institution ED. Methods Patients less than 18 years of age who presented to the ED of a tertiary academic medical center between 2017 and 2022 and were treated with epinephrine for anaphylaxis were included in the study. The frequency and timing of biphasic reactions were observed. Duration of ED observation, time between symptom onset and first dose of epinephrine, number and category of anaphylactic symptoms, and allergen type were compared between patients who did and did not experience a biphasic reaction. Additional variables analyzed included persistence of anaphylactic symptoms, additional doses of epinephrine, and adjuvant medications. Contingency tables and two-sample t-tests were used to compare categorical and continuous variables, respectively, between those who did and did not develop a biphasic reaction. Results A total of 292 patients met the inclusion criteria and were included in the analysis. All patients were observed in the ED for a mean of 233.1 minutes. Ten patients (3.4%) developed a biphasic reaction. Six had a reaction within 150 minutes of initial symptom resolution, and four developed one after discharge, within 10 to 33 hours following symptom resolution. There was no significant difference in the length of time observed in the ED (p=0.98) or from symptom onset to the first epinephrine dose (p=0.90) between groups. Presenting with respiratory symptoms was associated with persistent anaphylactic symptoms despite epinephrine administration (p=0.01). Patients with symptoms involving at least two organ systems were 3.45 times more likely to experience persistent symptoms post-epinephrine than those with involvement of only one organ system (OR=3.45; CI: 1.28-9.30). Allergen type, anaphylactic symptoms, or the number of organ systems involved were not linked to developing a biphasic reaction or the need for additional epinephrine doses. Conclusions The patients who developed a biphasic reaction did so either shortly following initial symptom resolution or many hours past the recommended observation period. Extending the observation period of patients within reasonable parameters would not have reduced the number of patients who experienced a biphasic reaction after discharge. The results of this study support potentially adopting a more individualized approach to anaphylaxis management following epinephrine administration. Shortening the observation period for patients at low risk for biphasic reactions could reduce the patient burden on EDs without negatively impacting patient outcomes. Although no significant risk factors for biphasic reactions were identified in this study, closer monitoring of patients with respiratory symptoms and/or involvement of a greater number of organ systems may help mitigate the number of patients who experience persistence of anaphylaxis despite treatment.

Evidence based use of epinephrine in anaphylaxis.

Epinephrine is the first line treatment for anaphylaxis, however, there are limited data to support this. This review examines data surrounding evidence for the use of epinephrine in anaphylaxis, data on prescription for and use of epinephrine autoinjectors, and data examining newer routes of delivery of epinephrine; with a focus on recent publications over the past few years. With recent epidemiologic studies of anaphylaxis and new forms of epinephrine being studied, new data on the effects of epinephrine are aiding in the understanding of epinephrine's effects and the shortcomings of epinephrine both in its effect and utility in the real world. Epinephrine is still considered the first line therapy for anaphylaxis, and we are starting to have a better understanding of its effects in both healthy patients and those with anaphylaxis.

English

Background: Sunflower seed is one of the most common edible seeds and its consumption is growing. Case reports of sunflower seed allergy have been described since the 1970s. However, there are few data on the prevalence and clinical manifestations of sunflower seed allergy. Objective: To improve understanding of sunflower seed allergy. Methods: We evaluated the clinical and immunological features of patients with sunflower seed allergy diagnosed in the Allergy Department of a tertiary hospital in Madrid over a 5-years period. Results: Forty-seven patients reported adverse reactions after ingestion of sunflower seed and had specific sensitization to sunflower seed determined by skin prick test (median 8 mm) or specific IgE (median 1.10 kUA/L). Most had an adult-onset reaction to sunflower seed preceded by a history of atopy and other food allergies, predominantly to peach, peanut and nuts. Clinical presentation of sunflower seed allergy ranged from mild to severe, with a high proportion of patients suffering severe reactions, often undertreated. A variability in the severity of symptoms was seen on repeated exposures to sunflower seed on a same patient. Levels of sunflower seed IgE were strongly correlated with levels of IgE to non-specific lipid transfer proteins, while no significant differences were found in the severity of the reactions according to sensitization to those proteins. Conclusion: Our findings reveal a variability of clinical presentations of sunflower seed allergy on repeated exposures and an underuse of epinephrine in anaphylaxis. We highlight the importance of strict avoidance of sunflower seed and accurate prescription and administration of epinephrine in allergic patients.

Use of epinephrine in anaphylaxis: a retrospective cohort study at a Swiss university emergency department

Anaphylaxis is a medical emergency and requires prompt treatment to prevent life-threatening conditions. Epinephrine, considered as the first-line drug, is often not administered. We aimed first to analyse the use of epinephrine in patients with anaphylaxis in the emergency department of a university hospital and secondly to identify factors that influence the use of epinephrine. We performed a retrospective analysis of all patients admitted with moderate or severe anaphylaxis to the emergency department between 1 January 2013 and 31 December 2018. Patient characteristics and treatment information were extracted from the electronic medical database of the emergency department. A total of 531 (0.2%) patients with moderate or severe anaphylaxis out of 260,485 patients admitted to the emergency department were included. Epinephrine was administered in 252 patients (47.3%). In a multivariate logistic regression, cardiovascular (Odds Ratio [OR] = 2.94, CI 1.96-4.46, p <0.001) and respiratory symptoms (OR = 3.14, CI 1.95-5.14, p<0.001) were associated with increased likelihood of epinephrine administration, in contrast to integumentary symptoms (OR = 0.98, CI 0.54-1.81, p = 0.961) and gastrointestinal symptoms (OR = 0.62, CI 0.39-1.00, p = 0.053). Less than half of the patients with moderate and severe anaphylaxis received epinephrine according to guidelines. In particular, gastrointestinal symptoms seem to be misrecognised as serious symptoms of anaphylaxis. Training of the emergency medical services and emergency department medical staff and further awareness are crucial to increase the administration rate of epinephrine in anaphylaxis.

Personalized Nutrition in Food Allergy

Background : Food allergies have been increasing in people worldwide especially in infants and children. Allergic reactions can be mild, but can be so severe to the point where a person can pass away from their allergic reaction. Since there is now a wide spectrum of disorders from food allergies, more awareness on personalized approaches need to be cultivated based on a patients unique allergic reactions..Objective : This is a review on common allergies, allergic reactions and how personalized nutrition in food allergy is an important component for the safety of all individuals experiencing food allergy. Method : Using credible studies and trusted sources, information on the susceptibility, symptoms, and prevention of each allergy type are summarized within this literature review for better accessibility. Result : The most common food allergies are cow milk, eggs, peanuts, fish, shellfish, wheat, soybeans, and tree nuts which are often found from infancy or childrenhood. They share multiple common symptoms as well as prevention and treatment. Symptoms include gastrointestinal diseases, respiratory diseases, and anaphylaxis. As for treatment, medicines such as antihistamines that can be used as an acute treatment for a mild allergic reaction and epinephrine for anaphylaxis. However, prevention has to be varied and personalized based on an individuals needs.

Penicillin allergy SHACK: Survey of hospital and community knowledge.

AimPenicillin allergy accounts for the majority of all reported adverse drug reactions in adults and children. Foregoing first‐line antibiotic therapy due to penicillin allergy label is associated with an increased prevalence of infections by resistant organisms and longer hospitalisation. Clinician awareness of allergy assessment, referral indications, management of allergy and anaphylaxis is therefore vital but globally lacking. We aim to assess the knowledge of penicillin allergy, assessment and management in Western Australian health professionals.MethodsAn anonymous survey was distributed to pharmacists, nurses and physicians within Western Australian paediatric and adult Hospitals, Community and General Practice.ResultsIn total, 487/611 were completed and included in the statistical analysis. Only 62% (301/487) of respondents routinely assessed for patient medication allergies. Of those who assessed allergy, 9% (28/301) of respondents met the Australian standards for allergy assessment. Only 22% (106/487) of participants correctly cited all indications for management with adrenaline in anaphylaxis to antibiotics and 67% (197/292) of physicians rarely or never referred to an allergy service. Paediatric clinicians had an increased understanding of allergy assessment and anaphylaxis management. Recent penicillin allergy education within a 5‐year period led to significant improvements in allergy knowledge.ConclusionOverall, knowledge, assessment and management of penicillin allergies among practitioners in Western Australia are currently inadequate in adults and paediatric clinicians to provide safe and effective clinical care. The implementation of a targeted education program for WA health professionals is urgently required and is expected to improve clinician knowledge and aid standardised penicillin assessment (de‐labelling) practices.

Eosinophilic gastrointestinal disorders and allergen immunotherapy: Lights and shadows.

Allergic diseases, such as IgE-mediated food allergy, asthma, and allergic rhinitis, are relevant health problems worldwide and show an increasing prevalence. Therapies for food allergies are food avoidance and the prompt administration of intramuscular epinephrine in anaphylaxis occurring after accidental exposure. However, allergen immunotherapy (AIT) is being investigated as a new potential tool for treating severe food allergies. Effective oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) induce desensitization and restore immune tolerance to the causal allergen. While immediate side effects are well known, the long-term effects of food AIT are still underestimated. In this regard, eosinophilic gastrointestinal disorders (EGIDs), mainly eosinophilic esophagitis, have been reported as putative complications of OIT for food allergy and sublingual immunotherapy (SLIT) for allergic asthma and rhinitis. Fortunately, these complications are usually reversible and the patient recovers after AIT discontinuation. This review summarizes current knowledge on the possible causative link between eosinophilic gastrointestinal disorders and AIT, highlighting recent evidence and controversies.

Community Use of Epinephrine for the Treatment of Anaphylaxis: A Review and Meta-Analysis

Community use of epinephrine for the treatment of anaphylaxis is low. Knowledge of rates of epinephrine use in the pre-hospital setting along with identification of barriers to its use will contribute to the development of policies and guidelines. A search was conducted on PubMed and Embase in April 2020. Our systematic review focused on 4 domains: (1) epinephrine use in the pre-hospital setting; (2) barriers to epinephrine use in the pre-hospital setting; (3) cost evaluation and cost-effectiveness of epinephrine use; and (4) programs and strategies to improve epinephrine use during anaphylaxis. Two meta-analyses with logit transformation were conducted to: (1) calculate the pooled estimate of the rate of epinephrine use in the pre-hospital setting among cases of anaphylaxis and (2) calculate the pooled estimate of the rate of biphasic reactions among all cases of anaphylaxis. Epinephrine use in the pre-hospital setting was significantly higher for children compared with adults (20.98% [95% confidence interval (CI): 16.38%, 26.46%] vs 7.17% [95% CI: 2.71%, 17.63%], respectively, P= .0027). The pooled estimate of biphasic reactions among all anaphylaxis cases was 3.92% (95% CI: 2.88%, 5.32%). Our main findings indicate that pre-hospital use of epinephrine in anaphylaxis remains suboptimal. Major barriers to the use of epinephrine were identified as low prescription rates of epinephrine autoinjectors and lack of stock epinephrine in schools, which was determined to be cost-effective. Finally, in reviewing programs and strategies, numerous studies have engineered effective methods to promote adequate and timely use of epinephrine. The main findings of our study demonstrated that across the globe, prompt epinephrine use in cases of anaphylaxis remains suboptimal. For practical recommendations, we would suggest considering stock epinephrine in schools and food courts to increase the use of epinephrine in the community. We recommend use of pamphlets in public areas (ie, malls, food courts, etc.) to assist in recognizing anaphylaxis and after that with prompt epinephrine administration, to avoid the rare risk of fatality in anaphylaxis cases.

Ten Myths about Medical Emergencies and Medical Kits

ABSTRACTWilderness medicine is plagued by myths and dogmatic teachings not supported by evidence. This article focuses particularly on those teachings and tools that would be most likely used in archaeological fieldwork. It lays out 10 of the most common and concerning myths taught in wilderness medicine and wilderness emergency medical services, both in terms of first aid and preparation of medical kits. The myths described are provide a structure for the main purpose of the article: to explain interventions and medical kit contents that are more evidence based and supported by modern understandings of wilderness medicine and fieldwork risk management. The list of top 10 myths includes (1) the use of medications other than epinephrine for anaphylaxis and (2) the availability and proper use of epinephrine auto-injectors, (3) the use of suction devices and tourniquets for snakebites, (4) the use of spinal immobilization for neck injuries, (5) the identification and treatment of heat illnesses, (6) the use of CPR in remote areas, (7) the appropriateness of dislocation reduction in remote areas, (8) the use and choice of tourniquets for arterial bleeding, (9) the initial definition and management of drowning patients, and (10) wound management myths.

The role of epinephrine in anaphylaxis at all stages of management in pediatric populations

Anaphylaxis is a severe and generalized form of hypersensitivity or allergic reaction. It can be life-threatening and requires rapid management. Cases of anaphylaxis are growing worldwide. The first line treatment in anaphylaxis is epinephrine. However, despite guidelines emphasizing the importance of this drug, studies show that use of epinephrine in anaphylaxis is suboptimal. In this article we describe the practical approach to recognizing and managing anaphylaxis in various settings.

Preference through the side vast in the administration of intramuscular adrenaline in anaphylaxis

OBJETIVOS: expor, com base na análise de artigos previamente publicados, o porquê da preferência pela via intramuscular no músculo vasto lateral ao administrar adrenalina em casos de anafilaxia. MÉTODO: Foi realizado um levantamento nas bases de dados SCIELO e PUBMED, de artigos publicados entre os anos 1998 até 2020. Foram utilizados como palavras-chave os termos: anafilaxia, adrenalina, epinefrina e via intramuscular. RESULTADOS: A pesquisa resultou em 452 estudos, 40 deles foram selecionados para análise de elegibilidade após análise de títulos e resumo. Na análise de elegibilidade classificou-se 23 estudos inelegíveis e 17 elegíveis para inclusão. CONCLUSÕES: A bibliografia consultada reitera os benefícios da escolha de via e local de administração previamente citados. Esses benefícios têm grande importância clínica, visto que a rapidez com que o tratamento é realizado está relacionada à sua eficácia.

Epinephrine in anaphylaxis: too little, too late.

Epinephrine is the agreed-upon first line treatment for anaphylaxis, yet it continues to be underused by patients/caregivers and providers alike. There are unfortunately limited data on how epinephrine can best be utilized in anaphylaxis, which hinders how best to inform patients and providers. Studies reporting underuse suggest various barriers and themes on why this may happen. Continued education of patients, caregivers, and providers is needed; however, is not likely to be enough to close the gap. Thus, novel studies on how to increase use; increase availability in a cost-effective manner; and newer, effective delivery routes are still needed.

Community first responders for out-of-hospital cardiac arrest in adults and children.

Community first responders for out-of-hospital cardiac arrest in adults and children.

Non-Auto-Injector Epinephrine Administration by Basic Life Support Providers: A Literature Review and Consensus Process

Anaphylaxis is a life-threatening condition with a known effective prehospital intervention: parenteral epinephrine. The National Association of EMS Physicians (NAEMSP) advocates for emergency medical services (EMS) providers to be allowed to carry and administer epinephrine. Some states constrain epinephrine administration by basic life support (BLS) providers to administration using epinephrine auto-injectors (EAIs), but the cost and supply of EAIs limits the ability of some EMS agencies to provide epinephrine for anaphylaxis. This literature review and consensus report describes the extant literature and the practical and policy issues related to non-EAI administration of epinephrine for anaphylaxis, and serves as a supplementary resource document for the revised NAEMSP position statement on the use of epinephrine in the out-of-hospital treatment of anaphylaxis, complementing (but not replacing) prior resource documents. The report concludes that there is some evidence that intramuscular injection of epinephrine drawn up from a vial or ampule by appropriately trained EMS providers—without limitation to specific certification levels—is safe, facilitates timely treatment of patients, and reduces costs.

The knowledge of and attitudes toward anaphylaxis emergency management among Polish dentists

INTRODUCTION: Anaphylaxis is a life-threatening medical emergency condition requiring immediate diag- nosis and implementation of proper treatment. For the medical personnel facing a patient suspected of anaphylaxis, the necessary rapid initial management includes removing the allergen, calling for help, clear- ing the airway, laying the patient, and administering adrenaline in an intramuscular injection and oxygen. Airway management, intravenous access, and intravenous fluid challenge, as well as chlorphenamine and hydrocortisone injection, are also suggested if the medical personnel has appropriate skills and equipment available. Many studies emphasize that dentists feel inadequately trained to recognize and treat medical emergencies in dental offices, which especially refers to anaphylaxis. The aim of the study was to assess the dentists’ preparedness, knowledge, and attitudes with regard to anaphylaxis in dental offices in Poland. METHODS: The study was conducted between November 2016 and November 2017 during scientific meet- ings and congresses in Poland. The participants (Polish dentists) received information on the study objectives and voluntarily took part in the questionnaire survey. The questionnaire included 20 items concerning age, gender, work experience, specialization, latest training in cardiopulmonary resuscitation, onset time of aller- gic reaction, stridor, first line pharmacological treatment, route of administration and doses of adrenaline in different age groups, other medications recommended in anaphylaxis. RESULTS: Overall, 500 active dentists working in Poland were offered to participate in the questionnaire study; 268 questionnaires were returned (53.6%), including 18 partially filled. Finally, 250 questionnaires were further analyzed. The mean age of the participants was 42.33 ± 10.53 years, 226 (90.4%) were fe- male, and the mean work experience equaled 14.35 ± 9.27 years. The total of 28.8% of subjects attended cardiopulmonary resuscitation training within 12 months prior to the study, 38.40% within the previous 2–5 years, 17.20% within the previous 6–10 years, 8.00% 10 or more years earlier, and 7.60% had never participated in such training since graduation. 24.4% of the participants stated that ingestion of food to which a patient was allergic resulted in severe anaphylactic reaction typically within 30 minutes, and 21.60% stated that in the case of contact with bee or wasp venom, severe anaphylaxis typically occurred within 10–15 minutes. Out of the study participants, 66.40% maintained that adrenaline was the first line drug in anaphylaxis; 27.2% indicated intramuscular route as the standard route for adrenaline injection in anaphylaxis; 46.4% pointed at the correct dose of adrenaline in anaphylaxis. The proper adrenaline dose in anaphylaxis for a 4-year-old child was indicated by 42.00% and for a 10-year-old child by 36.4%. The correct dose of hydrocortisone in a 10-year-old child was provided by 18.40%. CONCLUSIONS: Among Polish dentists, the knowledge concerning the diagnosis and emergency treatment in anaphylaxis is low. Better postgraduate training including anaphylaxis management in dental offices should be recommended.

Syringe Administration of Epinephrine by Emergency Medical Technicians for Anaphylaxis

Objective: In recent years, the costs of epinephrine autoinjectors (EAIs) in the United States have risen substantially. King County Emergency Medical Services implemented the “Check and Inject” program to replace EAIs by teaching emergency medical technicians (EMTs) to manually aspirate epinephrine from a single-use 1 mg/mL epinephrine vial using a needle and syringe followed by prehospital intramuscular administration of the correct adult or pediatric dose of epinephrine for anaphylaxis or serious allergic reaction. Treatment was guided by an EMT protocol that required a trigger and symptoms. We sought to determine if the “Check and Inject” program was safely implemented by EMTs treating presumed prehospital anaphylaxis or serious allergic reaction. Methods: We conducted a prospective investigation of all cases treated as part of the “Check and Inject” program from July 2014 through December 2016 in suburban King County, Washington, and January 2016 through December 2016 within the city of Seattle. All cases were prospectively collected using a custom quality improvement data form completed by the first responding EMTs. Two physicians completed a structured review of each EMS medical record to determine if the EMTs followed the Check and Inject protocol and determine if epinephrine was clinically-indicated based on physician review. Results: Of the 411 cases eligible for analysis, EMTs followed the protocol appropriately in 367 (89.3%) cases. In the remaining 44 (10.7%) cases, the EMS incident report form failed to document either a clear inciting allergic trigger or an appropriate symptom from the protocol list. Physician review determined that epinephrine was clinically indicated in 36 of the 44 cases. Among the remaining 8 cases (1.9%) that did not meet protocol criteria and were not clinically-indicated based on physician review, none had a documented adverse reaction to the epinephrine. Conclusion: We observed that EMTs successfully implemented the manual “Check and Inject” program for severe allergic reactions and anaphylaxis in a manner that typically agreed with physician review and without any overt identified safety issues.

A case of vasospastic angina induced by adrenaline for anaphylaxis

A case of vasospastic angina induced by adrenaline for anaphylaxis

Pattern of use of epinephrine as anti-anaphylactic at a university hospital, Saudi Arabia

Epinephrine is life-saving treatment of anaphylaxis. This study was conducted to identify pattern of use of epinephrine in treatment of anaphylaxis in the Emergency Department at King Abdulaziz University (KAU) Hospital, Jeddah. A 40 staff (10 physicians and 30 nurses) was asked to fill a structured and validated questionnaire about their use of epinephrine as an anti-anaphylactic treatment. The results showed that the most commonly used doses of epinephrine were 0.3 mg drawn from ampoules followed by use of auto-injectors (EpiPens). A single dose was enough for most patients. Intramuscular injection was the most common route. Epinephrine was kept mostly in the emergency trolley away from light and humidity. Keeping epinephrine in a box attached to the walls but protected from light was a rare practice. The time needed for delivery of epinephrine to patients was mostly 30-60 s, and there was no significant difference between physicians and nurses. In conclusion, the pattern of use of epinephrine as an anti-anaphylactic treatment at the KAU hospital is generally similar to the international reports. To our knowledge, there is very few data published in Saudi Arabia handling this issue, thus this study improves knowledge of the medical staff about proper use of epinephrine in anaphylaxis and opens gate for larger studies.

Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit?

BackgroundAnaphylaxis is an acute, potentially fatal medical emergency. Myocardial injury or infarction in the setting of an anaphylaxis can be due the anaphylaxis itself, when it is known as Kounis syndrome or it can also be due to the effect of epinephrine treatment. Epinephrine is considered as the cornerstone in management of anaphylaxis. Myocardial infarction secondary to therapeutic doses of adrenaline is a rare occurrence and only a few cases have been reported in literature. The mechanism of myocardial injury was considered to be due to coronary vasospasm secondary to epinephrine as the coronary angiograms were normal on these occasions.Case presentationA 21-year- old previously healthy male got admitted to the local hospital with an urticarial rash and difficulty in breathing, one hour after ingestion of prawns for which he was known to be allergic. He was treated with 0.5 ml of intramuscular adrenaline (1:1000) which was administered to the lateral side of the thigh, following which he developed palpitations and tightening type central chest pain. Electrocardiogram showed ST segment depressions in leads III, aVF and V1 to V5 and he was transferred to a tertiary care hospital. The second electrocardiogram, done 2 h later, showed resolution of ST segment depressions but new T inversions in leads I and aVL. Troponin I was elevated with a titer of 2.15 ng/ml. He was treated with sublingual GTN in the emergency treatment unit and the symptoms resolved. Transthoracic 2D echocardiogram and stress testing with treadmill was normal and CT coronary angiogram revealed normal coronary arteries.ConclusionHere we present a case of a young healthy adult with no significant risk factors for coronary artery disease who developed myocardial infarction following intramuscular administration of therapeutic dose of adrenalin for an anaphylactic reaction. The postulated mechanism is most likely an alpha receptor mediated coronary vascular spasm. However the use of adrenaline in the setting of life threatening anaphylaxis is life saving and the benefits far outweigh the risks of adverse effects. Therefore the purpose of reporting this case is not to discourage the use of adrenaline in anaphylaxis but to make aware of this potential adverse effect which can occur in the acute setting.

Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register

Background: The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. Methods: Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis. Results: 277 registered valid cases were included: 138 (51.49%) female, median age 29 years (12-47), and 6 children under 2 years with a median age of 9 months (1-21). Side effects occurred in 58 cases (21.64%), with tremors, palpitations, and anxiety being the most frequent. There was a significant association of developing side effects with older age, higher dose of adrenaline, or use of the intravenous route. Potentially severe adverse effects (high blood pressure, chest discomfort, or ECG alterations) occurred only in 8 cases (2.99%); in these cases, no differences were found according to age or adrenaline dose, but again, intravenous administration was associated with more severe adverse events. Conclusion: This study shows that side effects affect less than 1 in 5 patients who receive adrenaline for an anaphylactic reaction, and are usually mild and transient. Therefore, in an emergency situation such as anaphylaxis, restricting adrenaline administration due to potential adverse effects would, in general, not be justified.