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An update on self-injectable epinephrine

Rudders, Susan A.; Banerji, Aleena

Current Opinion in Allergy and Clinical Immunology: August 2013 - Volume 13 - Issue 4 - p 432–437
doi: 10.1097/ACI.0b013e328362b8aa

Purpose of review Epinephrine is an important life-saving treatment in patients with anaphylaxis. However, despite the guidelines recommending the use of epinephrine in the management of all patients with anaphylaxis, many patients are either not prescribed epinephrine auto-injectors (EAIs) or remain hesitant to use them.

Recent findings In this review, we examine our current knowledge base regarding EAIs, including issues related to dosing, medication availability and new modes of administration. Our findings suggest that all patients at risk for anaphylaxis should always carry two epinephrine doses. Once an EAI is prescribed, the patient should receive appropriate education on when and how to use it and it should be administered without delay. Current EAI devices have been redesigned to address limitations and decrease unintentional injury.

Summary Epinephrine remains the cornerstone of anaphylaxis treatment and EAIs are critical because of their ability to rapidly deliver this potentially life-saving medication outside of a medical setting. Continued efforts are needed to establish evidence-based parameters for delivery of this medication and to optimize education of healthcare providers and patients on the use of EAIs.

aDivision of Allergy and Immunology, Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island

bDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence to Dr Susan A. Rudders, MD, Rhode Island Hospital/Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02906, USA. Tel: +1 401 444 9879; fax: +1 401 444 6381; e-mail:

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