A recent study in the Annals of Allergy, Asthma, and Immunology reports only 36 percent of young people (mean age 7 years) seeking emergency treatment for anaphylaxis received epinephrine before arriving at the treatment center. The study also revealed that when food reactions occurred in the home, less than a third of the patients received an epinephrine injection from caregivers, whereas in reactions at school more than 60 percent were given epinephrine.
Why epinephrine is used less frequently for home-based reactions is unknown, though it’s conjectured that parents’ fears about injecting their child may play a role. This is unfortunate since, in the event of anaphylaxis onset, there is no substitute for the life-saving effects of epinephrine.
Why Epinephrine Is Necessary
Epinephrine, more commonly called adrenaline, occurs naturally in the body. Most of us associate it with our “fight or flight” response since adrenaline is involved in the contraction and relaxation of muscles, and affects our energy, fear, and alertness during emergencies.
To address allergic reactions, epinephrine is recommended for its effect on our veins, and smooth muscles. Smooth muscle is associated with the automatic functions of our body, or those we don’t need to consciously think about, such as breathing.
When someone is having a food reaction, an injection of epinephrine is effective because it increases blood flow and, more importantly, opens closed airways. When receptors on our smooth muscles connect with epinephrine, any airway-blocking muscle contractions relax, allowing people to breathe.
When anaphylaxis occurs the relaxing action of epinephrine on a person’s airway is vital for survival. Antihistamines, such as Benadryl, do not open closed airways.
For patient safety the standard recommendation following a food reaction is to administer epinephrine immediately, without waiting to see whether symptoms improve, and to seek emergency medical care right away—even if the medication relieves symptoms. Anaphylaxis is unpredictable, and further treatment may be necessary.
An anaphylaxis emergency plan that clearly displays the symptoms requiring an immediate epinephrine injection can be downloaded from the FARE website (link below).