Epinephrine is the first-line treatment for anaphylaxis, and delay is the commonest avoidable error. Give it intramuscularly into the anterolateral thigh as soon as anaphylaxis is suspected, before antihistamines or steroids, which do not reverse airway or circulatory compromise.
The usual dose is 0.01 mg/kg of the 1 mg/mL (1 in 1000) solution, up to 0.5 mg in adults, and it can be repeated after about 5 to 15 minutes if there is no improvement. Lie the patient flat with the legs raised, give oxygen and fluids as needed, and arrange observation, because symptoms can return after the first episode.
- Give intramuscular epinephrine into the anterolateral thigh first.
- Do not delay it for antihistamines or steroids.
- Repeat after about 5 to 15 minutes if there is no improvement.
- Observe after recovery because symptoms can recur.
Why it matters
Giving antihistamines or steroids first delays the one drug that treats the airway and circulation.
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