Adrenaline (epinephrine) is a natural hormone released in response to stress. It is an antidote to the chemicals released during a severe allergic reaction (anaphylaxis) to allergens such as foods, drugs or insects. It is therefore used as first aid emergency treatment of anaphylaxis. As adrenaline is destroyed by enzymes in the stomach, it needs to be injected. When injected, it rapidly reverses the effects of anaphylaxis by reducing throat swelling, opening the airways, and maintaining blood pressure.
Management of anaphylaxis
1. Identify and avoid the cause (where possible)
2. Have an ASCIA Action Plan for Anaphylaxis - to treat accidental exposure.
ASCIA Action Plans for Anaphylaxis (completed by a doctor) should be stored (or carried) with the adrenaline autoinjector as the plans include instructions on how to give an adrenaline autoinjector. These devices contain a single, premeasured dose of adrenaline, and have been designed to be given by a non-medical person, such as a friend, teacher, childcare worker, parent, passer-by or by the patient themselves (if they are not too unwell to do this).
Use of adrenaline in anaphylaxis assists the body's natural response
The body's natural response to anaphylaxis is to release adrenaline, a natural "antidote" to some of the chemicals released as part of a severe allergic reaction. Therefore injected adrenaline assists the body's natural response. As adrenaline is destroyed by enzymes in the stomach, it needs to be injected. It cannot be given by mouth, and inhaled adrenaline is ineffective. Injected adrenaline works rapidly to reduce throat swelling, open up the airways, and maintain blood pressure. It is the only medication available for the immediate treatment of severe allergic reactions.
The potential risks of NOT giving adrenaline far outweigh the potential risks of giving adrenaline
Adrenaline is advised when you have evidence of a potentially life threatening allergic reaction, such as inability to breathe or a drop in blood pressure. When administered as directed, the risks of not giving adrenaline far outweigh any potential side effects of the medication. Common side effects from adrenaline are increased heart rate, an increase in blood pressure, thumping of the heart, shaking, nervousness or a transient headache. Of course needles may hurt, but you have to remember why you are using it.
Store adrenaline at room temperature
Adrenaline autoinjectors should be stored in a cool dark place (such as an insulated wallet) at room temperature - but NOT refrigerated. Whilst they should be kept out of the reach of small children, adrenaline autoinjectors must be readily available when needed and not in a locked cupboard. The shelf life of adrenaline is normally 1 or 2 years from the date of supply. You need to check the expiry date from time to time.
Adrenaline should be injected into the muscle of the outer mid thigh
Injecting adrenaline into the muscle of the outer mid thigh makes it extremely unlikely that damage to any nerves or tendons will occur, or that it will be inadvertently injected into an artery or vein. It is also the least painful part of the body to give an injection.
Adrenaline autoinjectors currently available in Australia and New Zealand are EpiPen Jr and EpiPen.
Each adrenaline autoinjector has only one dose of adrenaline. It is designed to be used as a first aid device by people without formal medical or nursing training. Instructions for adrenaline autoinjectors are shown on the ASCIA Action Plans for Anaphylaxis which are available on the ASCIA website
© ASCIA 2015
The Australasian Society of Clinical Immunology and Allergy (ASCIA) is the peak professional body of Clinical Immunologists and Allergists in Australia and New Zealand.
Postal address: PO Box 450 Balgowlah, NSW Australia 2093
This document has been developed and peer reviewed by ASCIA members and is based on expert opinion and the available published literature at the time of review. Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner. The development of this document is not funded by any commercial sources and is not influenced by commercial organisations.
Content last updated May 2015