“If you are willing to use it and use it quickly, that’s what I want you to have.”

– Dr. Jay Lieberman

Epinephrine is everywhere in allergy practice. Prescribed, refilled, demonstrated, repeated. And still, it carries a strange kind of fear. Patients hesitate. Clinicians sometimes hesitate too. Is it dangerous? Is it a last resort? How bad does the reaction have to be before it counts?

On this episode, our host is joined by Dr. Jay Lieberman, professor of pediatrics at the University of Tennessee and interim division chief of allergy and immunology at Le Bonheur Children’s Hospital. He talks through what epinephrine does in the body, where the evidence is still messier than many assume, and how new needle-free options may change whether patients actually use it when it matters.

On this episode, they discuss:

• Epinephrine remains first-line because it targets the major physiologic problems in anaphylaxis.
• Fear of epinephrine still gets in the way of early use.
• Anaphylaxis definitions are useful, but hard to translate for patients.
• Nasal and sublingual routes may reduce the barrier of the needle.
• The best device is still the one the patient will actually use.

Needle-free epinephrine won’t answer every question in anaphylaxis care. But it may change the most practical one: not whether patients know they should treat, but whether they actually will.

Posted on July 7, 2026.