Page 14 - Anaphylaxis in Schools & Other Settings, 3rd Edition

Emergency Protocol About Epinephrine
Despite best avoidance efforts, accidents can and do happen. Treatment protocols, including the use of an epinephrine auto-injector, must be provided by a healthcare professional. All persons at risk
of anaphylaxis and their relatives, caregivers, and school personnel must be prepared to respond
in emergency situations. Accidents are seldom predictable. Being prepared for the unexpected is always necessary.
Epinephrine is the drug form of a hormone (adrenaline) that the body produces naturally. Epinephrine is the treatment or drug of choice to treat anaphylaxis and as a result is widely prescribed for those at risk of anaphylaxis. All efforts should be directed toward its immediate use.3,4,12 Individuals at risk of anaphylaxis are instructed to carry it with them at all times when age appropriate. Depending on the maturity level of the child, this is usually by the age of 6 or 7.
Sometimes people who are at risk for anaphylaxis also have asthma. Epinephrine can be used to treat potentially life-threatening allergic reactions and severe asthma attacks.
Epinephrine helps to reverse symptoms of an allergic reaction by opening the airways, improving blood pressure, and accelerating heart rate. There are currently two epinephrine auto-injectors available in Canada – EpiPen® and AllerjectTM. Both products come in two dosages or strengths – 0.15 mg and 0.30 mg – which are prescribed based on a person’s weight. (See Appendix A for more information.)
Individuals at risk of anaphylaxis will not always have the same symptoms during an allergic reaction.5
Key Recommendations
1. Epinephrine is the first line medication that should be used for the emergency management of a person having a potentially life-threatening allergic reaction.12
In studies of individuals who have died as a result of anaphylaxis, epinephrine was underused, not used at all, or administration was delayed.6-9 The course of an anaphylactic episode cannot be predicted with certainty and may differ from one person to another and from one episode to another in the same person.5 It is recommended that epinephrine be given at the start of a known or suspected anaphylactic reaction. Epinephrine should be injected into the muscle of the mid-outer thigh.
2. Antihistamines and asthma medications should not be used instead of epinephrine for treating anaphylaxis.1,3,4
While they will do no harm when given as additional or secondary medication, they have not been proven to stop an anaphylactic reaction. Epinephrine is the only treatment shown to stop an anaphylactic reaction. The main benefit of antihistamines is in treating hives or skin symptoms.
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Anaphylaxis in Schools & Other Settings
Copyright © 2005-2015 Canadian Society of Allergy and Clinical Immunology
Consensus Statement