Letter to the editorObesity is not a risk factor for repeat epinephrine use in the treatment of anaphylaxis
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Factors associated with repeated use of epinephrine for the treatment of anaphylaxis
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Multiple epinephrine doses for stinging insect hypersensitivity reactions treated in the emergency department
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Cited by (17)
Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis
2021, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Although this allowed for inclusion of a greater number of studies, we were unable to further assess potential risk factors for the use of multiple epinephrine doses, which would have been possible with an IPD meta-analysis. Given the inconsistencies in reported risk factors for multiple epinephrine use,10,11,13-15,21-23 an IPD meta-analysis would help address this evidence gap. Recommendations vary with respect to the number of EAIs that patients at risk of anaphylaxis should be prescribed—both between countries and within a single country in which guidelines from specialist societies may contradict official government advice.5-9
Epinephrine in the Management of Anaphylaxis
2020, Journal of Allergy and Clinical Immunology: In PracticeEpinephrine, auto-injectors, and anaphylaxis: Challenges of dose, depth, and device
2018, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :In studies of patients with fatal anaphylaxis, auto-injectors were thought to be of insufficient depth to reach muscle in at least some cases, but the role this may have played in the lethal outcome is unclear.47 In a study of 321 patients presenting to the ED for food allergy or stinging insect allergic reactions, the 69 obese patients were no more likely to receive 2 or more doses of epinephrine than their normal-weight or underweight peers.48 However, most of these subjects were children, in whom the skin-to-bone distances may have been smaller despite obesity.
Anaphylaxis: Assessment and management
2016, Pediatric Allergy: Principles and Practice: Third EditionAddressing barriers to emergency anaphylaxis care: From emergency medical services to emergency department to outpatient follow-up
2015, Annals of Allergy, Asthma and ImmunologyInternational consensus on (ICON) anaphylaxis
2014, World Allergy Organization JournalCitation Excerpt :The need for prompt epinephrine use to prevent escalation of mediator release in anaphylaxis has been confirmed in a new in vitro model [77]. Use of multiple epinephrine injections does not necessarily correlate with patient obesity [78]. Rates of epinephrine utilization as the initial medication for anaphylaxis in emergency departments are typically low [79]; however, they can be improved significantly with implementation of an anaphylaxis protocol [80, 81].
The study was supported, in part, by an unrestricted gift from Lincoln Medical UK to C.A.C.
Disclosure of potential conflict of interest: C. A. Camargo, Jr has consultancy arrangements with Dey Pharma (Basking Ridge, NJ) and Sanofi Aventis (Bridgewater, NJ). W. Phipatanakul has received one or more grants from or has one or more grants pending with the National Institutes of Health. The rest of the authors declare that they have no relevant conflicts of interest.