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ISSN (Online): 1873-4286

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Review Article

Is Adrenaline Always the First Choice Therapy of Anaphylaxis? An Allergist-cardiologist Interdisciplinary Point of View

Author(s): Gianfranco Calogiuri*, Michael P. Savage, Maurizio Congedo, Eustachio Nettis, Alessandro Mandurino Mirizzi, Caterina Foti, Angelo Vacca and Nicholas G. Kounis

Volume 29, Issue 32, 2023

Published on: 24 October, 2023

Page: [2545 - 2551] Pages: 7

DOI: 10.2174/0113816128257514231019165809

Price: $65

Abstract

Worldwide, adrenaline is considered the first choice therapy in the international guidelines for the management of anaphylaxis. However, the heart and cardiovascular apparatus are strongly involved in anaphylaxis; for that reason, there are some cardiac conditions and certain anaphylaxis patterns that make epinephrine use problematic without adequate heart monitoring. The onset of Kounis syndrome, takotsubo cardiopathy, or the paradoxical anaphylaxis require great attention in the management of anaphylaxis and adrenaline administration by clinicians, who should be aware of the undervalued evolution of anaphylaxis and the potential cardiologic complications of epinephrine administration. Numerous case reports and studies describe the unexpected onset of cardiac diseases following epinephrine treatment, despite the latter being the recommended therapy for anaphylaxis. Our review suggests that future anaphylaxis guidelines should incorporate cardiovascular specialists since the treatment of Kounis syndrome or takotsubo cardiopathy requires cardiologist skills.

Keywords: Adrenaline, anaphylaxis, Kounis syndrome, takotsubo cardiomyopathy, hypertension, heart attack.

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