Epinephrine is the drug of choice in
the treatment of anaphylaxis and is available in many parts of the world in the
form of epinephrine autoinjectors for self-treatment [1]. However, when
prescribing these devices, clinicians must teach patients how and when to use
them and dispel fears about adverse effects. Autoinjectors may be lifesaving
for patients but only if patients are willing and able to use these devices
effectively.
Children with serious allergies require access to
injectable epinephrine, but the standard dose available in Pediatric
Autoinjectors (0.15 mg) is relatively high for
infants and small toddlers. To deliver an ideal dose to infants, some
clinicians dispense an ampule of epinephrine and a syringe, although this
approach requires significant caregiver training. A lower-dose epinephrine Autoinjector
that delivers 0.1 mg has been developed (Auvi-q), which is labelled for use in
infants and toddlers 7.5 to 15 kg (16.5 to 33 lbs), and may be an easier option
for some families.
Epinephrine is a sympathomimetic agent
with multiple actions that can reverse the symptoms of anaphylaxis.
Beneficial effects — Epinephrine
acts as an agonist at alpha-1 receptors to mediate increased vasoconstriction,
increased peripheral vascular resistance, and decreased mucosal edema. Agonist
effects at beta-2 receptors result in bronchodilation and decreased
mediator release from mast cells and basophils
Adverse effects — Even
when injected properly, epinephrine is often associated with minor and
transient adverse effects such as tremor, dizziness, palpitations, anxiety,
restlessness, and headache
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