Anaphylaxis Management with Epinephrine

Immediate Administration

• The American Academy of Allergy, Asthma, and Immunology recommends administering epinephrine 0.3 mg (adult) or 0.15 mg (child <30 kg) intramuscularly into the anterolateral thigh immediately upon recognition of anaphylaxis, and repeat every 5 minutes as needed until symptoms resolve 1, 2
• Administer epinephrine as first-line treatment without delay, as delaying epinephrine is associated with increased mortality and morbidity 1, 3

Proper Administration Technique

• Inject into the anterolateral thigh (vastus lateralis muscle), as this is the only recommended site, achieving peak plasma concentrations in 8±2 minutes 4, 5, 2
• The EpiPen can be administered through clothing directly into the lateral thigh 6, 2

Dosing Protocol

• Adults and children ≥30 kg: 0.3 mg (EpiPen) 4, 6, 2
• Children 15-30 kg: 0.15 mg (EpiPen Jr) 4, 6, 2
• Repeat every 5 minutes if symptoms persist, worsen, or recur 1, 6, 2

Concurrent Management Steps

• Call 911 immediately or activate emergency medical services after administering epinephrine 2
• Position patient supine with legs elevated, unless respiratory distress prevents this 6, 2

Post-Administration Requirements

• All patients must be transported to the emergency department via EMS for observation, even if symptoms completely resolve 1, 2
• Prescribe two epinephrine autoinjectors for home use at discharge 2
• Provide education on trigger avoidance, symptom recognition, and proper autoinjector use 1

Special Populations

• Patients with cardiovascular disease should still receive epinephrine, as the risk of death from untreated anaphylaxis far exceeds the risk of epinephrine-related cardiac effects 2, 3
• Patients with asthma are at higher risk of fatal anaphylaxis and require particularly prompt epinephrine administration 3