A 2016 letter to the editor discussed risks and benefits of early epinephrine administration for treatment of anaphylaxis. The letter describes experience from a single pediatric hospital, finding that administration of epinephrine before arrival of the patient to the emergency department (ED) is associated with a decreased likelihood of requiring multiple doses of epinephrine in the ED, reflecting the benefit of more prompt or early administration. This conclusion is derived from a multivariate analysis, which revealed an odds ratio of 0.25 (95% confidence interval 0.04 to 0.6) for use of epinephrine outside of the ED and later need for ≥ 2 doses of epinephrine in the ED. [1]
A 2017 retrospective review article primarily investigated the factors associated with anaphylaxis management prior to arrival at the ED or urgent care, but also included a subanalysis of whether receiving prehospital epinephrine affected outcomes. The population consisted of 408 pediatric patients with a record of anaphylactic reaction to food. A total of 264 patients (64.7%) had known prior history of anaphylactic reaction and 195 (47.9%) had previously been prescribed self-injectable epinephrine. Patients who received epinephrine prior to arrival were found to be significantly less likely to be subsequently treated with epinephrine (odds ratio [OR] 0.07; 95% confidence interval [CI] 0.04 to 0.13). Furthermore, prehospital epinephrine use was associated with lower hospitalization rates compared to those who did not receive epinephrine (OR 0.56; 95% CI 0.37 to 0.86). The majority of patients who were transferred from urgent care to the ED for further treatment or observation did not receive epinephrine prior to arrival (91%). There were no reported deaths in either cohort. These findings suggest that earlier administration of epinephrine prior to hospitalization has greater potential for clinical benefits. However, the primary focus of the study was an assessment of different factors and not to establish a difference in delaying epinephrine. [2]