Use Intramuscular Epinephrine for Anaphylaxis, Even in Older Patients

Epinephrine rapidly reverses the effects of allergy and anaphylaxis and can be life-saving. Because it causes vasoconstriction, there has been often dogmatic concern (though scant evidence) that epinephrine can cause cardiac complications, especially in elders.

This retrospective study examined epinephrine use and cardiac complications in two Canadian emergency departments over 5 years. Among 2995 allergy-related visits by patients older than 17 years, 492 met criteria for anaphylaxis, including, usually, respiratory compromise or systolic blood pressure <90 mm Hg.

Epinephrine was administered in only 55% of anaphylaxis visits. Epinephrine use decreased significantly with age (e.g., 67% of patients aged 30–39 vs. 16% of those older aged 70 an…