13% of patients with anaphylaxis required repeated epinephrine doses

A medical record review included 208 patients with anaphylaxis. Treatment included epinephrine in 50% of patients. Repeated doses were used in 13%.

The inciting agents were:

- food (29.6%)
- insects (11.1%)
- medications (22.2%)
- others (7.4%)
- unknown (29.6%)

Patients who received repeated doses were more likely to have wheezing, cyanosis, hypotension and shock, stridor and laryngeal edema, nausea and emesis, arrhythmias, and cough. They were also more likely to be admitted to the hospital.

Mind map diagram of anaphylaxis.


Factors associated with repeated use of epinephrine for the treatment of anaphylaxis. Manivannan V, Campbell RL, Bellolio MF, Stead LG, Li JT, Decker WW. Ann Allergy Asthma Immunol. 2009 Nov;103(5):395-400.
@AllergyNet: Coroner's Report of anaphylactic death due to food allergy in Australiahttp://bit.ly/k2QK0c - A lot to be learned from this tragic episode.

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