Editing Anaphylaxis (section)

===Epinephrine===
[[File:Epipen.jpg|thumb|upright=1.3|An old version of an EpiPen brand auto-injector]]
[[Epinephrine (medication)|Epinephrine]] (adrenaline) (1 in 1,000) is the primary treatment for anaphylaxis with no absolute [[contraindication]] to its use.<ref name=EAACI2014/> It is recommended that an epinephrine solution be given [[Intramuscular injection|intramuscularly]] into the mid anterolateral thigh as soon as the diagnosis is suspected.<!-- <ref name=EAACI2014/> --> The injection may be repeated every 5 to 15 minutes if there is insufficient response.<ref name=EAACI2014/> A second dose is needed in 16–35% of episodes with more than two doses rarely required.<ref name=EAACI2014/> The intramuscular route is preferred over [[Subcutaneous tissue|subcutaneous]] administration because the latter may have delayed absorption.<ref name=EAACI2014/><ref name=Epi10>{{cite journal|last=Simons|first=KJ|author2=Simons, FE|title=Epinephrine and its use in anaphylaxis: current issues|journal=Current Opinion in Allergy and Clinical Immunology|date=August 2010|volume=10|issue=4|pages=354–61|pmid=20543673|doi=10.1097/ACI.0b013e32833bc670|s2cid=205435146}}</ref> It is recommended that after diagnosis and treatment of anaphylaxis, the patient should be kept under observation in an appropriate clinical setting until symptoms have fully resolved.<ref name="pmid32001253">{{cite journal | vauthors = Shaker MS, Wallace DV, Golden DK, Oppenheimer J, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Greenhawt M, Khan DA, Lang DM, Lang ES, Lieberman JA, Portnoy J, Rank MA, Stukus DR, Wang J, Riblet N, Bobrownicki AP, Bontrager T, Dusin J, Foley J, Frederick B, Fregene E, Hellerstedt S, Hassan F, Hess K, Horner C, Huntington K, Kasireddy P, Keeler D, Kim B, Lieberman P, Lindhorst E, McEnany F, Milbank J, Murphy H, Pando O, Patel AK, Ratliff N, Rhodes R, Robertson K, Scott H, Snell A, Sullivan R, Trivedi V, Wickham A, Shaker MS, Wallace DV, Shaker MS, Wallace DV, Bernstein JA, Campbell RL, Dinakar C, Ellis A, Golden DK, Greenhawt M, Lieberman JA, Rank MA, Stukus DR, Wang J, Shaker MS, Wallace DV, Golden DK, Bernstein JA, Dinakar C, Ellis A, Greenhawt M, Horner C, Khan DA, Lieberman JA, Oppenheimer J, Rank MA, Shaker MS, Stukus DR, Wang J | title = Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis | journal = J Allergy Clin Immunol | volume = 145 | issue = 4 | pages = 1082–1123 | date = April 2020 | pmid = 32001253 | doi = 10.1016/j.jaci.2020.01.017 | doi-access = free }}</ref> Minor adverse effects from epinephrine include [[tremor]]s, anxiety, headaches, and [[palpitation]]s.<ref name=World11/>

People on [[Beta blocker|β-blockers]] may be resistant to the effects of epinephrine.<ref name=CEA11/> In this situation if epinephrine is not effective intravenous [[Glucagon_(medication)|glucagon]] can be administered which has a mechanism of action independent of [[Adrenergic receptor|β-receptor]]s.<ref name=CEA11/>

If necessary, it can also be given [[Intravenous therapy|intravenously]] using a dilute epinephrine solution. Intravenous epinephrine, however, has been associated both with [[Cardiac dysrhythmia|dysrhythmia]] and [[myocardial infarction]].<ref name=EAACI2014/> [[Epinephrine autoinjector]]s used for self-administration typically come in two doses, one for adults or children who weigh more than 25&nbsp;kg and one for children who weigh 10 to 25&nbsp;kg.<ref>{{cite journal|last1=Halbrich|first1=M|last2=Mack|first2=DP|last3=Carr|first3=S|last4=Watson|first4=W|last5=Kim|first5=H|title=CSACI position statement: epinephrine auto-injectors and children &lt; 15 kg.|journal=Allergy, Asthma, and Clinical Immunology|date=2015|volume=11|issue=1|pages=20|pmid=26131015|pmc=4485331|doi=10.1186/s13223-015-0086-9|doi-access=free}}</ref>