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Review
. 2025 Aug;15(8):e70085.
doi: 10.1002/clt2.70085.

Optimizing Adrenaline Administration in Anaphylaxis: Clinical Practice Considerations and Safety Insights

Motohiro Ebisawa  1 , Antonella Muraro  2 , Margitta Worm  3 , Constance H Katelaris  4 , Guillaume Pouessel  5 , Johannes Ring  6 , George Du Toit  7   8   9 , Adam T Fox  7   8   9
Affiliations
Review

Optimizing Adrenaline Administration in Anaphylaxis: Clinical Practice Considerations and Safety Insights

Motohiro Ebisawa et al. Clin Transl Allergy. 2025 Aug.

Abstract

Background: Anaphylaxis is an acute, severe, and potentially fatal reaction marked by the fast onset of symptoms and organ involvement that may lead to death from vascular collapse or airway obstruction. Despite adrenaline (epinephrine) being the first-line medication for reversing anaphylactic symptoms, misconceptions about its safe and correct use persist and lead to improper administration.

Methods: This review provides a comprehensive overview of clinical use of adrenaline autoinjectors (AAIs) in the management of anaphylaxis, key safety considerations, and pharmacokinetic/pharmacodynamic profile of three of the currently marketed AAIs.

Results: When administered intramuscularly (IM) at the recommended dose for anaphylaxis, adrenaline is considered safe; however, adequate training in emergency care is essential to minimize dosage errors and mitigate safety risks. In specific situations, such as refractory anaphylaxis, intravenous (IV) administration is advised under specialized settings due to the potential risk of severe cardiovascular complications that can result from dosing errors.

Conclusion: Although adrenaline can cause mild and transient side effects even when administered correctly at the recommended dosage, the potential side effects should not deter its use in critical situations such as anaphylaxis. This review aims to highlight the role of AAIs in improving patient outcomes during anaphylactic emergencies.

Keywords: adrenaline; anaphylaxis; autoinjector; life‐threatening; safety.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Pharmacological effects of adrenaline in the treatment of anaphylaxis.
See this image and copyright information in PMC

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