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优化过敏性反应中的肾上腺素给药:临床实践考量与安全性见解

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

作者信息

Ebisawa Motohiro, Muraro Antonella, Worm Margitta, Katelaris Constance H, Pouessel Guillaume, Ring Johannes, Toit George Du, Fox Adam T

机构信息

Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.

Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy.

出版信息

Clin Transl Allergy. 2025 Aug;15(8):e70085. doi: 10.1002/clt2.70085.

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.

摘要

背景

过敏反应是一种急性、严重且可能致命的反应,其特征为症状迅速发作并累及多个器官,可能因血管性虚脱或气道阻塞而导致死亡。尽管肾上腺素是逆转过敏症状的一线药物,但对其安全正确使用仍存在误解,导致用药不当。

方法

本综述全面概述了肾上腺素自动注射器(AAIs)在过敏反应管理中的临床应用、关键安全考量以及目前市场上三种AAIs的药代动力学/药效学特征。

结果

按推荐剂量用于过敏反应进行肌内注射(IM)时,肾上腺素被认为是安全的;然而,接受急救方面的充分培训对于尽量减少用药剂量错误和降低安全风险至关重要。在特定情况下,如难治性过敏反应,由于给药错误可能导致严重心血管并发症的潜在风险,建议在特殊环境下进行静脉注射(IV)。

结论

尽管即使按推荐剂量正确使用肾上腺素也可能引起轻微和短暂的副作用,但在过敏反应等危急情况下,潜在副作用不应妨碍其使用。本综述旨在强调AAIs在改善过敏紧急情况期间患者预后方面的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5348/12328063/1b88deaa6a11/CLT2-15-e70085-g001.jpg

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