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Emergency Rooms Often Skip The Epinephrine For Severe Allergies

People with severe allergies often carry an epinephrine pen to stop life-threatening reactions. But emergency room doctors may not know that's the best treatment.

An epinephrine injection can be life-saving for someone with a severe allergic reaction to a bee sting, a peanut or a piece of shrimp. But just half of internal medicine doctors know that epinephrine should be the first treatment, a recent study finds.

And it gets worse in the emergency room — up to 80 percent of the time, a person experiencing anaphylaxis, a severe allergic reaction, isn't receiving epinephrine when they should, another study found.

"I think moms are probably more aggressive than physicians are in using [epinephrine]," says Dr. Andrew Murphy, an allergist and member of the American Academy of Allergy, Asthma and Immunology.

That's why a joint task force of allergists published guidelines on Tuesday in the Annals of Allergy, Asthma and Immunology, reinforcing that emergency rooms should be using epinephrine "first and fast" to treat a severe allergic reaction.

Part of the problem may be that doctors use epinephrine to treat cardiac arrest, so it's "associated with really life-ending events and people get really nervous about it," says Murphy.

But epinephrine has proven to be safe and effective for treating severe allergic reactions, Murphy says.

Though the allergists have recommended epinephrine as a first treatment for years, "It's the first time that we've collaborated with emergency department specialists," says Dr. Stanley Fineman, past president of the ACAAI. He is not an author of the guidelines but has been involved with the organization's past work.

The guidelines are based on a review of previous studies documenting epinephrine use in the emergency department. Fineman says one goal is to make sure emergency department staff refer people who have had a severe reaction for appropriate follow-up care.

These specialists can "refer the patients to the allergist to make sure that the patient's triggers that caused the anaphylaxis get identified," says Fineman.

The precautions have become increasingly important, given that food and skin allergies are on the rise for children under 18, according to the Centers for Disease Control and Prevention.

So what should you do if you or your child shows up at the emergency room with a severe allergic reaction?

If you know you're having an allergic reaction and have an epinephrine auto-injector, use it, says Murphy. And tell the doctors your allergy history and what's happened to you.

"You just have to be a strong advocate for yourself," he says, such as, " 'I'm having anaphylaxis,' and that should get them to administer epinephrine."

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