Timing of adrenaline administration
The most effective timing of adrenaline administration is unknown because the certainty of evidence is very low (supplement S5b). One case control study in children found that administering adrenaline before hospital arrival reduced admissions by 26% compared to administration in the emergency department. There was no reduction in ICU admissions (very low certainty, see Table 3).11Fleming JT, Clark S, Camargo CA Jr, Rudders SA. Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization. J Allergy Clin Immunol Pract 2015;3(1):57-62. One consecutive case series in children and adults found that administering adrenaline within 30 minutes of symptom onset reduced the incidence of biphasic reactions by 23% (OR 3.39, 95% CI 1.13 to 10.18, very low certainty).22Liu X, Lee S, Lohse CM, Hardy CT, Campbell RL. Biphasic reactions in emergency department anaphylaxis patients: a prospective cohort study. J Allergy Clin Immunol Pract 2020;8(4):1230-1238. Studies did not report on mortality.