Adrenaline
Adrenaline is the cornerstone of acute pharmacotherapy for anaphylaxis
and has been used for more than 100 years. A number of reviews have
examined the benefits of adrenaline,11Ring J, Klimek L, Worm M.
Adrenaline in the acute treatment of anaphylaxis. Dtsch Arztebl Int
2018;115(31-32):528–534. but these mainly reported studies at high
risk of bias. Our review only included comparative studies or
consecutive case series with at least 20 participants, but robust
studies comparing adrenaline versus no adrenaline are unrealistic
because it is not ethical to withhold adrenaline in an emergency.
We identified no eligible studies comparing adrenaline versus no
adrenaline in terms of mortality or most other outcomes. Two
case-control studies reported on biphasic reactions in children, but it
is unclear whether adrenaline prevents biphasic anaphylactic reactions
because the certainty of evidence is very low. One study found a
non-statistically significant reduction of 9% and the other a
significant reduction of 18% (odds ratio (OR) 0.08, 95% CI 0.014 to
0.43, see Table 3 and supplement S5a).22Manuyakorn W,
Benjaponpitak S, Kamchaisatian W, Vilaiyuk S, Sasisakulporn C,
Jotikasthira W. Pediatric anaphylaxis: triggers, clinical features,
and treatment in a tertiary-care hospital. Asian Pac J Allergy Immunol
2015;33(4):281-8.,33Mehr S, Liew WK, Tey D,
Tang ML. Clinical predictors for biphasic reactions in children
presenting with anaphylaxis. Clin Exp Allergy 2009;39(9):1390-1396.