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.