The Emperor Has No Symptoms: The Risks of a Blanket Approach to Using Epinephrine Autoinjectors for All Allergic Reactions

J Allergy Clin Immunol Pract. Nov-Dec 2016;4(6):1143-1146. doi: 10.1016/j.jaip.2016.05.005. Epub 2016 Jun 7.


Fatal anaphylaxis in humans is rare and unpredictable. We note a trend to provide allergic individuals with care plans that recommend immediate use of epinephrine autoinjectors if allergen ingestion is suspected, even in the absence of any allergic symptoms, without any supporting evidence base. Instructions to use an autoinjector device, irrespective of reaction severity and especially when symptoms are actually absent, are likely to add to parental and patient anxiety. Of greater concern is the possibility of epinephrine being administered "too early" to treat initial, mild symptoms that then progress to severe anaphylaxis. It is not hard to visualize a scenario where one or both epinephrine autoinjectors have been deployed for mild symptoms, yet the reaction progresses to a severe reaction and no further epinephrine is available for administration. Epinephrine needs to be available as a rescue treatment for anaphylaxis, potentially buying valuable minutes while emergency medical services are activated to attend. Food-allergic individuals and their carers need to be provided with more constructive strategies and support than merely being told to "use your pen."

Keywords: Anaphylaxis; Autoinjector; Emergency management; Epinephrine; Food allergy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use*
  • Epinephrine / administration & dosage
  • Epinephrine / therapeutic use*
  • Humans
  • Hypersensitivity / drug therapy*
  • Injections, Intramuscular
  • Practice Guidelines as Topic


  • Bronchodilator Agents
  • Epinephrine