#2-91E. Epinephobia vs. Evidence: Safety of Intramuscular Epinephrine in Anaphylaxis (J Allergy Clin Immunol Pract, 2025)

Have you ever hesitated to administer epinephrine during a suspected anaphylactic event due to concerns about cardiac safety? In this episode, we examine the 2025 narrative review "Benefits of Epinephrine for Anaphylaxis Outweigh Potential Harm," which confronts the widespread underuse of epinephrine driven by fear of adverse events. The authors synthesize existing data to demonstrate that while cardiovascular complications are a valid concern, they are significantly more likely to occur with accidental intravenous bolus overdose rather than the recommended intramuscular administration, which has a favorable safety profile. The most critical clinical point established is that there are no absolute contraindications to using epinephrine in anaphylaxis; the potential harm of withholding or delaying this life-saving medication far outweighs the rare risk of adverse effects from an intramuscular injection. However, critical appraisal is necessary, as this is a narrative review funded by a pharmaceutical company rather than a systematic meta-analysis, suggesting listeners should remain aware of potential selection bias or conflicts of interest. Ultimately, this review is vital for clinicians to help overcome "epinephobia," ensuring that fear of rare side effects does not impede immediate, life-saving intervention.

Citation: Bernstein DI, Blaiss M, Dellon ES, Rance K. Benefits of Epinephrine for Anaphylaxis Outweigh Potential Harm—A Safety Review. J Allergy Clin Immunol Pract. 2025. DOI: 10.1016/j.jaip.2025.04.018

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.