Adrenaline as the Medication of Choice
Worm et al. (1) correctly explain that administration of adrenaline is the crucial therapeutic measure in anaphylactic shock. However, when reviewing the reality of the situation (Figure 4), almost all anaphylaxis patients are given antihistamines (H1-receptor antagonists) and glucocorticoids, but only 20% receive adrenaline. From a pharmacological perspective, it should be stressed that H1-receptor antagonists are effective particularly in urticaria, but not in asthma, cardiocirculatory failure, and edema in the orolaryngeal area (2). Adrenaline has a positive effect on all these parameters in anaphylaxis: β2-adrenopreceptors induce bronchodilation, α1-adrenoreceptors mediate vasoconstriction and thus a reduction in oropharyngeal edema, and β1-adrenoreceptors support cardiac function. Adrenaline’s pleiotropic effects addresses all key symptoms of anaphylaxis. The immediate onset of effect is also an important aspect of treatment with adrenaline. By contrast, the effect of glucocorticoids sets in far too slowly and is more of prophylactic value. The request articulated by Worm et al. (1), that doctors should be better trained in how to apply adrenaline for anaphylactic shock, therefore deserves wide support. For patients with repeated anaphylactic events, adrenaline autoinjectors are available (2) whose use is easy to learn and which can be applied in order to bridge the period between onset of the anaphylactic shock and the arrival of the emergency physician.
Prof. Dr. med. Roland Seifert
Institut für Pharmakologie, Medizinische Hochschule Hannover
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Worm M, Eckermann O, Dölle S, et al.: Triggers and treatment of anaphylaxis: an analysis of 4000 cases from Germany, Austria and Switzerland. Dtsch Arztebl Int 2014; 111: 367–75. VOLLTEXT|
|2.||Ring J, Beyer K, Biederman T, et al.: Akuttherapie und Management der Anaphylaxie. Allergo J 2014, im Druck.|