{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:15:37Z","timestamp":1790151337098,"version":"4.0.1"},"reference-count":149,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Anaphylaxis affects up to 5% of people during their lifetime. Although anaphylaxis usually resolves without long\u2010term physical consequences, it can result in anxiety and quality of life impairment. Rarely and unpredictably, community anaphylaxis can cause rapid physiological decompensation and death. Adrenaline (epinephrine) is the cornerstone of anaphylaxis treatment, and provision of adrenaline autoinjectors (AAI) has become a standard of care for people at risk of anaphylaxis in the community. In this article, we explore the effectiveness of AAIs for preventing fatal outcomes in anaphylaxis, using information drawn from animal and human in\u00a0vivo studies and epidemiology. We find that data support the effectiveness of intravenous adrenaline infusions for reversing physiological features of anaphylaxis, typically at doses from 0.05 to 0.5\u2009\u03bcg\/kg\/min for 1\u20132\u2009h, or ~\u200910\u2009\u03bcg\/kg total dose. Intramuscular injection of doses approximating 10\u2009\u03bcg\/kg in humans can result in similar peak plasma adrenaline levels to intravenous infusions, at 100\u2013500\u2009pg\/mL. However, these levels are typically short\u2010lived following intramuscular adrenaline, and pharmacokinetic and pharmacodynamic outcomes can be unpredictable. Epidemiological data do not support an association between increasing AAI prescriptions and reduced fatal anaphylaxis, although carriage and activation rates remain low. Taken together, these data suggest that current AAIs have little impact on rates of fatal anaphylaxis, perhaps due to a lack of sustained and sufficient plasma adrenaline concentration. Effects of AAI prescription on quality of life may be variable. There is a need to consider alternatives, which can safely deliver a sustained adrenaline infusion via an appropriate route.<\/jats:p>","DOI":"10.1111\/cea.14565","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T15:01:12Z","timestamp":1728486072000},"page":"19-35","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Adrenaline Auto\u2010Injectors for Preventing Fatal Anaphylaxis"],"prefix":"10.1111","volume":"55","author":[{"given":"Marcus","family":"Sim","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vibha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Royal Manchester Children's Hospital  Manchester UK"},{"name":"Lydia Becker Institute of Inflammation and Immunology University of Manchester  Manchester 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