A new set of international recommendations on epinephrine use during acute allergic reactions (AARs) aims to help not just doctors, but also caregivers, teachers, and bystanders quickly recognize and respond to anaphylaxis. Developed by a 34-member global panel of allergy experts, the guidelines standardize how allergic emergencies are assessed and treated, with the ultimate goal of reducing preventable deaths and complications.
Allergic reactions can be triggered by foods, insect stings, medications, or even unknown factors, and can escalate within minutes. The most severe form — anaphylaxis — causes breathing difficulty, low blood pressure, and shock. Despite being the first-line treatment, epinephrine is underused, with only 7% of adults and 21% of children receiving it before reaching hospital care. Experts say confusion about when to inject the life-saving medication and fear of misuse often delay action. The new recommendations hope to change that.
Led by Dr. Timothy Dribin from Cincinnati Children’s Hospital (USA), the panel first defined clear severity levels across key body systems — cardiovascular and neurologic, respiratory, skin and mucosa, and gastrointestinal. They then tested 24 clinical scenarios, ranging from mild hives to multi-system reactions, to determine precisely when epinephrine should be administered. Importantly, the criteria were designed so non-medical individuals could easily identify symptoms and act without hesitation.
The team also highlighted the need for real-world accessibility. To ensure these recommendations reach as many people as possible, the full guideline is being adapted into an open-access smartphone app. Users will be able to enter symptoms and receive instant, evidence-based guidance on whether epinephrine is indicated — helping parents, teachers, and flight attendants manage allergic emergencies confidently.
Dr. Dribin emphasized that these tools were developed through collaboration with patients, caregivers, and clinicians, ensuring they’re practical and easy to use.
The initiative marks a turning point in allergy management — one where technology, education, and medical science combine to empower everyday people to save lives faster and more effectively than ever before.
REFERENCE: Dribin TE et al. Epinephrine and emergency medical services activation recommendations during acute allergic reactions in community settings: international consensus report. J Allergy Clin Immunol. 2025:S0091-6749(25)01180-7
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