Abstract
Background: The primary treatment for anaphylaxis is intramuscular
injection of adrenaline, but sometimes the response to treatment is
inadequate and continuous intravenous administration of adrenaline is
required. However, there is a lack of knowledge on the frequency and
optimal method of administration. We aimed to report cases in which
continuous adrenaline infusion was required during oral food challenges
(OFCs) at our hospital.
Method: We retrospectively reviewed the medical records of the last 6
years for cases of continuous Adrenaline administration in OFC.
Result: Of 8531 patients, 214 patients received intramuscular adrenaline
injection, and 7 patients required continuous administration. The reason
for initiation of continuous administration was cardiovascular symptoms
in all patients, one of which was associated with severe upper airway
obstruction. All patients received intravenous fluid bolus, and one
needed endotracheal intubation. Continuous infusion was started at
0.02-0.04 µg/kg/min, and because of prolonged hypotension in two
patients, the dose had to be increased. Thereafter, all patients
improved, and continuous administration was discontinued at a median of
155 (IQR:145-190) minutes. All patients had no adverse events or
biphasic reactions.
Conclusion: Continuous adrenaline administration in OFC was successful
at 0.04-0.06 µg/kg/min in treating severe anaphylaxis refractory to
multiple intramuscular injections of adrenaline, and therapeutic
response was achieved at a lower dose than previously recommended
(0.1-1.0 µg/kg/min).