Health Experts Urge Use of EpiPen as Key to Anaphylaxis Treatment

A recent article in the Canadian Medical Association Journal emphasizes that epinephrine is the only effective treatment for preventing death in cases of anaphylaxis, a severe allergic reaction. The article highlights the importance of using an epinephrine auto-injector, commonly known as an EpiPen, which delivers the medication directly into the major thigh muscle. This method allows for rapid reversal of airway swelling and shock, which are critical in managing anaphylaxis.

The article warns against relying on less effective treatments such as antihistamines and corticosteroids, stating that current evidence does not support their use to prevent the escalation of anaphylaxis or to mitigate biphasic reactions. It stresses that administering these medications should never delay the use of epinephrine. Anaphylaxis can occur in response to various allergens, including common foods like peanuts, tree nuts, milk, eggs, fish, shellfish, and sesame seeds.

Alternative Treatments Under Review

The article notes that while second-generation antihistamines are often employed to assist in treating allergic reactions due to their reduced side effects, they are not substitutes for epinephrine. Health Canada estimates that approximately 600,000 Canadians are at risk of life-threatening allergic reactions, with the prevalence particularly rising among children.

For individuals hesitant to use needle-based treatments, the article mentions a new option: an epinephrine nasal spray. Although this alternative has been approved in the United States, it is still undergoing review in Canada. The article states, “Intranasally delivered epinephrine could benefit those with needle phobia or other limitations.” As of November 2025, the nasal spray is pending approval as a needle-free treatment for patients aged four years and older who weigh at least 15 kilograms.

Recommendations for Emergency Care

Guidelines for emergency medical services (EMS) following epinephrine administration vary. A 2023 update on anaphylaxis practice parameters suggests that home observation may be appropriate if symptoms resolve completely within 10 to 15 minutes after administering a single dose of epinephrine, as long as the patient can access a second dose and emergency medical care if needed. In contrast, previous guidance from the Canadian Paediatric Society recommended that all children treated with epinephrine should be evaluated in an emergency department.

The article also recommends that auto-injectors be prescribed to all patients with a history of anaphylaxis, whether it is their first occurrence or not. Those with less severe allergic reactions, individuals at risk for anaphylaxis—such as those with mast cell disorders or uncontrolled asthma—and patients living more than 30 minutes from EMS should also have access to self-injectable epinephrine.

This comprehensive overview from the Canadian Medical Association Journal highlights the critical role of epinephrine in managing anaphylaxis and encourages proactive measures for those at risk. For further details, readers can access the full article online.