HomeSevere allergic reactions: epinephrine is the only treatment and it’s underused

Severe allergic reactions: epinephrine is the only treatment and it’s underused

August 23, 2021

Given early enough, it could reduce serious after-effects.

Montréal, August 16th, 2021 – Using epinephrine promptly to treat severe allergic reactions (anaphylaxis) has been reported to reduce deaths, after-effects and the risk of biphasic reactions. However, it is not being used enough to treat anaphylaxis outside of hospitals.

According to a study published in The Journal of Allergy and Clinical Immunology: In Practice, only 20.98% of children and 7.17% of adults around the world use epinephrine to treat anaphylaxis prior to arriving in the hospital.

Dr. Moshe Ben-Shoshan, principal investigator of the study from the Research Institute of the McGill University Health Centre, pediatric allergy and immunology specialist at the Montreal Children’s Hospital and Associate Professor at the Department of Pediatrics of McGill University, explains: “The average time it takes to die due to food-induced anaphylaxis is 30 minutes. Although fatality is rare, the benefits of using epinephrine early cannot be overstated in order to prevent morbidity and the rare occurrence of death.”

The study, which Food Allergy Canada also contributed to, is the first systematic review and meta-analysis on the pre-hospital use of epinephrine. Researchers reviewed 7,012 scientific studies published between April 2010 and April 2020, revealing significant underutilization of epinephrine by those experiencing anaphylaxis.


“Although early administration of epinephrine is crucial in improving anaphylaxis outcomes, prompt use of epinephrine remains extremely low on an international scale. Knowledge and awareness of the importance of early treatment needs to be improved,” says Laura May Miles, first author of the study, research associate at McGill University and a member in the Division of Allergy and Clinical Immunology at the Montreal Children’s Hospital.

The review illuminates two broad themes on why epinephrine is underutilized: not having an epinephrine auto-injector available, and not using it. Several studies point to the fact that almost half of people with food allergy in Canada don’t carry their auto-injector, thinking that they don’t need it anymore, or that food allergen avoidance offers enough protection. Furthermore, more than half of those diagnosed with food allergy in North America don’t get prescribed epinephrine, and prescription refills are also under 50%.


When it comes to not using an auto-injector, there is a lack of awareness that epinephrine is the first-line treatment for anaphylaxis and can be used safely. Studies report low levels of understanding of when and how to use an epinephrine auto-injector in the population.

The research also shows that rate of epinephrine use in schools is lower than at home when treating anaphylaxis. In Canada, 20% of allergic reactions happen in schools, making it essential that epinephrine is available, and staff is fully trained to use it. Based on this review and analysis, the researchers recommend having stock epinephrine auto-injectors that are not prescribed to anyone available in schools and public settings and can be used in an emergency to increase access to this life-saving medication.

“This research reinforces the need for policy and educational programming to prevent allergic reactions and in the event that they occur, ensure anaphylaxis is identified and properly treated in community settings. Schools and public facilities where food is served are good places to start,” says Jennifer Gerdts, executive director of Food Allergy Canada.

Given the medical expenses linked to the treatment of anaphylaxis, stocking epinephrine for easy access as is done with defibrillators in Canada, should be considered. 


About the study

The study Community Use of Epinephrine for the Treatment of Anaphylaxis: A Review and Meta-Analysis was realized by Laura May Miles, Kayadri Ratnarajah, Sofianne Gabrielli, Elissa M. Abrams, Jennifer L.P. Protudjer, Philippe Bégin, Edmond S. Chan, Julia Upton, Susan Waserman, Wade Watson, Jennifer Gerdts and Moshe Ben-Shoshan.

DOI : 10.1016/j.jaip.2021.01.038

About the Montreal Children’s Hospital

Established in 1904, the Montreal Children’s Hospital (MCH) is Quebec’s oldest children’s hospital and the pediatric hospital of the McGill University Health Centre (MUHC). A tertiary and quaternary care teaching and research facility, treating newborns, children and adolescents up to age 18, it serves 63% of the geographic population of Quebec.

With its pediatric care and research facilities adjacent to the adult facility on the Glen site, the Children’s is in a unique position to offer services and research across the lifespan.  The Centre for Innovative Medicine – the only clinical research centre in a hospital setting in North America – allows its researchers to conduct clinical trials on the Hospital site.

The Children’s is a leader in providing a broad spectrum of highly specialized care to young patients and families from all across Quebec.  The hospital is a provincially designated trauma centre and is recognized for its wealth of expertise in cardiology and cardiac surgery, emergency care, neurology and neurosurgery.

About the RI-MUHC

The Research Institute of the McGill University Health Centre (RI-MUHC) is a world-renowned biomedical and healthcare research centre. The institute, which is affiliated with the Faculty of Medicine of McGill University, is the research arm of the McGill University Health Centre (MUHC) – an academic health centre located in Montreal, Canada, that has a mandate to focus on complex care within its community. The RI-MUHC supports over 450 researchers and around 1,200 research trainees devoted to a broad spectrum of fundamental, clinical and health outcomes research at the Glen and the Montreal General Hospital sites of the MUHC. Its research facilities offer a dynamic multidisciplinary environment that fosters collaboration and leverages discovery aimed at improving the health of individual patients across their lifespan. The RI-MUHC is supported in part by the Fonds de recherche du Québec – Santé (FRQS).

About Food Allergy Canada

Food Allergy Canada is a national charity and the country’s leading patient organization committed to educating, supporting, and advocating for the more than 3 million Canadians impacted by food allergy. The organization focuses on improving daily quality of life by providing education and support needed to effectively navigate this medical condition, building informed and supportive communities, and acting as the national voice on key patient issues.

Media contacts

Christine Bouthillier 

Information agent

Montreal Children’s Hospital 

514-412-4307, ext. 23870

Christopher Holcroft
Empower Consulting, for Food Allergy Canada