Severe anaphylaxis requiring continuous adrenaline infusion during oral
food challenge: a case series
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).