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Michael J. Bennett, MD, PhD; Carol A. Hirshman, MD
The Oregon Health Sciences University Portland

JAMA. 1985;253(4):510.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

We certainly agree with Barach et al¹ that there should be definite recommendations for epinephrine therapy in anaphylaxis. However, we are afraid that some readers may perceive their article as recommending that epinephrine be the sole therapy for anaphylactic reactions. We write to attempt to avoid such a misperception.

The authors describe a case of probable anaphylaxis manifested by dyspnea, urticaria, pruritus, and moderate hypotension (90/60 mm Hg) without bronchospasm. Their patient was unresponsive to 0.3 mg of subcutaneous epinephrine. No mention was made of fluid therapy. Ten minutes later, 0.5 mg of epinephrine was given intravenously (IV) over three minutes. This was followed by marked hypertension, tachycardia, chest pain, and ECG changes.

Anaphylaxis can vary in severity from mild urticaria and flushing to severe, prolonged cardiovascular collapse and even death. Prominent in the life-threatening manifestations of anaphylaxis is vasodilation with increased capillary permeability and loss . . . [Full Text PDF of this Article]

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