@article{Dribin:2026:10.1016/j.jaip.2026.07.004,
author = {Dribin, TE and Sobolewski, B and Campbell, RL and Turner, PJ and Garvey, LH and Soar, J and Wang, J and Shaker, MS and Fox, AT and McGuire, SS and Michelson, KA and Schnadower, D and Roberts, G and Alqurashi, W and Ben-Shoshan, M and Brousseau, DC and Campbell, DE and Clark, AT and Deschildre, A and Frith, K and Giovannini, M and Lack, G and Muraro, A and Neuman, MI and Patel, N and Pouessel, G and Rueter, K and Sargant, N and Smith, P and Waserman, S and Wong, GW-K and Worm, M and Sampson, HA},
doi = {10.1016/j.jaip.2026.07.004},
journal = {J Allergy Clin Immunol Pract},
title = {Anaphylaxis Clinical Care Pathway: Incorporating Intranasal Epinephrine (Adrenaline).},
url = {http://dx.doi.org/10.1016/j.jaip.2026.07.004},
year = {2026}
}

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TY  - JOUR
AB  - Health care providers across settings must be trained to manage anaphylaxis by (1) removing the offending allergen if still present; (2) positioning the patient with legs elevated, and if respiratory distress is present, allow the patient to sit upright with legs extended and elevated; (3) immediately administering epinephrine (adrenaline) intramuscularly (IM) or intranasally (IN) every 5 to 15 minutes for persistent anaphylaxis; and (4) optimizing airway, breathing, and cardiovascular (ABC) resuscitation. This may include supplemental oxygen, noninvasive or invasive positive-pressure ventilation, and intravenous fluid resuscitation. For life-threatening or refractory presentations, (5) IM/IN epinephrine should be administered every 5 minutes while addressing ABC derangements; this includes aggressive intravenous fluid resuscitation for patients in anaphylactic shock. Providers may continue IM or IN epinephrine or switch to the other, as both routes are considered equally efficacious based on pharmacokinetic data. An intravenous epinephrine infusion should be prepared for patients with persistent anaphylaxis after 2 doses of IM/IN epinephrine and initiated after the third dose, or earlier at the provider's discretion. In settings without epinephrine infusions, repeat IM/IN epinephrine should be administered every 5 minutes, along with other ABC interventions, and the patient should be transferred quickly to a setting equipped to provide advanced resuscitative care.
AU  - Dribin,TE
AU  - Sobolewski,B
AU  - Campbell,RL
AU  - Turner,PJ
AU  - Garvey,LH
AU  - Soar,J
AU  - Wang,J
AU  - Shaker,MS
AU  - Fox,AT
AU  - McGuire,SS
AU  - Michelson,KA
AU  - Schnadower,D
AU  - Roberts,G
AU  - Alqurashi,W
AU  - Ben-Shoshan,M
AU  - Brousseau,DC
AU  - Campbell,DE
AU  - Clark,AT
AU  - Deschildre,A
AU  - Frith,K
AU  - Giovannini,M
AU  - Lack,G
AU  - Muraro,A
AU  - Neuman,MI
AU  - Patel,N
AU  - Pouessel,G
AU  - Rueter,K
AU  - Sargant,N
AU  - Smith,P
AU  - Waserman,S
AU  - Wong,GW-K
AU  - Worm,M
AU  - Sampson,HA
DO  - 10.1016/j.jaip.2026.07.004
PY  - 2026///
TI  - Anaphylaxis Clinical Care Pathway: Incorporating Intranasal Epinephrine (Adrenaline).
T2  - J Allergy Clin Immunol Pract
UR  - http://dx.doi.org/10.1016/j.jaip.2026.07.004
UR  - https://www.ncbi.nlm.nih.gov/pubmed/42447993
ER  - 

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