SynthesisThe Journal of allergy and clinical immunology2021
Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis.
Synthesis in The Journal of allergy and clinical immunology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- 2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 11. First aid.Clinical and experimental emergency medicine · 2026Guideline
- Peanut Can Be Used as a Reference Allergen for Hazard Characterization in Food Allergen Risk Management: A Rapid Evidence Assessment and Meta-Analysis.The journal of allergy and clinical immunology. In practice · 2022Pooled it
- Epinephrine treatment of food-induced and other cause anaphylaxis in United States and Canadian Emergency Departments: a systematic review and meta-analysis.Expert review of clinical immunologyPooled it
- Recent Updates in the Management of Anaphylaxis: The Role of the Pediatrician.Journal of pediatrics. Clinical practice · 2026Article
- Regarding emergency medical services activation after epinephrine for anaphylaxis.The World Allergy Organization journal · 2026Article
- Uncommon yet critical: Immediate hypersensitivity reactions to Gadobutrol in magnetic resonance imaging procedures.Asia Pacific allergy · 2026Article
- Epinephrine Underuse for Anaphylaxis in Infants and Toddlers: A Practical Review for Pediatricians.Paediatric drugs · 2026Review
- Successful treatment of refractory anaphylactic shock with angiotensin II: A case report.European journal of anaesthesiology and intensive care · 2026Article
- Biphasic, Refractory, and Persistent Anaphylaxis in Children.Clinical and translational allergy · 2026Article
- Economic modelling of providing 'spare' adrenaline autoinjectors to all schools to improve the management of anaphylaxis.Archives of disease in childhood · 2026Article
- Management of paediatric anaphylaxis: evaluation of clinical practice according to the 2024 Polish Paediatric Society guidelines.Postepy dermatologii i alergologii · 2026Article
- Food allergy knowledge and attitudes among university students in Palestine: a cross-sectional study of determinants and educational needs.BMC public health · 2025Article
- The Bruton tyrosine kinase inhibitor acalabrutinib aborts ongoing acute food-induced anaphylactic reactions in humanized mice.The Journal of allergy and clinical immunology · 2025Article
- Lactate in Anaphylaxis: 100 Years On.Sports medicine (Auckland, N.Z.) · 2025Review
- Emergency Monitoring Following A Diagnosis of Anaphylaxis.Current allergy and asthma reports · 2025Review
- Exploring the anti-anaphylaxis potential of natural products: A Review.Inflammopharmacology · 2025Review
- Cost-effectiveness of watchful waiting versus immediate emergency department transfer after epinephrine autoinjector use in Canada.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2025Article
- Anaphylactic Shock Caused by Eating Buckwheat.Journal of clinical medicine · 2024Article
- Management of Refractory Anaphylaxis: An Overview of Current Guidelines.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2024Review
- Epinephrine autoinjectors for individuals with food allergy: Who, how many, and when to use.Journal of food allergy · 2024Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundRegulatory bodies recommend that all patients at risk of anaphylaxis be prescribed 2 epinephrine autoinjectors, which they should carry at all times. This is in contrast to some guidelines. The proportion of anaphylaxis reactions that are treated with multiple doses of epinephrine has not been systematically evaluated.
objectiveOur aim was to undertake a systematic review and meta-analysis of published studies reporting epinephrine treatment for anaphylaxis in which data relating to the number of doses administered were available.
methodsWe searched the Medline, Embase, and Cochrane databases for relevant studies reporting at least 10 anaphylaxis events (due to food or venom) from 1946 until January 2020. Data were extracted in duplicate for the meta-analysis, and the risk of bias was assessed. The study was registered under the PROSPERO identifier CRD42017069109.
resultsA total of 86 studies (36,557 anaphylaxis events) met the inclusion criteria (20 of the studies [23%] were prospective studies; 64 [74%] reported reactions in the community, and 22 [26%] included food challenge data). Risk of bias was assessed as low in 50 studies. Overall, 7.7% of anaphylaxis events from any cause (95% CI = 6.4-9.1) were treated with multiple doses of epinephrine. When only epinephrine-treated reactions for which subsequent doses were administered by a health care professional were considered, 11.1% of food-induced reactions (95% CI = 9.4-13.2) and 17.1% of venom-induced reactions (95% CI = 11.3-25.0) were treated with more than 1 epinephrine dose. Heterogeneity was moderate to high in the meta-analyses, but at sensitivity analysis this estimate was not affected by study design or anaphylaxis definition.
conclusionAround 1 in 10 anaphylaxis reactions are treated with more than 1 dose of epinephrine.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.