Adrenaline given outside the context of life threatening allergic reactions

The true incidence of anaphylaxis is unknown. A study in an accident and emergency department suggested an incidence of between 1 in 2300 and 1 in 1500 attendances.1 Fatal anaphylaxis is rare but probably underestimated. A register established in 1992, recording fatal reactions, gave an incidence of only 20 cases a year in the United Kingdom.2 Using adrenaline (epinephrine) in the context of acute severe anaphylaxis characterised by hypotension or marked respiratory difficulty is not contentious.3 Adrenaline, however, is not a treatment without risk2—especially in patients with cardiovascular comorbidity or who are taking an interacting medication.4 Despite the low incidence of life threatening anaphylaxis, over 100 000 adrenaline syringes have been prescribed throughout the United Kingdom for community use.5 We report two cases with serious outcomes as a direct result of adrenaline treatment, highlighting the dangers of this drug outside the context of acute severe anaphylaxis.