In an Emergency, ‘Epi First, Epi Fast’



AAT-Winter-2016-31First responders, emergency medical technicians (EMTs) and emergency department staff often need to make quick decisions when evaluating a patient in distress. If the patient has anaphylaxis, a life-threatening allergic reaction, the provider must be able to correctly identify symptoms and provide treatment.

Because many first responders, EMTs and emergency physicians see anaphylaxis so infrequently, greater awareness and education is needed.

Last year, the American College of Allergy, Asthma & Immunology (ACAAI) brought together an expert panel of allergists and emergency physicians to address challenges in anaphylaxis treatment and discuss strategies to improve care.

The panel – which included Anaphylaxis Community Expert (ACE) volunteers J. Wesley Sublett, MD, Dana Wallace, MD and Stanley Fineman, MD – came up with the phrase “Epi First, Epi Fast” to emphasize that epinephrine is the first line of treatment for anaphylaxis, not antihistamines or glucocorticoids, and any delay in administering epinephrine may lead to a more severe reaction.

Panel members also recommended a series of key messages for anaphylaxis care in emergency settings, including:

  • Epinephrine is safe when given correctly and in the appropriate dose. There are no contraindications for its use when treating anaphylaxis.
  • Patients treated for anaphylaxis in an emergency department should be provided with a prescription for two epinephrine auto-injectors, an Anaphylaxis Action Plan and a referral to an allergist.

Allergy & Asthma Network asked Drs. Sublett, Wallace and Fineman to present their findings at USAnaphylaxis Summits in St. Louis, Orlando and Las Vegas earlier this year. The ACE volunteers were joined by W. Scott Russell, MD, a pediatric  emergency medicine physician, at each summit.

They addressed specific questions, such as when undesignated stock epinephrine should be given to patients without a prior history of anaphylaxis, and whether a fear of epinephrine side effects is justifiable.

The panelists also shared resources at the summit, including the pocket-sized “Anaphylaxis in the ED: A Reference for Physicians,” a useful tool for healthcare professionals.

“We ask community members to share these resources with healthcare providers and local emergency medical staff,” say Drs. Wallace, Fineman and Sublett. “ACE volunteers can be a part of this process. Let your local hospital know about the panel’s recommendations and encourage a partnership with a local allergist.”

For more information about the panel findings, visit ACAAI.org and search for “Addressing Barriers to Emergency Anaphylaxis Care.”


Anaphylaxis Community Experts (ACE) is a national, award-winning education, advocacy and outreach program developed and hosted by Allergy & Asthma Network in partnership with the American College of Allergy, Asthma & Immunology, sponsored by Mylan Specialty L.P. 


ACE1001ACE volunteer teams across the country offer free awareness and training programs about food, latex and venom allergies, signs and symptoms of anaphylaxis, and how to use an epinephrine auto-injector. Teams include allergists, school nurses, community members and parents.

Become an ACE member or request an anaphylaxis education presentation in your 
neighborhood. Visit www.allergyasthmanetwork.org/outreach, email 
ace@allergyasthmanetwork.org or call 800.878.4403.