Title:Is Adrenaline Always the First Choice Therapy of Anaphylaxis? An
Allergist-cardiologist Interdisciplinary Point of View
Volume: 29
Issue: 32
Author(s): Gianfranco Calogiuri*, Michael P. Savage, Maurizio Congedo, Eustachio Nettis, Alessandro Mandurino Mirizzi, Caterina Foti, Angelo Vacca and Nicholas G. Kounis
Affiliation:
- Respiratory Diseases Department, Civil Hospital Vito Fazzi, Lecce, Italy
Keywords:
Adrenaline, anaphylaxis, Kounis syndrome, takotsubo cardiomyopathy, hypertension, heart attack.
Abstract: Worldwide, adrenaline is considered the first choice therapy in the international guidelines for the
management of anaphylaxis. However, the heart and cardiovascular apparatus are strongly involved in anaphylaxis;
for that reason, there are some cardiac conditions and certain anaphylaxis patterns that make epinephrine
use problematic without adequate heart monitoring. The onset of Kounis syndrome, takotsubo cardiopathy, or
the paradoxical anaphylaxis require great attention in the management of anaphylaxis and adrenaline administration
by clinicians, who should be aware of the undervalued evolution of anaphylaxis and the potential cardiologic
complications of epinephrine administration. Numerous case reports and studies describe the unexpected
onset of cardiac diseases following epinephrine treatment, despite the latter being the recommended therapy
for anaphylaxis. Our review suggests that future anaphylaxis guidelines should incorporate cardiovascular specialists
since the treatment of Kounis syndrome or takotsubo cardiopathy requires cardiologist skills.
