Epinephrine (
adrenaline) is the treatment of choice for
anaphylaxis. While other medications, including H1-antihistamines, H2-antihistamines,
corticosteroids, and inhaled beta-2 agonists are often used to treat
anaphylaxis in the emergency setting, none of these medications has been shown to reverse
anaphylaxis. Fatal
anaphylaxis is related to the delayed use of
epinephrine. In community settings,
epinephrine is available as an auto-injector in two doses, 0.15 mg and 0.3 mg. The recommended dose for children is 0.01 mg per kilogram. For infants at risk of
anaphylaxis in the community, there are few options with regard to providing an optimal
epinephrine dose for
first-aid treatment. The Canadian Society of Allergy and Immunology (CSACI) therefore recommends, for the child weighing less than 15 kg, given the lack of a suitable alternative, prescribing the 0.15 mg
epinephrine autoinjector. Adverse effects of an
epinephrine dose of 0.15 mg given intramuscularly in infants or children weighing less than 15 kg are expected to be mild and transient at the plasma
epinephrine concentrations achieved; therefore, these effects need to be measured against the consequences of not receiving
epinephrine at all, which can include fatality.