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Severe anaphylaxis requiring continuous adrenaline infusion during oral food challenge: a case series
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  • Aiko Honda,
  • Takanori Imai,
  • Chihiro Kunigami,
  • Mayu Maeda,
  • Yuki Okada,
  • Toshinori Nakamura,
  • Taro Kamiya
Aiko Honda
Showa University

Corresponding Author:honda-a@med.showa-u.ac.jp

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Takanori Imai
Showa University School of Medicine
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Chihiro Kunigami
Showa University
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Mayu Maeda
Showa University School of Medicine
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Yuki Okada
Showa University School of Medicine
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Toshinori Nakamura
Showa University School of Medicine
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Taro Kamiya
Showa University School of Medicine
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Abstract

Background: The primary treatment for anaphylaxis is intramuscular injection of adrenaline, but sometimes the response to treatment is inadequate and continuous intravenous administration of adrenaline is required. However, there is a lack of knowledge on the frequency and optimal method of administration. We aimed to report cases in which continuous adrenaline infusion was required during oral food challenges (OFCs) at our hospital. Method: We retrospectively reviewed the medical records of the last 6 years for cases of continuous Adrenaline administration in OFC. Result: Of 8531 patients, 214 patients received intramuscular adrenaline injection, and 7 patients required continuous administration. The reason for initiation of continuous administration was cardiovascular symptoms in all patients, one of which was associated with severe upper airway obstruction. All patients received intravenous fluid bolus, and one needed endotracheal intubation. Continuous infusion was started at 0.02-0.04 µg/kg/min, and because of prolonged hypotension in two patients, the dose had to be increased. Thereafter, all patients improved, and continuous administration was discontinued at a median of 155 (IQR:145-190) minutes. All patients had no adverse events or biphasic reactions. Conclusion: Continuous adrenaline administration in OFC was successful at 0.04-0.06 µg/kg/min in treating severe anaphylaxis refractory to multiple intramuscular injections of adrenaline, and therapeutic response was achieved at a lower dose than previously recommended (0.1-1.0 µg/kg/min).