Epinephrine / Adrenaline for Anaphylaxis in Dental Practice

Generic name: Epinephrine / Adrenaline

German term: Adrenalin bei Anaphylaxie / anaphylaktischem Schock

Category: Emergency drug; sympathomimetic catecholamine; first-line treatment for anaphylaxis

Dental role: Immediate management of suspected anaphylaxis in the dental clinic while emergency medical services are activated

Emergency form: Adrenaline 1 mg/mL, also called 1:1000 adrenaline, for intramuscular injection into the anterolateral thigh. Auto-injectors may be present, but clinic protocols should also cover ampoule, syringe, and needle use.

This article is for dental education only. Anaphylaxis is life-threatening. In a real emergency, follow local emergency protocols, call emergency medical services immediately, use an ABCDE approach, and give intramuscular adrenaline early when anaphylaxis is suspected. Do not delay adrenaline while waiting for antihistamines, corticosteroids, or diagnostic certainty.

Epinephrine, called adrenaline in many countries, is the most important emergency drug for anaphylaxis. In dentistry, anaphylaxis may follow exposure to allergens such as latex, chlorhexidine, antibiotics, local anesthetic components, NSAIDs, or other materials.

The key action is early intramuscular injection into the anterolateral thigh. The adult emergency dose commonly used in UK guidance is 500 micrograms, which equals 0.5 mL of adrenaline 1 mg/mL / 1:1000. Repeat doses may be needed after about 5 minutes if there is no improvement.

The key clinical principle is: airway, breathing, or circulation symptoms after allergen exposure mean adrenaline now. Antihistamines and steroids are not first-line life-saving treatment for anaphylaxis.

• Best dental use: first-line emergency treatment for suspected anaphylaxis
• Route: intramuscular injection into the anterolateral thigh
• Adult dose concept: 500 micrograms IM using 1 mg/mL / 1:1000 adrenaline, according to many UK emergency protocols
• Repeat dose: repeat after about 5 minutes if symptoms do not improve, according to emergency guidance
• Clinical priority: do not delay while searching for a perfect diagnosis if airway, breathing, or circulation features are present

Adrenaline acts on alpha and beta adrenergic receptors. In anaphylaxis, this helps reverse the dangerous airway, breathing, and circulation effects of the allergic reaction.

• Alpha-1 effect: vasoconstriction, helping raise blood pressure and reduce mucosal edema.
• Beta-1 effect: increases heart rate and contractility, supporting circulation.
• Beta-2 effect: bronchodilation and reduction of mediator release from mast cells and basophils.
• Clinical result: improves hypotension, bronchospasm, and airway swelling when given promptly.
• Important: delayed adrenaline is associated with worse outcomes in anaphylaxis.

Think of anaphylaxis when symptoms develop rapidly after possible allergen exposure and involve airway, breathing, circulation, or significant systemic features.

• Airway: tongue swelling, throat tightness, hoarse voice, difficulty swallowing, stridor.
• Breathing: wheeze, bronchospasm, shortness of breath, persistent cough, low oxygen saturation.
• Circulation: hypotension, collapse, faintness, pallor, tachycardia, weak pulse.
• Skin and mucosa: urticaria, flushing, itching, facial or lip swelling. Skin signs may be absent in severe cases.
• Gastrointestinal: abdominal pain, vomiting, or diarrhea may occur, especially with systemic reaction.

• Latex gloves, rubber dam, or latex-containing materials
• Chlorhexidine exposure, including mouthrinse, gel, or skin/mucosal antisepsis
• Antibiotics such as penicillins or cephalosporins
• NSAIDs such as ibuprofen or aspirin in susceptible patients
• Local anesthetic solution components, preservatives, or additives, although true allergy to amide local anesthetics is uncommon
• Dental materials such as resin components, impression materials, or flavoring agents
• Foods, medications, or allergens unrelated to dentistry that become apparent during the appointment

1. Stop dental treatment immediately.
2. Call emergency medical services. Assign one team member to call and one to bring the emergency kit.
3. Use ABCDE assessment. Airway, Breathing, Circulation, Disability, Exposure.
4. Give IM adrenaline early into the anterolateral thigh if anaphylaxis is suspected.
5. Position the patient safely. Usually supine with legs raised if tolerated; avoid sudden standing.
6. Give high-flow oxygen if available and trained to use it.
7. Monitor pulse, blood pressure, breathing, consciousness, and oxygen saturation where possible.
8. Repeat adrenaline after about 5 minutes if there is no improvement.
9. Prepare for CPR if the patient collapses or stops breathing normally.
10. Document timing, dose, route, symptoms, suspected trigger, and response.

• Adults and teenagers: 500 micrograms IM, equal to 0.5 mL of 1 mg/mL / 1:1000 adrenaline in many UK protocols.
• Children 6–12 years: 300 micrograms IM is commonly listed in UK emergency guidance.
• Children 6 months–6 years: 150 micrograms IM is commonly listed in UK emergency guidance.
• Repeat: repeat after about 5 minutes if airway, breathing, or circulation features persist.
• Always follow local protocol: dose systems may differ by country, product, age, weight, and clinic policy.

• Auto-injector: fast and simple, but dose depends on device, often 150, 300, or 500 micrograms depending on brand and country.
• Ampoule with syringe: allows guideline dose drawing, but requires training, practice, and safe storage.
• Dental team requirement: the whole team must know where adrenaline is stored and how to use the available format.
• Practical rule: do not let uncertainty about format delay treatment.

• Do not wait for a rash before treating severe airway, breathing, or circulation symptoms.
• Do not give antihistamines or corticosteroids before adrenaline when anaphylaxis is suspected.
• Do not inject adrenaline into the mouth, gingiva, or dental surgical site for anaphylaxis.
• Do not give intravenous adrenaline in a dental clinic unless you are specifically trained and it is part of advanced emergency care.
• Do not make the patient stand or walk around after suspected anaphylaxis.
• Do not assume improvement after one dose means the emergency is over.
• Do not leave the patient alone.
• Do not delay ambulance transfer because symptoms temporarily improved.

The biggest dental-clinic mistake is treating anaphylaxis like ordinary fainting or anxiety. Syncope usually improves quickly when the patient lies flat. Anaphylaxis progresses with airway, breathing, circulation, skin, mucosal, or gastrointestinal features after allergen exposure and needs adrenaline.

• Oxygen: supportive treatment for hypoxia and respiratory distress.
• Salbutamol inhaler: helps bronchospasm but does not replace adrenaline in anaphylaxis.
• Antihistamines: may help skin symptoms after adrenaline, but they do not treat airway obstruction, shock, or bronchospasm as first-line therapy.
• Corticosteroids: not immediate life-saving treatment; do not delay adrenaline to give steroids.
• Glucagon: may be considered by advanced responders in refractory anaphylaxis in beta-blocked patients, depending on protocol.

• Palpitations or fast heartbeat
• Tremor, shaking, anxiety, or restlessness
• Headache, pallor, or sweating
• Temporary rise in blood pressure
• Chest discomfort in susceptible patients, requiring urgent medical evaluation
• Rare arrhythmia risk, especially with incorrect route, excessive dose, or significant cardiac disease
• Despite side effects, IM adrenaline is the first-line life-saving treatment for anaphylaxis.

• The patient requires medical assessment and observation because symptoms can recur.
• Document the suspected trigger, timing, signs, vital signs, dose, route, and response.
• Do not continue elective dental treatment on the same day.
• Arrange allergy referral or medical follow-up to identify the trigger.
• Update the dental record with allergy warnings and emergency details.
• Review the team response and restock used emergency medicines immediately.
• Before future dental care, plan safe alternatives and communicate with the patient’s physician or allergist when needed.

In anaphylaxis, adrenaline is not the “last drug.” It is the first life-saving drug. If airway, breathing, or circulation is affected after allergen exposure, give IM adrenaline and call emergency services.

• Throat tightness, hoarse voice, tongue swelling, or stridor
• Wheezing, bronchospasm, shortness of breath, or low oxygen saturation
• Hypotension, collapse, faintness, weak pulse, or confusion
• Rapidly spreading urticaria, flushing, itching, or facial swelling
• Vomiting, abdominal pain, or diarrhea with systemic allergic features
• No improvement after first adrenaline dose
• Need for repeated adrenaline doses
• Chest pain, arrhythmia symptoms, or severe cardiovascular disease
• Pregnancy, severe asthma, beta-blocker therapy, or immunocompromised status
• Any suspected anaphylaxis in a dental clinic should be transferred for medical assessment.

• Oxygen in Dental Emergencies
• Salbutamol for Bronchospasm
• Hydrocortisone and Adrenal Crisis
• Antihistamines in Allergic Reactions
• Medical Emergency Kit in Dentistry
• Syncope vs Anaphylaxis
• Latex Allergy in Dentistry
• Chlorhexidine Allergy
• Local Anesthetic Allergy Assessment
• Basic Life Support in Dental Practice

Epinephrine, also called adrenaline, is the first-line life-saving treatment for anaphylaxis in dental practice. Anaphylaxis should be suspected when rapid allergic symptoms involve airway, breathing, or circulation, especially after exposure to dental materials, latex, chlorhexidine, antibiotics, NSAIDs, or other allergens. The correct emergency action is to stop treatment, call emergency services, assess ABCDE, give intramuscular adrenaline into the anterolateral thigh, position the patient safely, give oxygen if available, monitor, and repeat adrenaline after about 5 minutes if symptoms do not improve. Antihistamines and corticosteroids are not first-line life-saving treatment and must not delay adrenaline. Every dental team should know the location, dose, route, expiry date, and practical use of adrenaline in the emergency kit.