{
  "abstract": "Health care providers across settings must be trained to manage anaphylaxis by (1) removing the offending allergen if still present; (2) positioning the patient with legs elevated, and if respiratory distress is present, allow the patient to sit upright with legs extended and elevated; (3) immediately administering epinephrine (adrenaline) intramuscularly (IM) or intranasally (IN) every 5 to 15 minutes for persistent anaphylaxis; and (4) optimizing airway, breathing, and cardiovascular (ABC) resuscitation. This may include supplemental oxygen, noninvasive or invasive positive-pressure ventilation, and intravenous fluid resuscitation. For life-threatening or refractory presentations, (5) IM/IN epinephrine should be administered every 5 minutes while addressing ABC derangements; this includes aggressive intravenous fluid resuscitation for patients in anaphylactic shock. Providers may continue IM or IN epinephrine or switch to the other, as both routes are considered equally efficacious based on pharmacokinetic data. An intravenous epinephrine infusion should be prepared for patients with persistent anaphylaxis after 2 doses of IM/IN epinephrine and initiated after the third dose, or earlier at the provider’s discretion. In settings without epinephrine infusions, repeat IM/IN epinephrine should be administered every 5 minutes, along with other ABC interventions, and the patient should be transferred quickly to a setting equipped to provide advanced resuscitative care.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio",
    "Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio",
    "Department of Emergency Medicine, Mayo Clinic, Rochester, Minn",
    "National Heart & Lung Institute, Imperial College London, London, United Kingdom",
    "Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital—Herlev and Gentofte, Gentofte, Denmark",
    "Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark",
    "Southmead Hospital, Bristol, United Kingdom",
    "Elliot and Roslyn Jaffe Food Allergy Institute, Kravis Children’s Hospital, New York, NY",
    "Serena and John Liew Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY",
    "Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH",
    "Departments of Medicine and of Pediatrics, Dartmouth Geisel School of Medicine, Hanover, NH",
    "Department of Paediatric Allergy, Evelina London Children’s Hospital & King’s College, London, United Kingdom",
    "Division of Emergency Medicine, Ann & Robert Lurie Children’s Hospital, Chicago, Ill",
    "Faculty of Medicine, University of Southampton, David Hide Asthma and Allergy Centre, Southampton, United Kingdom",
    "St Mary’s Hospital, Isle of Wight, United Kingdom",
    "NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom",
    "Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada",
    "Departments of Pediatrics and Emergency Medicine, Faculty of Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada",
    "Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada",
    "Department of Pediatrics, Nemours Children’s Health, Wilmington, Del",
    "Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, Del",
    "The University of Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia",
    "National Allergy Centre of Excellence (NACE), Parkville, Victoria, Australia",
    "Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom",
    "Univ. Lille, CHU de Lille, Lille, France",
    "Service de Pneumologie et d’Allergologie Pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, Lille, France",
    "Department of Immunology, Sydney Children’s Hospital, Randwick, New South Wales, Australia",
    "School of Clinical Medicine, University of NSW, Sydney, New South Wales, Australia",
    "Allergy Unit, Meyer Children’s Hospital IRCCS, Florence, Italy",
    "Department of Health Sciences, University of Florence, Florence, Italy",
    "Department of Women and Children’s Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom",
    "Children’s Allergy Service, Evelina London Children’s Hospital, Guy’s and St Thomas’ Hospital, London, United Kingdom",
    "Food Allergy Referral Centre, Padua University Hospital, Padua, Italy",
    "Division of Emergency Medicine, Boston Children’s Hospital, Boston, Mass",
    "Department of Pediatrics, Children’s Hospital, CH Roubaix, Roubaix, France",
    "Pediatric Pulmonology and Allergy Department, Pôle Enfant, Hôpital Jeanne de Flandre, CHU Lille, Lille, France",
    "University of Lille, ULR 2694: METRICS, Lille, France",
    "Departments of Immunology and Emergency Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia",
    "UWA Medical School, Institute for Perioperative Excellence, The University of Western Australia, Perth, Western Australia, Australia",
    "UWA Medical School, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia"
  ],
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  "arxiv": null,
  "author_total": 33,
  "authors": [
    {
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        0,
        1
      ],
      "name": "Timothy E. Dribin"
    },
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      "name": "Lene H. Garvey"
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      "name": "Jasmeet Soar"
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      "name": "Moshe Ben-Shoshan"
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      "name": "David C. Brousseau"
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      "name": "Dianne E. Campbell"
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      "name": "Andrew T. Clark"
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      "name": "Hugh A. Sampson"
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  "doi": "10.1016/j.jaip.2026.07.004",
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  "pdf_url": "https://www.jaci-inpractice.org/article/S2213-2198(26)00583-0/pdf",
  "pmcid": "PMC13729804",
  "pmid": "42447993",
  "published": "2026-07-14",
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  "ris": "https://research.draconitic.com/paper/bbxqskrz7cbqq.ris",
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  "title": "Anaphylaxis Clinical Care Pathway: Incorporating Intranasal Epinephrine (Adrenaline)",
  "title_text": "Anaphylaxis Clinical Care Pathway: Incorporating Intranasal Epinephrine (Adrenaline)",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:22:32Z",
  "url": "https://research.draconitic.com/paper/bbxqskrz7cbqq",
  "venue": "The journal of allergy and clinical immunology. In practice",
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