The quality of evidence is upgraded by very large magnitude of effect.Use adrenaline as first line treatment for anaphylaxis.
There are no randomized controlled trials (Cochrane review 1 ) comparing adrenaline with no intervention, placebo or other adrenergic agonists in the treatment of anaphylaxis. Several observational studies and case series show a rapid and often dramatic effect of adrenaline, and a better prognosis for patients who receive adrenaline early compared to those who receive no or delayed adrenaline.
1. Sheikh A, Shehata YA, Brown SG, Simons FE. Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock. Cochrane Database Syst Rev 2008;(4):CD006312 [Review content assessed as up-to-date: 29 November 2010]. [PMID:18843712]
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