Adrenaline is effective for anaphylaxis although there is no evidence from randomized controlled trials.
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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"Adrenaline (epinephrine) for the Treatment of Anaphylaxis With and Without Shock." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/451796/all/Adrenaline__epinephrine__for_the_treatment_of_anaphylaxis_with_and_without_shock.
Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/451796/all/Adrenaline__epinephrine__for_the_treatment_of_anaphylaxis_with_and_without_shock. Accessed February 16, 2020.
Adrenaline (epinephrine) for the treatment of anaphylaxis with and without shock. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/451796/all/Adrenaline__epinephrine__for_the_treatment_of_anaphylaxis_with_and_without_shock
Adrenaline (epinephrine) for the Treatment of Anaphylaxis With and Without Shock [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2020 February 16]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/451796/all/Adrenaline__epinephrine__for_the_treatment_of_anaphylaxis_with_and_without_shock.
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