Understanding Anaphylaxis: Causes, Symptoms, and Treatment

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The primary treatment for anaphylaxis is epinephrine, usually delivered with an auto-injector, which is available by prescription.

In August 2024, an epinephrine nasal spray (Neffy) was approved in the United States as an alternative to injections for people with a history of severe allergic reactions.

While this form of epinephrine may be easier for some people to use, it may also be less effective in people with certain nasal conditions, like nasal polyps.

Epinephrine reverses the symptoms of anaphylaxis in several ways:

  • It causes the blood vessels to constrict, reducing swelling and raising blood pressure.
  • It relaxes the muscles of the airways, making it easier to breathe.
  • It slows or stops the release of some of the chemicals produced in an allergic reaction.

People who are at risk for anaphylaxis should carry an epinephrine auto-injector or nasal spray with them at all times and familiarize themselves with the instructions for using it.

Epinephrine should be injected into the side of the thigh muscle for rapid absorption. It can be injected through clothing, if necessary.

Sometimes a second dose of epinephrine is needed, if anaphylaxis symptoms recur. If this is necessary, a new auto-injector should be used.

Once a dose of epinephrine has been injected, the person experiencing anaphylaxis should be taken to the nearest emergency department for further treatment.

To help prevent shock (a sudden drop in blood pressure) during an anaphylactic reaction, after receiving epinephrine, the person should lie flat on their back with their feet elevated about 12 inches (30 centimeters) and covered by a coat or blanket. This should only be done if it feels comfortable for the person and if no injuries are suspected.

Emergency Care 

Epinephrine is the first-line treatment for anaphylaxis and should always be given as soon as possible after the onset of symptoms.

When you receive emergency care for anaphylaxis, your doctor may decide to treat you with a number of different drugs, such as:

Antihistamines and corticosteroids are given intravenously (by IV) to reduce inflammation in your airways and help you breathe.

Beta-agonists also can help open up your airways and may be given either by IV or in an inhaled form.

You may also be given fluids by IV to increase your blood volume and blood pressure, or given oxygen through a tube to help you breathe.

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