Dilemmas regarding the proper route of adrenaline administration in anaphylaxis.

The authors outline current practice regarding the pre-hospital use of adrenaline. They conclude that intramuscular adrenaline recommended in the current European guidelines may not be the only correct route of administration. Both intradermal and intravenous routes may be more appropriate in certain situations. The decision as to which route is the most appropriate in a particular situation will depend on several factors discussed in the article. Nevertheless, the early use of intramuscular adrenaline, particularly in pre-hospital or in the unmonitored setting, still warrants direct comparison with intravenous adrenaline to examine their relative efficacies compared with complication rates. Similarly, the benefits and risks of subcutaneous adrenaline in patients with milder reactions or increased cardiovascular risk warrant further investigation (Tab. 3, Ref. 24).