International Experts Reach Consensus on Epinephrine Use for Allergic Reactions

Panel provides guidance on when to administer epinephrine and activate emergency services for varying symptom severity

Published on Feb. 26, 2026

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An international panel of experts has developed consensus-based recommendations on when patients and caregivers should administer epinephrine and activate emergency medical services for acute allergic reactions in community settings. The panel categorized reactions across different organ systems and identified scenarios where epinephrine use is strongly recommended, not recommended, or lacked consensus, aiming to address persistent variation in anaphylaxis action plans.

Why it matters

The recommendations aim to reduce underuse and overuse of epinephrine, which can have important implications. Underuse of epinephrine has been associated with worse outcomes, including increased hospitalization risk, while overuse can lead to unnecessary healthcare utilization, missed work/school, and patient anxiety. Providing clear, consensus-based guidance is intended to help patients and caregivers make more informed decisions about when to administer this potentially life-saving medication.

The details

The 34-member international panel used a modified Delphi process to develop structured clinical scenarios reflecting differing severities and organ system involvement. They categorized reactions across 4 organ systems: cutaneous/mucosal, respiratory, cardiovascular, and gastrointestinal. The panel reached consensus recommending epinephrine administration in 21 of 24 scenarios, with strongest agreement when reactions involved 2 or more organ systems. Isolated but severe respiratory or cardiovascular symptoms also generated high agreement for immediate epinephrine. In contrast, isolated mild cutaneous or gastrointestinal symptoms did not warrant epinephrine according to the consensus. The panel also achieved consensus on 5 modifying factors and 10 EMS activation recommendations.

  • The panel convened from January 2024 through May 2025 to develop the consensus recommendations.
  • The resulting report was published on February 26, 2026.

The players

Timothy E. Dribin, MD

First author of the consensus report and a physician in the division of emergency medicine at Cincinnati Children's Hospital Medical Center.

International Panel

A 34-member panel of international experts who developed the consensus recommendations using a modified Delphi process.

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What they’re saying

“The number one question that I get when patients leave our emergency departments, when we prescribe them an autoinjector, is: when should I administer epinephrine? What symptoms should I administer epinephrine for? It's a very complicated answer because there's no consensus on what symptoms warrant epinephrine and what symptoms do not warrant epinephrine.”

— Timothy E. Dribin, MD, Physician, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center (HCPLive)

“To address that gap, we said, 'look, it'd be really helpful if we could have some international recommendations based on the views of an expert panel to try to resolve that variation and come up with consensus around…when…patients [should] administer epinephrine.'”

— Timothy E. Dribin, MD, Physician, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center (HCPLive)

“Ultimately, what we are doing right now is we're trying to build a smartphone application that can incorporate these algorithms, so that in real time, patients and caregivers can receive prescriptive advice about whether to administer epinephrine.”

— Timothy E. Dribin, MD, Physician, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center (HCPLive)

What’s next

The panel plans to develop a smartphone application that can provide real-time, prescriptive advice to patients and caregivers on whether to administer epinephrine based on the consensus recommendations.

The takeaway

These consensus-based guidelines aim to provide clarity and consistency around epinephrine use for acute allergic reactions, addressing both underuse and overuse of this potentially life-saving medication. By establishing international agreement on when to administer epinephrine and activate emergency services, the recommendations seek to improve outcomes and reduce unnecessary healthcare utilization.