Is IV adrenaline better than IM adrenaline in patients with acute angioedema?

Report By: Katherine Palmer - Medical Student
Search checked by Katherine Palmer - Medical Student
Institution: Manchester Royal Infirmary
Date Submitted: 12th July 2010
Last Modified: 13th July 2010
Status: Blue (submitted but not checked)

Three Part Question

In [patients with acute angioedema] is [IV adrenaline] better than [IM adrenaline] at [reducing mortality]?

Clinical Scenario

A 30 year old male patient with known allergic angioedema presents with acute angioedema with severe abdominal pain and stridor.

Search Strategy

MEDLINE 1950 to 2010 June Week 5 and Embase 1980 to 2010 Week 27 using the OVID interface on the world wide web on 12/7/2010
CINAHL using the EBSCOhost on the world wide web on 12/7/2010

MEDLINE and Embase - (exp Hereditary Angioedema Type III/ OR exp Angioedema/ OR exp "Hereditary Angioedema Types I and II"/ OR angioedema.mp.) AND (Epinephrine/ OR adrenaline.mp. OR epinephrine.mp.) AND (Injections, Intramuscular/ OR Injections, Intravenous/ OR Injections/ OR injection.mp. OR intravenous.mp. OR intramuscular.mp. OR intramuscular adj2 injection.mp. OR intravenous adj2 injection)
LIMIT to English Language and Humans
CINAHL - (Angioedema) AND (Epinephrine) AND (Intramuscular)

Search Outcome

MEDLINE - 25 papers, 0 relevant
Embase - 160 papers, 0 relevant
CINAHL - 1 paper, 0 relevant

Comment(s)

There has been little research into the use of IV vs IM adrenaline in any area. The Cochrane Collaboration did a systematic review on the the use of adrenaline in anaphylaxis and were unable to find any suitable trials. They concluded than IM adrenaline was better to use in acute anaphylaxis but without much clinical evidence to back this up.

Clinical Bottom Line

Trials need to be conducted in this area. Despite that IM adrenaline is easier to administer when a patient is acutely unwell and potentially peripherally shut down and it is easier to accurately assess the dose received. Until more evidence is available it seems that IM adrenaline is better and easier to administer than IV adrenaline in acute angioedema.