Marcus Shaker, MD, a professor of pediatrics and medicine at the Dartmouth Geisel School of Medicine

Marcus Shaker, MD

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Frequently asked questions (FAQ) about treating anaphylaxis:

When should I give my patients epinephrine for suspected anaphylaxis?

What’s the best observation period when treating anaphylaxis?

What test should I order for patients who experienced anaphylaxis?

Why should I instruct patients to call 911 after using an epinephrine auto-injector?

asked Marcus Shaker, MD, MSc, professor of pediatrics and medicine at the Geisel School of Medicine at Dartmouth, rapid-fire FAQ questions about the treatment of 

When should epinephrine be administered for suspected anaphylaxis?

 Right away. Epinephrine is the first-line treatment for suspected anaphylaxis.

What's the best observation period when treating anaphylaxis?

 The best observation period varies and depends on context and severity of anaphylaxis. For patients who have resolved non-severe anaphylaxis for at least an hour, the likelihood of recurrence of anaphylaxis is in the range of 5%.

What test should you order for patients who experienced anaphylaxis?

 The blood test is called the serum tryptase, and it can be very helpful in establishing a diagnosis.

Why do some patients need to call 911 even after using an epinephrine auto-injector?

 If symptoms are severe or don't immediately resolve or nearly resolve, patients may need additional epinephrine.

They may need additional support, including oxygen and IV fluid. Anaphylaxis can be severe and life-threatening, so if symptoms have not completely resolved or if they recur, patients should call 911 and seek care immediately.

2025 American College of Allergy, Asthma, & Immunology Annual Scientific Meeting

 in Orlando, Florida, from November 6 – 10, Shaker presented on misconceptions many people have surrounding epinephrine use in anaphylaxis management.

 According to Shaker, one of the most enduring myths both clinicians and patients have about epinephrine is that it is dangerous

“It's not,” Shaker told HCPLive during the meeting. “Epinephrine is the first-line treatment of anaphylaxis, and if you're having a severe allergic reaction, it is the recommended approach.”

Another misconception he listed was the necessity of calling 911 after administering epinephrine. Although patients may need to call 911 in certain situations, such as experiencing persistent or worsening symptoms, cardiovascular involvement, or a history of severe reactions, involving emergency services is not always necessary. Shaker said this misconception may result in patients not using their epinephrine to avoid a hospital visit. This myth can also feed the misbelief that epinephrine is dangerous.

At the conference, Shaker also discussed the nuanced approach clinicians must take when managing patients with a known trigger for anaphylaxis.

For instance, it may not be helpful to test a patient for peanut allergies if they are already 100% certain they have a peanut allergy. In this case, it would be more logical to shift the focus from diagnosis to treatment and preparedness.

Clinicians have many food allergy treatment options to select from, including oral and sublingual immunotherapy, biologics such as omalizumab, and a growing range of epinephrine delivery options. He said all of these options allow for richer discussions with patients and families about goals of care and management preferences.

Shaker M. Epinephrine Misconceptions Persist in Anaphylaxis Care, With Marcus Shaker, MD. HCPLive. November 7, 2025. 

https://www.hcplive.com/view/epinephrine-misconceptions-persist-anaphylaxis-care-marcus-shaker-md

Shaker M. When to Prescribe Epinephrine for Known Anaphylaxis Triggers, With Marcus Shaker, MD. HCPLive. November 7, 2025. 

https://www.hcplive.com/view/when-prescribe-epinephrine-known-anaphylaxis-triggers-marcus-shaker-md

Articles

Epinephrine is the primary treatment for suspected anaphylaxis and should be administered immediately. Observation periods vary based on the severity of the reaction, with a 5% recurrence rate for non-severe cases. Serum tryptase tests can aid in diagnosis. Patients should call 911 if symptoms persist or worsen after using an epinephrine auto-injector. Misconceptions about epinephrine's safety and the necessity of emergency services can hinder proper use. Clinicians should focus on treatment and preparedness, especially when triggers are known, and consider various allergy treatment options.

A quick guide for clinicians on epinephrine dosing, optimal observation periods, and the role of tryptase and other labs in anaphylaxis care.


Anaphylaxis Treatment FAQ: When to Give Epinephrine, Order Tests, Call 911

Epinephrine Misconceptions Persist in Anaphylaxis Care, With Marcus Shaker, MD

American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting

, Marcus Shaker, MD, MSc, professor of pediatrics and medicine at the Dartmouth Geisel School of Medicine, addressed persistent misconceptions surrounding epinephrine use in 

 management and how shifting these perceptions could save lives.

According to Shaker, one of the most enduring myths among both clinicians and patients is that epinephrine is dangerous.

“It's not,” Shaker said. “Epinephrine is the first-line treatment of anaphylaxis, and if you're having a severe allergic reaction, it is the recommended approach.”

Another widespread misunderstanding, Shaker noted, is the belief that administering epinephrine automatically requires calling 911. Although activating emergency services may be appropriate in some situations, such as persistent or worsening symptoms, cardiovascular involvement, or a history of severe reactions, it is not always necessary.

“This idea that ‘if I use epinephrine, I have to call 911’ can actually lead to people not using epinephrine. One, because of cost, and two, because of inconvenience, and three, because of fear that epinephrine is dangerous,” Shaker said. “I believe that patients should be empowered to use epinephrine when they are having a severe allergic reaction, and they shouldn't feel that if they use it, they have to call 911.”

He also highlighted the importance of clinician-patient connection, noting that anaphylaxis management in 2025 is increasingly centered on individualized care.

“I think engaging with patients and conversations around what matters to them and how they want to manage their allergy, giving them empowerment and how they manage their allergy, is very important, addressing needle phobia and fear, using novel approaches to deliver lifesaving therapies, improving access,” Shaker said. “Probably the most important thing is that patients and families have a connection with the clinician that they're working with, and they feel heard, and they feel that their values and their preferences matter, because they do. So much of how we manage anaphylaxis and risk for anaphylaxis in 2025 is about connecting with people, understanding what's important to them, because there's so many options [that] we have available now, much more than we used to, and the future is bright.”

A reported disclosure for Shaker includes 

Shaker, M. A Case of Anaphylaxis of Known Cause: When to Test, When to Prescribe Epinephrine, When to Prescribe 911. Presented at ACAAI 2025 in Orlando, Florida, on November 7, 2025.

Videos

At ACAAI 2025, Shaker dispels epinephrine myths, emphasizing that it is safe, effective, and underused in anaphylaxis care.

When to Prescribe Epinephrine for Known Anaphylaxis Triggers, With Marcus Shaker, MD

2025 American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting

 in Orlando, Florida, Marcus Shaker, MD, a professor of pediatrics and medicine at the Dartmouth Geisel School of Medicine, discussed the nuanced approach clinicians must take when managing patients with a known trigger for 

 Shaker emphasized that no single strategy fits all cases. Effective management hinges on shared decision-making and an understanding of the patient’s individual context, history, and goals.

He illustrated this with a common scenario: a child who reacts consistently to peanut exposure, where repeated testing may not offer new insight. In such cases, he said, the clinical focus should shift from diagnosis to treatment and preparedness.

“If I were to ask you, what do you think the chances are that [a] patient's allergic to peanut, you[d] probably say 100%, right? At that point, how does testing raise that level of confidence? Those are the types of situations that I think it's important to engage families in a conversation about what their goals are,” Shaker said.

Shaker noted that today’s treatment landscape for food allergies looks very different from just a few years ago. Beyond traditional avoidance and emergency preparedness strategies, clinicians now have multiple therapeutic tools, including oral and sublingual immunotherapy, biologics such as omalizumab, and a growing range of epinephrine delivery options. He said this evolution invites richer discussions with patients and families about goals of care and management preferences.

Regarding epinephrine use, Shaker reaffirmed that patients at risk for anaphylaxis should have access to self-administered epinephrine, whether via autoinjector, nasal spray, or other formulations. However, he highlighted that real-world use remains far from optimal, despite ongoing work to bring epinephrine resources to schools and airplanes. Barriers such as inconvenience, needle fear, and lack of awareness persist.

“The question is, why do people not use epinephrine in the community? I think we're starting to scratch the surface.”

Shaker expressed optimism that emerging non-injectable epinephrine options, including nasal formulations, could improve access and adherence. He also pointed to ongoing discussions around potential over-the-counter availability of nasal epinephrine as a promising avenue to expand accessibility and public preparedness for severe allergic reactions.

“Now that we have non-injectable forms of epinephrine currently on the market and coming to market, I think it might change the discussion [on access],” Shaker said. “There's a group convening an FDA Panel Report… next month to explore these questions about over-the-counter epinephrine access. I think it's something we need to think more about.”

Shaker has no relevant reported disclosures.

At ACAAI 2025, Shaker highlighted evolving therapies and real-world barriers that continue to limit optimal anaphylaxis management.