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

Marcus Shaker, MD

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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.

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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.”

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

Marcus Shaker, MD

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