I have come across a situation where patients and doctors and nurses
say adrenaline allergy exists so adrenaline must never be given. On detailed
questioning this seems to occur at the dentist where local anaesthetic is
injected with adrenaline to prolong the effect of anaesthesia.


The problem is if there is an anaphylactic (severe reaction) then the first
remedy is too inject adrenaline to combat the reaction. So what can or should
be done?


In evolutionary terms any animal that collapsed due to any sudden shock would
quickly become extinct because it could not run or fight. Mammals and perhaps
other animals have adrenal glands to deal with "fright" by reacting
with "fight or flight".


In human terms, any time you suddenly have to jump out of the way of danger or
even have an unpleasant nightmare would bring on collapse - leading
automatically to more adrenaline release leading to hugely elevated blood
pressure leading to still more stress and further adrenaline release and
inevitable stroke or cardiac arrest. i.e. an uncontrolled positive feedback
loop.

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No!

People who have severe allergic reactions (anaphylaxis) as you describe are reacting to the local anaesthetic or a constituent of the liquid formulation rather than the adrenaline itself. As you imply any animal that was truly allergic to a major secreted hormone would not last very long at all post-natally.

On the flip side, there have been reports of autoantibodies against the beta1 adrenergic receptor subtype in some people with cardiomyopathy, and studies in the 1980’s (some of Craig Venter’s early work!) found antibodies against the beta2 adrenergic receptor in some individuals with asthma or allergies. David, do you know whether this work ever transposed itself to the clinical setting?

Last edited by Steve Lolait (23rd Apr 2011 08:39:05)

Just to clarify what Steve is asking - some people have been found to have made antibodies which block the adrenergic receptor (which is what adrenaline binds to and activates). In that situation at least in theory the effects of adrenaline would be greatly reduced.

To answer your question Steve - the jury is still out! a few recent papers have again made a link to cardiomyopathy or to congestive heart failure but at the moment there is no substantive causal link between the two - merely an association. What I mean is we do not know whether the presence of the antibodies causes the disease or alternatively (probably more likely) the disease (or what ever causes it) also causes the antibodies - thus the presence of the antibody is at best a marker only.  

http://www.ncbi.nlm.nih.gov/pubmed/21141435

http://www.ncbi.nlm.nih.gov/pubmed/16919043