Use of subcutaneous epinephrine in addition to standard first-line treatment with short-acting β2-agonist and systemic steroids in children and adolescents with an acute severe asthma exacerbation: a systematic review of randomised controlled trials.

Abstract

Asthma is a common chronic disease with significant morbidity and mortality. To assess the safety and efficacy of subcutaneous epinephrine in addition to the standard first-line treatment of acute asthma in children. The following databases were inspected from 1966 to 22 June 2025: MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. Only randomised controlled trials were included. One study out of 197 citations was included in this review. The outcome measures were morbidity, escalation of care, length of hospital stay, adverse events, mortality due to exacerbation and change in lung function. We included one study with a total number of participants (n)=43. Participants who received subcutaneous epinephrine showed no significant difference in the asthma clinical score postintervention (3.3 compared with 4.0, respectively), as well as in the hospitalisation rate (risk ratio (RR) 0.38, 95% CI 0.04 to 3.40, p=0.39, n=43) and the need for additional intravenous medications (RR 0.23, 95% CI 0.03 to 1.81, p=0.16, n=43), or predicted increase in peak expiratory flow (PEF) percentage at 2 hours (mean difference -1.00, 95% CI -8.21 to 6.21, p=0.79, n=31). This review demonstrated very low certainty of evidence based on a single paper indicating that subcutaneous epinephrine does not benefit children with acute asthma in terms of asthma clinical score, hospitalisation rate and the need for additional intravenous medications. No significant improvement in PEF percentage was observed after the intervention. CRD42023405407.