Study examines canine anaphylaxis outcomes without early epinephrine

A new retrospective study in the Journal of Veterinary Emergency and Critical Care looked at 49 dogs with severe anaphylaxis treated between January 2019 and December 2023 that did not receive epinephrine as part of early treatment. The authors found an overall survival-to-discharge rate of 91.8%, even though these were severe cases managed with either late epinephrine or no epinephrine at all. The study also found that higher shock index and higher blood lactate were associated with worse outcomes and greater resource use, suggesting those measures may help identify the sickest patients earlier. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For veterinary professionals, the findings are notable because epinephrine remains widely described as first-line therapy for canine anaphylaxis, yet this case series suggests some dogs can still survive without early epinephrine, likely reflecting heterogeneity in presentation, timing, and response to aggressive supportive care. That doesn’t change the standard approach: veterinary emergency references and expert commentary still frame epinephrine as the treatment of choice, with antihistamines and glucocorticoids as adjuncts rather than substitutes. What this paper may do is sharpen triage thinking around prognostic markers, especially lactate and shock index, in cases where treatment is delayed, incomplete, or atypical. (dvm360.com)

What to watch: Watch for follow-up studies that compare early epinephrine versus delayed or omitted epinephrine directly, ideally in multicenter cohorts with standardized severity scoring. (pubmed.ncbi.nlm.nih.gov)