Anaphylaxis preparedness in dental practices: what to know to be prepared

Wesley Sublett, MD, MPH, Board-Certified Allergist in Louisville, Kentucky, and Donald Cohen, DMD, from New York State, inform dentists on how to approach this dangerous allergic reaction

One of the most dangerous emergencies you may encounter in a dental office is anaphylaxis, a severe allergic reaction that can happen within minutes and can be fatal if not treated immediately with epinephrine. The American Dental Association (ADA) recommends that dental practices have plans in place for responding to allergic emergencies, including using epinephrine auto-injectors to treat anaphylaxis. We asked J. Wesley Sublett, MD, and Donald Cohen, DMD, about the key facts every dental practice should know about anaphylaxis and how to prepare for it.

Q: What are common triggers for anaphylaxis in a dental office? 

Dr. Cohen: The most common triggers of anaphylaxis in dental practice are antibiotics, antiseptics, and latex-containing products, such as gloves, bite-wing tabs, adhesive tape, and rubber dams. But these are not the only possible triggers.¹ Medications, such as NSAIDs, local anesthetics, sedatives, and the materials used in endodontics and impressions can also cause anaphylaxis.¹

Q: What are the symptoms of anaphylaxis?

Dr. Sublett: Because anaphylaxis is life-threatening and can occur quickly, it’s critical for dentists and their staff to recognize symptoms and respond immediately. Symptoms can occur in a number of different systems in the body.² For example, there may be skin changes, including rash, hives, redness, itching, or swelling below the skin surface. The patient’s mouth, throat, or tongue can become swollen, causing swallowing or breathing difficulties such as wheezing or rapid breathing. The patient may experience nausea, vomiting, or other gastrointestinal symptoms. Cardiac symptoms, such as rapid heartbeat and a drop in blood pressure, can also occur.

Q: How can dentists and their staff treat anaphylaxis when it happens in the office?

Dr. Sublett: Epinephrine is the first-line treatment for anaphylaxis,⁴ and administering epinephrine early has been shown to reduce the risk of hospitalization and life-threatening consequences.^5,6 A dose of epinephrine appropriate to the patient’s weight class should be given immediately.⁷ I recommend Intramuscular Injection (IM), as it is a proven route of administration that reliably delivers the full dose of epinephrine and whose effects have a rapid onset.⁸ The ADA recommends that practices have a plan in place, which includes using epinephrine to deliver a premeasured dose to treat anaphylaxis.⁷

In addition, the World Allergy Organization Anaphylaxis Guidance recommends implementing the following protocol immediately if anaphylaxis is suspected:⁵

1. If the trigger can be identified, remove it immediately (if feasible).
2. Activate emergency medical services.
3. Assess the patient’s vitals and weight.
4. And, simultaneously, give the weight-appropriate dose of epinephrine.
5. If necessary, give the patient high-flow supplemental oxygen via a face mask.

Q: What are considerations during surgery for administering epinephrine to respond to anaphylaxis? 

Dr. Cohen: Since use of a nasal cannula is common during dental surgery,¹⁰ I recommend IM epinephrine since it can easily be given during use of a nasal cannula and IV.

Q: When choosing an epinephrine device, what features should dental practices consider?

Dr. Sublett: Epinephrine auto-injectors, like AUVI-Q, simplify administration during an emergency because they can be administered through clothing and are pre-measured with a weight-appropriate dose to keep anaphylaxis symptoms from progressing. AUVI-Q is the only epinephrine device available in three weight-appropriate doses: 0.1 mg for young children weighing 16.5-33 pounds, 0.15 mg for children weighing 33 to 66 pounds, and 0.3 mg for adults and children weighing 66 pounds and above.

In addition, AUVI-Q has voice instructions that guide untrained users through administration during a moment of anxiety. In a recent usability study, users of AUVI-Q were significantly more likely to correctly demonstrate its use compared to other epinephrine auto-injectors.¹⁴

Q: What other steps can dental practices take to ensure their anaphylaxis preparedness?

Dr. Cohen: It’s critical to ensure the dental team is always prepared and confident in their ability to respond to allergic emergencies. To this end, regular team training in recognizing anaphylaxis and how to properly use emergency devices, like AUVI-Q, is essential.¹⁵

Dental practices should also keep emergency medical kits on hand.¹⁵ The ADA Member Advantage program has endorsed HealthFirst as its exclusive provider of dental emergency medical kits for ADA members. Dental professionals can learn more about emergency kits from HealthFirst that include AUVI-Q by visiting healthfirst.com/EMK.

Disclosure: Dr. Sublett is a paid advisor of Kaléo

This information was provided by Kaléo.

Indication

AUVI-Q^® (epinephrine injection, USP) is indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to allergens, idiopathic and exercise-induced anaphylaxis. AUVI-Q is intended for patients with a history of anaphylactic reactions or who are at increased risk for anaphylaxis.

Important Safety Information

AUVI-Q is intended for immediate self-administration as emergency supportive therapy only and is not a substitute for immediate medical care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. Each AUVI-Q contains a single dose of epinephrine for single-use injection. More than two sequential doses of epinephrine should only be administered under direct medical supervision. Since the doses of epinephrine delivered from AUVI-Q are fixed, consider using other forms of injectable epinephrine if doses lower than 0.1 mg are deemed necessary.

AUVI-Q should ONLY be injected into the anterolateral aspect of the thigh. Do not inject intravenously, or into buttock, digits, hands, or feet. Instruct caregivers to hold the leg of young children and infants firmly in place and limit movement prior to and during injection to minimize the risk of injection-related injury.

Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection. Advise patients to seek medical care if they develop any of the following symptoms at an injection site: redness that does not go away, swelling, tenderness, or the area feels warm to the touch.

Epinephrine should be administered with caution to patients with certain heart diseases, and in patients who are on medications that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported in patients with underlying cardiac disease or taking cardiac glycosides or diuretics. Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.

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Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

AUVI-Q® and AUVI-q® are registered trademarks of Kaléo, Inc. Other referenced trademarks are owned by their respective third-party owners. © 2025 Kaléo, Inc. CM-US-AQ-3704.