The Pivotal Role of Vasopressin in Refractory Anaphylactic Shock

In Brief BACKGROUND: Severe anaphylaxis can be associated with cardiovascular collapse that is difficult to manage and does not respond to treatment with epinephrine. Because anaphylaxis is uncommon, unpredictable and may be fatal, a prospective, randomized, controlled trial in humans on the best management is difficult and guidelines are based on theory and anecdotes only. METHODS AND RESULTS: We report six cases in which the use of vasopressin was successful in the treatment of anaphylactic shock. CONCLUSIONS: Standard treatment of anaphylactic shock, including discontinuation of the causative agent, administration of epinephrine, and infusion of IV fluids, did not stabilize cardiocirculatory function, and adding arginine vasopressors resulted in prompt hemodynamic stabilization. IMPLICATIONS: Because anaphylaxis is uncommon, unpredictable and may be fatal, a prospective, randomized, controlled trial in humans on the best management is difficult and guidelines are based on theory and anecdotes only. We add six more anecdotes in which the use of vasopressin was successful in the treatment of anaphylactic shock.