Is intramuscular adrenaline used promptly against drug-induced anaphylaxis? A perspective from recent analyses of fatal cases in Japan

Adrenaline (epinephrine) is the established first-line treatment for anaphylaxis, but its timely and appropriate administration is not always achieved in real-world settings. This review introduces two governmental activities related to drug-induced anaphylactic shock-related deaths. The Medical Accident Investigation and Support Center (MAISC), a main section of the Japan Medical Safety Research Organization, analyzed such deaths and released alert reports in 2018 and 2025, recommending the prompt use of adrenaline. In the 2025 report, a review of fatal cases showed earlier intervention, with adrenaline administered within 5 min of symptom onset in 8 of 19 patients. The number of reported cases of fatal anaphylactic shock to MAISC has been halved. Data from another governmental organization, the Pharmaceuticals and Medical Devices Agency's adverse event relief system, imply a decreased number of reported cases of fatal anaphylactic shock in these several years. These findings collectively suggest that deaths from anaphylactic shock-related death may be declining in recent years. Nationwide efforts to educate physicians appear to have promoted faster preparation and intramuscular injection of adrenaline in clinical settings. However, further clarification is needed to determine whether the fatality rate from anaphylactic shock is truly decreasing in Japan.