Summary: Anaphylaxis is a life-threatening condition with an increasing prevalence in the developed world. It is commonly accepted that intramuscular adrenaline is the first-line treatment of anaphylaxis, even when the diagnosis is uncertain. However, studies regularly show that epinephrine remains severely underutilized. Recent data from several reports highlight key barriers which limit the availability and efficacy of self-administered adrenaline, which should be prescribed to all patients at risk of anaphylaxis. Limitations can arise from underprescribing of epinephrine autoinjectors (EAI), limited availability, failure to identify anaphylaxis by the patient or caregivers, or inability to use the device properly. Moreover, physicians also remain reluctant to using adrenaline, despite the lack of absolute contraindications and data showing that delayed administration is associated with increased mortality. There is room for improvement when it comes to adrenaline utilization and extensive education of both patients and physicians is required to effectively cover the current gaps in anaphylaxis emergency treatment.