Introduction: Although epinephrine is a cornerstone of initial anaphylaxis treatment, it is not often used. The main reasons for this are because of lack of education and fear about the side effects of epinephrine. We sought to assess whether use of epinephrine in hemodynamically stable patients with anaphylaxis could prevent the development of hypotension. Material & Methods: Incident case control study nested within a retrospective cohort study of 761 adult patients with anaphylaxis presenting to the emergency department (ED) of a tertiary care, universityaffiliated, hospital over a 10-year period. We divided the patients into 2 groups according to the occurrence of hypotension and compared demographic characteristics, clinical features, treatments and outcomes. Results: Incident case control study nested within a retrospective cohort study of 761 adult patients with anaphylaxis presenting to the emergency department (ED) of a tertiary care, university-affiliated, hospital over a 10-year period. We divided the patients into 2 groups according to the occurrence of hypotension and compared demographic characteristics, clinical features, treatments and outcomes. Conclusion: Epinephrine use in hemodynamically stable anaphylaxis patients less associated with inhospital occurrence of hypotension. Adverse event induced by epinephrine was rare when intramuscular route was used.