Written by SMH Emergency Medicine Pharmacy Resident Alexandra Carlson, PharmD
Not all allergic reactions are treated in the same way, and it’s important to understand the difference in symptoms and treatments.
Allergies that are seasonal or are brought on by things like pets, dust, pollen or grass may cause a runny nose and itchy, red or watery eyes, but these reactions are not medical emergencies and typically are not life-threatening. They usually can be relieved with over-the-counter oral antihistamine medications, nose sprays or topical antihistamines.
Severe allergies — reactions typically associated with such things as bee stings, nuts or shellfish — lead to anaphylaxis, a sudden, potentially life-threatening condition that can occur within seconds of exposure to the allergen, causing the body to go into shock and breathing to become difficult. Anaphylaxis is a medical emergency that requires prompt treatment and medical attention.
Anaphylaxis symptoms can include hives, rash or itching; difficulty breathing, wheezing and chest tightness; swelling of the tongue/throat, upper airway, face or lips; dizziness or fainting; difficulty swallowing; and even a serious drop in blood pressure.
Severe reactions with anaphylaxis require immediate treatment with an epinephrine injector, followed by immediate medical attention, regardless of whether symptoms improve.
There are several brands of epinephrine injectors available, including the well-known EpiPen. In the U.S., generic and other brands include Adrenaclick, Auvi-Q and Symjepi. If you are prescribed an epinephrine injector, talk to your doctor, insurance company and local pharmacy to determine which one is the best and most affordable option for you.
Anaphylaxis is a medical emergency, and you must seek medical attention right away. Do not wait.
If someone has been diagnosed with a severe allergy and is known to be at risk for anaphylaxis when exposed to a specific allergen — from the environment (i.e. bees), foods, or something else — they likely will have a prescription for an EpiPen or a generic injector. They should always carry the medication on their person, everywhere. (For young patients, parents should ensure the child always has an epinephrine injector handy.)
Epinephrine, which can be administered by the allergy sufferer or someone nearby, must be given immediately after any symptom appears. The epinephrine will bring fast relief, but the allergen can last longer in the system than the medication, so following up with immediate medical care is necessary to avoid a second reaction that can potentially be just as severe and life threatening as the first.
Each package of epinephrine injectors comes with two injecting devices. When possible, the second dose should be carried along en route to medical care after a reaction — even if by ambulance — in case a second reaction occurs before to arriving at a medical site.
Using an Epinephrine Injector
Be prepared for a medical emergency: Carefully read your medication’s directions as soon as you purchase it. Each type and brand of epinephrine injector has its own specific set of directions for use.
Dosing amounts depend on body weight and vary for infants, toddlers, youth and adults. Epinephrine’s side effects can include an increased heart rate, flushed face, nervousness/agitation and shakiness.
In addition to the two active epinephrine injectors, most brands include a practice injector in each package as well. We recommend using the practice injector with guidance from a medical professional familiar with administration, such as your pharmacist, doctor or a nurse, etc., to ensure you’re using it properly.
If your kit doesn’t have a practice injector, ask your local pharmacy whether they have demo injectors available and someone who can demonstrate proper usage. You can also request a trainer/practice injector pen from most manufacturers’ websites.
The basic administration steps are similar for all epinephrine injectors:
- Remove the injector from its packaging.
- Remove the cap and any safety pieces. (There is usually a piece that comes off the top, as well as the bottom of each injector.)
- Forcefully push the epinephrine injector into the outer-upper portion of the thigh in a stabbing motion, and hold it there for 10 seconds. (Brands may instruct users to hold the pen in place for 3, 5 or 10 seconds. But holding it for 10 seconds is appropriate in all cases, and it may easier to remember.)
- Pull the injector straight up and discard it properly. The injector should cover the needle automatically once it’s removed from the leg.
- Call 9-1-1, or seek medical attention immediately. Have the second injector close by in case of a second reaction.
NEVER inject epinephrine into the arm, chest, back, buttocks, hands or anywhere else, if at all possible.
Disposing of a Used Epinephrine Injector
The injector’s needle is very sharp and is long enough to penetrate denim, so use these precautions when removing and disposing of used or expired injectors.
- DO NOT throw away injectors in household trash.
- Some local pharmacies accept expired medications for disposal; ask if your local pharmacy will take used epinephrine injectors.
- Some cities or counties have household hazardous waste collection programs that include medical waste. Contact your local sanitation department or hospital to find out whether there is a drop-off site available near you.
Reminder: Anaphylaxis is a medical emergency, and you must seek medical attention right away. Do not wait.
SMH Pharmacy Resident Alex Carlson, PharmD, is a licensed pharmacist in Illinois and Florida. After graduating from the University of Iowa College of Pharmacy, she completed her PGY1 Pharmacy Residency in Illinois before moving to Sarasota, Fla., where she is a PGY2 Pharmacy resident in Emergency Medicine at Sarasota Memorial Hospital.