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Epinephrine for Anaphylaxis

By Published August 20, 2012

Epinephrine is the treatment of choice for acute anaphylaxis, a severe and life-threatening allergic reaction. Epinephrine is available by prescription in single-dose, pre-filled automatic injection devices. (EpiPen®, Twinject®).

Who needs self-injectable epinephrine?

Anything that triggers an allergic reaction can trigger anaphylaxis. This means that anyone with a history of allergies or asthma is at greater risk of developing anaphylaxis (also called "anaphylactic shock").

The most common triggers of anaphylaxis are insect stings, foods (peanuts, shellfish, milk), latex and medications. Everyone at risk for anaphylaxis should be educated in the use of the epinephrine self-injection and allergen avoidance measures.

If you have been prescribed self-injectable epinephrine, keep it with you at all times. It should only be used when someone is developing or likely to develop a serious allergic reaction.

When is epinephrine used for anaphlaxis?

If you, your child or someone you're caring for shows signs or symptoms of an allergic emergency, administer the self-injectable epinephrine immediately, then promptly call 911 and seek immediate medical attention.

Failure to inject epinephrine at the first signs of an allergic emergency can be life threatening. Even when epinephrine is used promptly, it is not always effective in cases of severe anaphylactic shock.

It is important to remember the following:

  • A mild allergic reaction may not always come before a more severe reaction.
  • Epinephrine needs to be administered quickly because there may not be time to get medical attention.
  • Seek emergency medical help (call 911) whenever epinephrine is administered, even if the symptoms appear to respond to treatment.

Epinephrine is not a cure for anaphylaxis and repeated treatments may be necessary to keep symptoms of anaphylaxis under control.

What else should I keep in mind about epinephrine for anaphylaxis?

1. A second injection of epinephrine may sometimes necessary.

  • About 1/3 of people who experience anaphylaxis may require an additional injection to control their allergic reaction until they can get medical attention
  • A second severe reaction can sometimes occur within 72 hours of the first reaction with no additional exposure to the trigger. This is known as a biphasic reaction. it occurs in 1-20% of those who experience anaphylaxs and requires a second dose of epinephrine

2. Severe allergic reactions can happen anytime, anywhere.

  • Most life-threatening allergic reactions occur away from home

3. Children at risk of anaphylaxis need a support team that is prepared.

  • Talk to the adults who interact with your child every day (teachers, camp counselors, day care, babysitters,..etc.)
  • Make sure these caregivers understand the severity of anaphylaxis and the importance of immediate treatment.
  • Teach them to recognize symptoms and provide them with epinephrine.

4. Epinephrine expires and needs to be replaced regularly.

  • Keep track of the expiration date of you self-injectable epinephrine
  • Replace it before it expires

How does epinephrine relieve symptoms of anaphylaxis?

During anaphylaxis, epinephrine reverses some of the symptom of anaphylaxis by doing the following

  • constricting blood vessels to increase blood pressure
  • relaxing smooth muscles in the lungs to reduce wheezing to improve breathing
  • stimulating the heart and results in a faster heart rate)
  • reducing hives and swelling that may occur around the face and lips.

What else might I need to know about?

Other allergy medications, such as antihistamines and corticosteroids (prednisone) may be prescribed to help manage allergy symptoms, but they will not provide immediate relief of anaphylaxis.

If you have severe allergies, or have been prescribed epinephrine, be sure to obtain a Medicalert bracelet to inform emergency workers or hospital personnel of your allergies and risk of anaphylaxis.

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