Epinephrine 101: Life-Saving Basics
Updated: Jun 26
This may be the most important post I ever write. Epinephrine is a life-saving medication, period. While the thought of using an epinephrine auto injector is incredibly intimidating to most people, including those with allergies and those without, the truth is it doesn't need to be. Each year, millions of people take CPR classes and learn life-saving strategies for managing emergencies like choking, and this kind of preparation results in lives saved every day. I want you to look at epinephrine the same way. Understanding how to use this medication is empowering, and you never know when this knowledge may save someone's life.
Let's start with the basics: what exactly is anaphylaxis? As defined by the American Academy of Allergy Asthma & Immunology (AAAAI), anaphylaxis is life threatening allergic reaction most commonly caused by food, insect bites, drugs and even latex. While all allergic reactions are caused when the immune system overreacts to an allergen and causes allergy symptoms, anaphylaxis typically affects more than one part of the body at the same time and can be fatal. The ONLY way to stop anaphylaxis is through a prompt treatment with an injection of epinephrine. (1)
Whenever I talk to people about epinephrine, one of the things that scares them the most - maybe even more than actually giving the shot - is knowing when they need to administer it. If you are caring for someone at risk for anaphylaxis, how do you know when an allergic reaction is becoming serious and requires the use of epinephrine? Here what you need to remember:
There are a number of symptoms that can occur during an allergic reaction. According to the AAAAI, symptoms may involve the skin (itchiness, hives and swelling); gastrointestinal system (nausea, vomiting and diarrhea); respiratory system (stuffy or runny nose, sneezing, coughing, wheezing, difficulty breathing); and/or cardiovascular system (low blood pressure, fainting, shock). (2)
As outlined by Food Allergy Research and Education (FARE) (see image above), while respiratory and cardiovascular symptoms always call for the use of epinephrine, symptoms of the skin and gastrointestinal system may range from mild to severe.
However, the AAAAI recommends: "When exposed to a known allergen, involvement of any two systems of the body necessitates immediate treatment with epinephrine." (2)
What that means is that if a child is sneezing and his mouth is swelling, or he has hives and has vomited, it is time to ADMINISTER. Even if it doesn't appear that the child's breathing is impacted, when two body systems are involved, it is time to use the epi.
The most important thing to remember is that time is of the essence. According to the Food Allergy & Anaphylaxis Connection Team (FAACT), "In 70% of fatal or near fatal cases of food allergy reactions, there was either a delay in the administration of epinephrine, or epinephrine was not administered at all." (3)
There are a number of auto injectors on the market and each have their own nuances in terms of how they are used, so it is very important that you follow your doctor's instructions regarding your particular device before you find yourself in an emergency situation (for information outlining the various types of auto injectors, visit a link on FARE's website here). However, there are life-saving basics that can be applied across the board when using any type of epinephrine auto injector.
All epinephrine must be administered in the fatty part of the outer thigh and kept in place for anywhere from *5-10 seconds to ensure that all of the medication is properly dispensed. (*Please note, the time recommended for holding an auto injector to the leg varies among devices, so please seek the manufacturer's and/or your doctor's recommendation for your particular auto injector.)
Call 911 immediately following administration and let the dispatcher know that you are treating an anaphylactic reaction so that the paramedics are prepared with additional epinephrine, if necessary. For those of you who are wondering if it's really necessary to call 911, the answer is YES. Any allergic reaction serious enough to warrant the use of epinephrine needs to be monitored by a physician, especially since secondary reactions can occur one to several hours after the initial reaction. (3)
While antihistamines and inhalers can be used following ephinephrine to assist with symptoms, they are NOT substitutes for an auto injector and can NOT stop the progression of anaphylaxis. (2)
Keep in mind that you have two auto injectors for a reason; sometimes it may be necessary to follow up with a second dose. According to AAAAI, "The effects of epinephrine may stop after 15 to 20 minutes. A second dose of epinephrine may be needed if there is inadequate response to the first dose, or symptoms relapse within 15 minutes of the first dose."(2) This is why epinephrine auto injectors always come in two-packs. Please discuss dosage with your doctor prior to an emergency.
Final points to keep in mind:
Epinephrine auto injectors are designed to be used through clothing, so you may administer through pant legs, if necessary.
After administering epinephrine, it is best to have the person sit or lie down with feet elevated to help with blood flow. (4)
Epinephrine auto injectors typically expire after a year, so keep an eye out on your expiration dates.
Epinephrine should be stored at room temperature, as extreme temperatures can impact the medication's effectiveness. (2)
If you do have an expired auto injector and have received a replacement, make good use out of your old medication and practice using your device on a piece of fruit. Medium to large citrus fruits like oranges and grapefruits are perfect; they have a surface area and "give" similar to the meaty part of the thigh.
Train your children to practice with their device's trainer, and have them do it often. This includes siblings and anyone who may be caring for your child.
Have a PLAN. Make sure your entire family and all those caring for your child understand the procedure that you will need to follow in case of an emergency. Make sure everyone knows where the epinephrine is stored in your home and that it is easily accessible.
(1) Anaphylaxis Oveview, AAAAI website (click here)
(2) What You Should Know About Anaphylaxis, AAAAI website (click here)
(3) Food Allergy and Anaphylaxis, FAACT website (click here)
(4) Anaphylaxis: First Aid, Mayo Clinic website (click here)