It’s nearly impossible to talk about food allergies without the conversation inevitably turning toward anaphylaxis, epinephrine and epinephrine auto-injectors. In fact, conversations about anaphylaxis and epinephrine have been so prevalent, they have affected business policy and law.
Since 2010, there have been several reports about fatal events involving children who experienced an anaphylaxis response to food allergies, particularly while at school. The reports triggered national debate about whether schools should keep epinephrine on hand to treat any child experiencing severe allergic reactions that result in anaphylaxis. And in November of 2013, the School Access to Emergency Epinephrine Act (the Act) was signed into law. The Act protects not only children whose epinephrine is not immediately accessible during an emergency, but also those who do not have an Epi-Pen prescribed to them. As of April 15, 2014, almost every state in the U.S. has a law requiring or allowing schools to stock emergency epinephrine and to administer it to any child reasonably believed to be experiencing anaphylaxis. Many businesses have also begun to adopt policies and procedures around rendering medical assistance to people suffering an allergy-related emergency while they are under the business’s care or control. For example, several major airlines are introducing new policies due to allergy-related incidents that have occurred during commercials flights. The incidents spurred similar conversations about epinephrine and epinephrine auto-injectors, among other things.
In nearly every conversation about food allergies, there comes a time when someone says, “You should always keep epinephrine nearby in case of emergency.” While this may be sage advice, the question remains, are you as knowledgeable about epinephrine and its use as you should be?
What Is Epinephrine?
Epinephrine is the first-line treatment for anaphylaxis. Anaphylaxis is a severe reaction to an allergen that affects several body functions simultaneously and can result in death. Epinephrine auto-injectors contain a single dose of epinephrine, which is a synthetic drug that mimics adrenaline.
A researcher from Poland, Napoleon Cybuski, first identified adrenaline in 1895. Nine years later two chemists, Friedrich Stolz and Henry Drysdale Dakin, synthesized adrenaline into epinephrine. Epinephrine works in a similar way to the body’s naturally-produced adrenaline, the fight-or-flight hormone. Like adrenaline, epinephrine restricts blood flow in some areas and increases it in others. It also opens airways in the lungs, increases heart rate and suppresses the immune system.
Since its invention in 1902, epinephrine, as used in various medical emergencies, has saved thousands of lives.
Epinephrine Auto-Injectors: The Choices and Differences
An epinephrine auto-injector is a life-saving device that allows the user to quickly and easily administer epinephrine during a serious allergic reaction. While best known for treating anaphylaxis, epinephrine can also treat asthma attacks and even cardiac arrest.
Currently, parents have a large variety of epinephrine auto-injectors to choose from for treating severe allergic reactions. Although the medication inside each auto-injector functions the same way to treat anaphylaxis, the mechanical features of various auto-injectors differ. Depending on the brand of auto-injector, the markings, operation and dosage may be different; some even talk. There is even an auto-injector designed for very young children. The Epi-pen Jr. contains half the dose of the standard epi-pen (0.3 mg of epinephrine, the recommended minimum dose for those who weigh 66 pounds or more) and is appropriate for children who weigh 33 to 66 pounds.
Choosing the right auto-injector for your child may depend on whether additional physical limitations are present that would make administration difficult, other illnesses your child may suffer from or contraindications to ingredients. Talk with your child’s doctor to determine which auto-injector is the best choice for your child.
After choosing an auto-injector, be sure to read the instructions included with the device prescribed for your child to ensure proper usage and dose.
When Should You Use Epinephrine?
Epinephrine should be used at the first sign of apparent anaphylaxis. Anaphylaxis requires immediate medical treatment. If it isn’t treated properly and immediately, anaphylaxis can be fatal.
Anaphylaxis usually affects several body functions simultaneously and can result in the following symptoms:
•Pale or Flushed Skin
•Swollen Lips or Tongue
•Low Blood Pressure—causing weak pulse, confusion or loss of consciousness
How to Use Epinephrine
Talk to the pharmacist or your child’s doctor to answer any questions you may have about the prescribed auto-injector and to get instructions on how to operate it properly to administer medication. Many physicians have access to auto-injector “trainers” (devices designed to practice administration instructions that do not contain medication). Try to use trainers to practice with your child so that he or she is able to self-administer medication if necessary. Since each auto-injector brand is different, be sure to train each time the prescription is changed.
Note that you may need to administer additional doses, but a trained medical professional should be the one who gives more than two. After you’ve successfully administered epinephrine, go to the hospital to get emergency medical help right away, even if your child’s symptoms subside. And be sure to bring the used auto-injector with you.
Allergies and Contraindications to Auto-Injector Ingredients
Although epinephrine is the main active ingredient in epinephrine auto-injectors, each brand contains various other ingredients, including sulfites. Be sure to talk with your child’s doctor about any allergies your child may have to ensure he or she is not allergic to any of the other ingredients. Additionally, ingredients may have contraindications to other medications your child may be taking.
Other general side effects of epinephrine include:
•Increased Heart Rate
•Rise in Blood Pressure
Even if your child has another allergy, his or her doctor may still prescribe the auto-injector since it is a life-saving medication and the benefits far outweigh the risks. However, that is a decision for you and your child’s doctor to make. Talking with your doctor can ensure any potential risks are avoided or minimized.
How to Store Epinephrine
Many parents wish to keep epinephrine auto-injectors close at all times in the event of an emergency while away from home. Auto-injectors are often stored in emergency kits left in the trunk of the family car so that the medication is never forgotten or left behind. However, the trunk of a car can become very hot or cold depending upon the climate. According to the National Institute of Health, epinephrine auto-injectors should never be stored in a vehicle. An auto-injector should be stored in the plastic carrying tube it came in, tightly closed, at room temperature and away from light, excess heat and moisture. Remember:
•Store epinephrine in a cool, dark place. Temperatures below 59°F and above 86°F tend to render epinephrine ineffective, so make sure to throw yours away if it is exposed to warmer or colder temperatures.
•Epinephrine is a medication and has an expiration date, so it will need to be replaced, usually annually. Discard after the expiration date.
•Keep auto-injectors close at hand at all times by using a carrying case specifically designed for that purpose. There are many different cases on the market in a variety of colors and styles for both children and adults. Take a look at the selection of auto-injector cases available on Amazon.