Food Allergies

When to Use an Epinephrine Auto-injector

The first-line treatment for anaphylaxis is epinephrine (adrenaline).

A food allergy reaction can cause symptoms that range from mild to life-threatening. In the United States, food allergy is the leading cause of severe, life-threatening allergic reactions (anaphylaxis) outside the hospital setting.  Food-allergic reaction can be life-threatening, and the severity of each reaction is unpredictable. People who have previously experienced only mild symptoms may suddenly experience a life-threatening reaction.

The first-line treatment for anaphylaxis is epinephrine (adrenaline). It is available by prescription in an auto-injector. A delay in using epinephrine is common in severe food allergic reaction deaths.  Epinephrine works to reverse the life-threatening symptoms. Other medications, such as antihistamines, are not adequate substitutes and will not save you or your child’s life, as they do not reverse swelling of the airway or raise low blood pressure.  Allergists advise that all patients who have food allergies carry their epinephrine auto injector with them at all times.  This is particularly important for those who have had a previous anaphylactic reaction; have both a food allergy and asthma; or have an allergy to peanuts, tree nuts, fish, or crustacean shellfish.

Be sure to have two doses available, as the severe reaction may reoccur. If you’ve had a history of severe reactions, take epinephrine as soon as you suspect you’ve eaten an allergy-causing food, or if you feel a reaction starting. Epinephrine should be used immediately if you experience severe symptoms such as shortness of breath, repetitive coughing, weak pulse, generalized hives, tightness in the throat, trouble breathing/swallowing, or a combination of symptoms from different body areas such as hives, rashes, or swelling on the skin coupled with vomiting, diarrhea, or abdominal pain. Repeated doses of epinephrine may be necessary.

If you are uncertain whether or not a reaction warrants epinephrine, use it right away, because the benefits of epinephrine far outweigh the risk that a dose may not have been necessary.

Common side effects of epinephrine may include anxiety, restlessness, dizziness, and shakiness. Rarely, the medication can lead to abnormal heart rate or rhythm, heart attack, sharp increase in blood pressure, and fluid build-up in the lungs, therefore patients with certain pre-existing conditions who may be at higher risk for adverse effects should speak to their allergist about when to use epinephrine.

Your allergist will provide you with a written emergency treatment plan that outlines which medications should be administered and when (note that between 10-20 percent of life-threatening severe allergic reactions have no skin symptoms.) Be sure you and those responsible for your children while not in your care understand how to properly and promptly use an epinephrine auto-injector.

Once epinephrine has been administered, immediately call 911 and inform the dispatcher that epinephrine was given and that more may be needed from the emergency responders.

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