Overview
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. People who have previously experienced only mild symptoms may suddenly experience a life-threatening reaction.
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About Epinephrine
The first-line treatment for anaphylaxis is epinephrine (adrenaline). It is available by prescription in an auto-injector or nasal spray. 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 delivery device with them. 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.
You will feel some symptoms when given epinephrine: a little bit of heart racing or jitteriness. But it’s working, and always know that it’s a very natural element that’s produced in your own body. So don’t fear the term ‘epinephrine auto injector.’
Allergist Ruchi Gupta, MD
Common Side Effects
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.
Using 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 use their epinephrine delivery device properly and promptly.
Important Safety Notes:
- Always carry two doses of epinephrine.
- Epinephrine may be repeated if symptoms do not improve or recur.
- Antihistamines do NOT replace epinephrine for anaphylaxis.
- After epinephrine is used, emergency medical care is sometimes needed. 2023 guidelines suggest developing a specialized plan with your allergist that will be easy for you to follow.
This page was reviewed for accuracy February 1, 2018. Most recently updated March 16, 2026.
