April 19, 2016 | Black & Kletz Allergy
The Allergy Doctor Centreville, VA Relies On Explains Epinephrine Auto-Injectors
Severe sensitivity to certain foods, insect venoms, and certain medications can lead to a life- threatening reaction called anaphylaxis. The symptoms usually begin within a few minutes after exposure and can progress very rapidly. Anxiety is often the initial symptom and the other usual manifestations include generalized itching, redness, hives, swelling of the eyelids, lips, tongue, and/or throat (i.e., angioedema) leading to difficulty in swallowing and breathing. Other signs can include excessive sweating, rapid pulse, and a sudden drop in blood pressure.
Epinephrine (adrenaline) is a self-injectable medication and is the first line treatment option for anaphylaxis. It can stall the progress of the reaction and can be life-saving by reversing the deleterious effects of anaphylaxis. To be maximally effective, epinephrine needs to be administered as soon as possible after the onset of the first symptom. In fact, delayed use of epinephrine is the leading cause of mortality in anaphylaxis. It is therefore imperative for all people susceptible to severe allergic reactions to have a self-injectable epinephrine immediately available at all times.
The foods most likely to cause anaphylaxis include peanuts, tree nuts, fish, and shellfish. In children and adults who are severely sensitized, other foods like milk and eggs can also cause severe adverse reactions. The insect stings that are known to cause anaphylaxis belong to the Hymenoptera family and include honeybees, yellow jackets, hornets, wasps, and fire ants. Penicillin and related antibiotics are the most common drugs that are associated with a tendency to cause life-threatening reactions.
Epinephrine auto-injectors are available by prescription only and are covered by most insurances. One of the products marketed under the trade name Auvi-Q was voluntarily recalled by the manufacturer in October 2015 and two other products Epipen and Adrenaclick are currently available. A generic version of an epinephrine auto-injector is also offered by certain pharmacies. Note that there are generally 2 doses (0.15 cc. and 0.3 cc.) of each epinephrine auto-injector. The dose depends on the weight of the individual, such that the 0.3 cc. dose is the dose usually given individuals weighing greater than or equal to 66 lbs. The 0.15 cc. dose (e.g., EpiPen Jr.) is generally given to children weighing 33-66 lbs.
Although the medication is identical, different brands have different administration methods and it is crucial that the patient receive adequate training and practice with a training device to get familiarized with the specific technique. The medicine is usually injected intramuscularly (IM) into the outer part of the thigh, even through clothing, and the device is kept in place for about 10 seconds. It is recommended that two doses be carried at all times, as the second dose may be needed if the symptoms persist about 10-15 minutes after the first dose.
The most common side effects of epinephrine include palpitations, tremors, and restlessness. However the benefits of epinephrine almost always outweigh the risks. After using the epinephrine, it is important to go to the nearest emergency department to be monitored. In some individuals with anaphylaxis, a late phase reaction can occur anywhere from 4 to 72 hours (4-8 hours is more typical) after the initial anaphylactic reaction. Patients and/or parents should also contact the allergist for reevaluation and for replenishment of epinephrine auto-injectors. The devices should be stored at room temperature and should never be frozen or exposed to high temperatures or direct sunlight.
The board certified allergists and the staff at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area are trained and experienced in evaluating the need for, prescribing, and teaching the technique for epinephrine auto-injectors. We have 3 offices in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices have on-site parking and the Washington, DC and McLean offices are Metro accessible. We offer free shuttle service between our McLean office and the Spring Hill metro station on the silver line. To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been providing quality care allergy, asthma, and immunology services to the Washington, DC , Northern Virginia, and Maryland metro area community for more than a half century.
