Those with severe food allergies can be at risk of experiencing life-threatening reactions. If the reaction is severe enough, it can cause anaphylaxis: a rapid allergic reaction that puts the body into shock.
A dose of epinephrine, delivered by an epinephrine auto-injector (EpiPen®, AuviQ®, Adrenaclick®, Symjepi®, etc.) is the primary treatment to counteract anaphylaxis. Epinephrine can provide life-saving relief from an allergic reaction for many who suffer from food allergies. In fact, approximately one-third of anaphylactic reactions are caused by food allergies.
Learn more about epinephrine auto-injectors in the sections below, including when to use them, how to store them, and why your food allergy might require an EpiPen prescription.
An EpiPen is a prescription device that allows people to quickly administer a dose of epinephrine to counteract anaphylaxis. While a prescription is necessary to obtain an EpiPen, they do not require a medical license to inject. It is, however, critical to be trained and informed on how to use one so that you are prepared in case of an emergency.
While the brand-name “EpiPen®” is frequently used as an umbrella term, there are many different kinds of epinephrine auto-injectors. The most common devices in the U.S. include:
Note that Auvi-Q® is the only device designed specifically for infants and toddlers between 16.5 lbs to 33 lbs. All dosages of the Auvi-Q® also come with audible administration directions, making it easier for parents and caregivers to react quickly and effectively. It is also the shortest needle length available, making administration as painless as possible.
If you suspect that you may have a food allergy, you should make an appointment with a medical professional — ideally an allergist, although a primary care physician or pediatrician may also be able to help you with an accurate diagnosis. The allergist will evaluate your medical history, perform a medical exam, assess your symptoms/reactions, and proceed with diagnostic testing. Ultimately, this may include recommended oral food challenges to clarify specific food-related triggers.
If the clinician determines that your food allergy puts you at risk of experiencing a severe reaction (i.e., anaphylaxis), you will be prescribed an epinephrine auto-injector. This ensures that immediate medical treatment is always at hand in cases of accidental exposure.
If you have been prescribed an EpiPen, it is crucial to understand how – and when – to use it. Unfortunately, many patients hesitate to use their epinephrine auto-injector when needed, putting their health and safety at risk.
To minimize anxiety and help you get comfortable with using an epinephrine auto-injector, your allergist will discuss the signs of anaphylaxis, show you how to use your device, and work with you to create a detailed reaction plan. Common signs of anaphylaxis include:
In a clinical study of fatalities due to food-related anaphylaxis, the median time interval between the initial symptoms and respiratory distress or cardiac arrest was 30 minutes. If you are experiencing these symptoms after coming into contact with a suspected allergen, you may need to administer epinephrine immediately.
Having an EpiPen can feel overwhelming, and in some cases, even scary. But a detailed emergency action plan will empower you to recognize the signs of anaphylaxis and feel confident administering treatment right away.
A reaction plan can also act as a way to communicate medical needs to family members, loved ones, babysitters, schools, camps, and daycares. Anyone who is in regular or close contact with a person at risk of an anaphylaxis reaction should have easy access to their reaction plan and to two epinephrine auto-injectors.
Those who have successfully undergone oral immunotherapy (OIT) are also advised to continue carrying EpiPens. Even after a significant time in maintenance, it is possible to have a reaction to an OIT maintenance dose or an accidental exposure.
When administering an epinephrine auto-injector, the patient should ideally be lying down. The EpiPen should be set firmly on the injection site on the outside of either thigh, and pressed fully to ensure that the entire dose is administered. Regardless of the brand or type, all epinephrine auto-injectors are designed to be used either directly on the skin or through clothing (even as thick as a pair of jeans). Push hard until a click is heard, and keep the EpiPen in place for three seconds to ensure that the entire dose has been administered. Once complete, the patient should continue lying down for anywhere between five and 15 minutes.
Administering an epinephrine auto-injector in a time-sensitive situation – especially if you are the person experiencing anaphylaxis – is undoubtedly stressful. Practicing the right method of administering an epinephrine auto-injector can help to train your body and mind to react quickly. Some people use expired EpiPens as a training tool with an orange. While an orange peel is tighter than skin, it is the closest comparison to human skin, and will help familiarize you with the injection process.
This can be empowering and give both adults and children a better sense of the mechanism of their auto-injector. Since they contain needles, expired auto-injectors should be disposed of properly at a local hospital, pharmacy, police or fire station, or sometimes at your doctor’s office.
Your allergist will always be your best resource for learning how to use an EpiPen. Talk with your clinician to ensure that you know how to administer your epinephrine auto-injector safely – and more importantly, to ensure that you feel comfortable and confident in doing so.
In order to deliver life-saving relief during a severe allergic reaction, two epinephrine devices should be on hand at all times. They should be in a safe, easily accessible place that keeps each dose at room temperature (between 68 to 77 degrees Fahrenheit). EpiPens should never be stored in a refrigerator or a freezer and should not be left in a hot car during the day or a cold car overnight.
If an epinephrine auto-injector is exposed to extreme temperatures for too long, the potency of the dose may become compromised. There are many temperature-controlled cases available for EpiPens that can be a great way to ensure that epinephrine doses are always at hand and safely stored at the correct temperature.
Many families keep multiple sets of epinephrine devices in important locations — classroom, purse or diaper bag, sports bags, kitchen, office, grandparents’ house, etc. Your clinician can help you to work with your insurance coverage to ensure that you have as many sets as you need for your or your child’s convenience and safety.
Epinephrine doses vary from patient to patient, and depend largely on physical factors such as age and weight. Your allergist will prescribe the most effective dose for you.
Those with food allergies should always carry two epinephrine devices with them at all times. While the vast majority of anaphylaxis reactions can be treated effectively with a single dose of epinephrine, in some cases, more than one dose is required. Between 6%–19% of pediatric anaphylaxis cases require two doses.
Additional doses of epinephrine may be required for a number of reasons. These include: a severe or rapidly progressing case of anaphylaxis; delayed injection of the first dose; an inadequate initial dose, or an insufficient injection site. While less common in food-related allergies, cases of biphasic anaphylaxis may also require two doses. Biphasic anaphylaxis occurs when symptoms reemerge hours after symptoms have been resolved.
The cost of an epinephrine auto-injector is entirely dependent upon external factors, such as the manufacturer / brand name (such as EpiPen®, AuviQ®, Adrenaclick®, Symjepi®, etc.) and individual health insurance plans. For example, some insurance companies will cover generic-only, some will cover name brands, and others only offer coverage for a certain number of epinephrine auto-injectors each year.
As such, there is no standard pricing guideline for the cost of an EpiPen. To get a general idea of what copay pricing may look like for you, please visit the links below to explore the top three epinephrine auto-injector brands:
If your insurance does not cover the cost of your EpiPen (or if you do not have health insurance coverage), you may be a candidate for Adrenaclick®, now available at drugstores. Talk to your allergist about any concerns you may have about your epinephrine auto-injector prescription.
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