Patients with food allergies are at risk for anaphylaxis, a severe systemic allergic reaction, when exposed to a trigger or allergen. Epinephrine is the recommended treatment for anaphylaxis. Epinephrine is given by direct injection into the muscle (most commonly in the outer thigh), with an epinephrine autoinjector. These devices are automatic injection devices that are disposable and pre-filled with epinephrine. They can be used quickly in the case of suspected anaphylaxis. Examples of epinephrine autoinjectors available include the Epi Pen® autoinjector, generic versions of Epi Pen, Adrenaclick®, generic versions of Adrenaclick, and the Auvi-Q®. These devices are prescribed to patients for use in the case of accidental exposure to a triggering allergen which results in anaphylaxis.
When prescribed, these devices usually come in a pack of 2, as some patients may experience ongoing symptoms following the first dose and may require a second dose. However patients are instructed to always call 911 immediately after using their emergency epinephrine device. Epinephrine autoinjectors come in different dosage forms based on the weight of the patient. The “junior” form of these devices holds 0.15 mg of epinephrine, designed for patients weighing between 15-30 kg, or 33-66 lbs. The regular or “adult” dosing holds 0.30 mg of epinephrine, for patients that weigh at least 30 kg, or 66 lbs. Certain autoinjectors also have a 0.1 mg dose available for children weighing <15 kg, or 33 lbs.
It is important to review the package insert instructions when you get a new device as administration instructions sometimes change. Always follow the package insert for instructions for administration. Also, please review the instructions regarding storage, as light and temperature may affect the medication. Patients, families, and all caretakers must be familiar with their epinephrine autoinjector and trained in its use.
The Epi Pen®/Epi Pen Jr.® autoinjector is one of the commonly used epinephrine autoinjectors. Prior to using the EpiPen, patients and families should first read and review the instructions within the package insert. When using the EpiPen, remove the blue safety cap from one end, identify the area of the body for injection and push the orange end of the device firmly against the outer thigh until you hear a “click”. Keep the device in place for at least 3 seconds prior to removal. The needle will automatically retract into the device after use.
For users of Adrenaclick® there are some differences in administration, and the package insert should be reviewed prior to use. First remove the gray cap labeled “1” to reveal a red tip. Then remove the gray cap labeled “2” prior to placing the red tip (needle end) firmly on the thigh until there is a “click”. Continue to hold the device in place for 10 seconds to ensure full dosage. The needle does not self-retract following use. Users must be extremely cautious when recapping the needle for disposal.
Auvi-Q® comes in 0.3 mg, 0.15 mg and 0.1 mg dosage forms of epinephrine. To administer Auvi-Q follow the built-in voice instructions to guide administration. You are to remove the device from its outer case after reviewing instructions on its use. If the medication is required, pull the red safety guard off and then place the black end of the device against the outer thigh until there is an audible “click”. Hold in place for at least 2 seconds prior to removal.
It is important for all family members caretakers and teachers to be aware of the signs and symptoms of anaphylaxis, and to know how to administer the epinephrine autoinjector. An injector should be carried with the child at all times in the case of exposure. Lastly, if epinephrine is administered, it is important to seek immediate medical attention by calling 911.
Other resources for Anaphylaxis and Epinephrine Autoinjector devices: