The first line of defense against anaphylaxis is epinephrine. Period. In fact, virtually all deaths associated with anaphylaxis occur because epinephrine is not administered in time. A shot of epinephrine, followed by a dose of liquid antihistamine, is the best combination we have to halt the rapid acceleration of anaphylactic symptoms.

Epinephrine is available by prescription only….The medicine is most commonly delivered by a device known as an EpiPen®. Each EpiPen delivers one premeasured dose. EpiPens are not reusable and should be thrown away immediately after use.

Most parents of allergic children need several EpiPen units: two for school (one for the school nurse, one for the classroom teacher) and two for home use….You definitely need access to two EpiPens at any given time, however. Think of the possible scenarios: one EpiPen might malfunction (this is quite rare, but it does happen occasionally, whether because of a manufacturing defect or because of exposure to temperature extremes), or one EpiPen might not be enough to reverse your child’s reaction. Epinephrine generally lasts for twenty minutes or less, so you might need to give your child a second injection before you reach the ER.

When you give your child a shot of epinephrine, the immediate effect is an overall constricting of the blood vessels and a stronger, faster heartbeat. The bronchial tubes enlarge as well.

Once those blood vessels go back to normal size, the swelling that is the most alarming (and life-threatening) symptom of anaphylaxis rapidly abates. Swollen airways open up; lips and tongue shrink back to normal; wheezing is replaced by easy breathing.

Storing Your EpiPen:

1. Make sure that epinephrine is stored as close to room temperature as possible at all times. Refrigeration or exposure to prolonged cold may cause the unit to malfunction. When traveling outside with epinephrine during the winter – while skiing, for example – you should keep the EpiPen in a breast pocket or in a waist pocket under your jacket.



2. Your EpiPen should also not be exposed to extreme heat. During the summer, it’s important not to store your EpiPen in the glove compartment or trunk of your car. (Of course, it should be with you at all times, anyway). At the beach, keep your epinephrine in a cooler. Walking around on a hot summer day with epinephrine in your handbag is okay.



3. Do not expose your EpiPen to direct sunlight. It will oxidize (turn dark) and not be effective.



4. Epinephrine is perishable; check the expiration date every few months to make sure that you don’t get caught short.



5. Also check your EpiPen every few months to make sure it hasn’t oxidized for whatever reason. If the liquid has turned dark, you need to get a new EpiPen.

Above excerpts reprinted from pp. 40-47 of The Parent’s Guide to Food Allergies: Clear and Complete Advice from the Experts on Raising Your Food-Allergic Child by Marianne Barber, © 2001 by Marianne Barber. Reprinted by permission of Henry Holt & Co., LLC.

How to Give an EpiPen Injection:

1. Although the EpiPen Auto-Injector may be used through clothing, it’s preferable to use it on bare skin.



2. Remove the EpiPen from its amber tube.



3. Pull off the gray activation cap. Once the activation cap is removed, do not touch the exposed black tip with your fingers since this is where the needle comes out.



4. Hold the EpiPen at a 90° angle about two inches from the outer part of the thigh.



5. Quickly swing and jab the black tip into the outer portion of the thigh. Hold it in place for 5 to10 seconds. The full dose of medicine will be fully discharged within a few seconds. If you have practiced with EpiPen trainers in the past, understand that you will not hear a “click” when you are using a real EpiPen.



6. Remove the EpiPen and massage the injection site for a few seconds. You will see the needle protruding. Press the needle against a hard surface and then bend it back toward the shaft. Slip the EpiPen back into its amber tube. Take it to the emergency room with you, give it to the personnel there to show that you've used epinephrine, and ask them to dispose of it properly while you’re being further evaluated.



7. Don’t be concerned if you see some medicine left in the EpiPen; that’s normal.