Epi Essentials

(Reprinted from The MA Report, November 2003)

Matthew and his parents decided to stop for a bite to eat on their way home from a day playing in the park. Within minutes of eating his first piece of pizza, Matthew complained of a stomachache, developed hives on his face, and began feeling short of breath. What started out as a fun family outing ended up in a medical emergency called anaphylaxis. Matthew had an allergy to soy and much to the surprise of his parents, the pizza Matthew ate contained soy.

Food allergies affect 5.4 million to 7 million Americans. They are an increasingly common cause of anaphylaxis, a life-threatening allergic reaction that affects many organs simultaneously and can cause swelling of the throat, lips or tongue, hives, difficulty breathing or a sudden drop in blood pressure and loss of consciousness. Anaphylaxis results in 125 deaths each year in the U.S. Most food-related anaphylaxis occurs away from home. So, if you or your child has food allergies, how do you equip yourself for such an emergency?

Read food labels carefully and question restaurant staff or hosts about ingredients, but remember that you are always at risk of accidental exposure. Your physician will give you a written plan of action stating exactly how to respond to specific symptoms. Response tools may include oral antihistamines, inhaled bronchodilators and/or epinephrine.

The most widely used treatment for anaphylaxis is an immediate injection of epinephrine, available by prescription as a self-injectable EpiPen®, accompanied by emergency medical care. A 1992 study of children and adolescents with food allergy demonstrated the importance of carrying epinephrine at all times. According to the study, 10 out of 13 fatal or near-fatal anaphylactic reactions to food occurred away from home and in public places. None of the children or adolescents who died had epinephrine with them. In contrast, all of the adolescents and children who survived received epinephrine within 5 minutes of developing severe allergic symptoms (The New England Journal of Medicine, 1992:327:380-384).

What you need to know about EpiPens:

  • The effects of epinephrine usually last 10-20 minutes. Sometimes a single dose of epinephrine is not enough to reverse the effects of an anaphylactic reaction before emergency medical help is reached. To be safe, always carry two EpiPens with you at all times. Be sure to keep them handy at school and work as well
  • Depending on where you live, calling 911 for emergency medical technicians (EMTs) may not be a lifesaving answer to anaphylaxis. Only 21 U.S. states have legislation currently that allows all EMTs (Basic, Intermediate and Paramedics) to carry and administer epinephrine to a person suffering from anaphylaxis. Therefore, in many situations they cannot give the needed medication but only offer supportive care.
  • The amount of epinephrine needed to treat an anaphylactic reaction is based on body weight. EpiPen and EpiPen Jr. satisfy the range of dosing needs.
  • The EpiPen 2-Pak™ contains two auto-injectors and a free trainer.
  • Dey L.P., which manufactures EpiPens, offers an expiration reminder program that will notify you when your EpiPen is due to expire and needs replacement. Go to www.dey.com.
  • Keep your EpiPen at room temperature, never refrigerated or in a hot car. If the solution appears brown, replace the unit immediately.
  • Some medication will remain in the EpiPen after an injection, but it should never be re-used. Take your used EpiPen with you to the hospital emergency room you visit for follow-up care.