Epinephrine for anaphylaxis

People with severe allergies can have life-threatening allergic reactions involving more than one organ system (lungs, skin, gastrointestinal tract, cardiovascular system) called anaphylaxis. If someone has symptoms of anaphylaxis, he or she needs emergency medical attention. If the person has an injectable epinephrine device, epinephrine should be given right away, and 911 should then be called to transport the person to an emergency medical facility.

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Epinephrine is the most important medication for the treatment of anaphylaxis. It works best when injected into a muscle on the outer thigh. Once absorbed into the bloodstream, epinephrine works rapidly to contract blood vessels, preventing them from leaking fluid. It also relaxes airways, relieves cramping in the gastrointestinal tract, decreases swelling, and blocks itching and hives.

Physicians often suggest that individuals who have had allergic reactions to foods carry epinephrine with them at all times. This medication, available only by prescription, is sold under the names Ana-Kit® , EpiPen® or EpiPen Jr.® (for children), Twinject 0.3 mg auto-injector® , or Twinject 0.15 mg auto-injector® (for children). At-risk individuals or any person who might need to administer the injection should be trained in the use of these devices.

Some medicines given for high blood pressure (called beta blockers) can partially counteract the effects of epinephrine, making the treatment of anaphylaxis more difficult in these people. Allergic individuals with high blood pressure may want to ask their physician about the possibility of switching to a different type of high blood pressure medication.

Even if the individual responds to epinephrine, it is vitally important to go to an emergency room immediately! The effects of epinephrine may wear off after several minutes, requiring another dose, or other treatments may be needed, such as oxygen and/or medications to improve breathing. Intravenous fluids may be necessary to restore and maintain adequate blood pressure. Additional medications may be given to counteract the effects of histamine and to help prevent a delayed allergic reaction.

In addition, people at risk for anaphylaxis should consider:

• Wearing a medical alert bracelet at all times.
• Seeing a board-certified allergist.
• Carrying an emergency kit with an antihistamine in addition to the self-injectable epinephrine device. (Make sure to replace the injectable epinephrine device before it reaches its expiration date.) The emergency kit should also contain a written plan outlining the treatment of allergic reactions along with the phone numbers of people to be notified in case of a reaction. If your child has Food Allergies, have an action plan and emergency kit available at each place your child spends time, including school and day-care centers. Make sure to review the action plan with the staff at these places, and be sure that they know when and how to administer epinephrine and any other medication listed on the action plan.