Josef George Thundiyil, MD
Emergency Medicine
Orlando Health

Almost everyone has a friend or coworker who has a deadly allergy, but how many of us know how to use an EpiPen? Here’s what you need to know to be safe when administering this drug in a life-threatening anaphylaxis emergency.

What an EpiPen Does

EpiPens deliver epinephrine, which is another name for adrenaline. They are designed for acutely life-threatening emergencies brought on by an allergic reaction to anything from peanuts to a bee sting. Anaphylaxis follows as the body’s immune system switches to an intense defense mode.

Signs and symptoms of anaphylaxis can include:

  • Lips swelling
  • Throat closing due to impending respiratory failure
  • Triggering asthma attack
  • Blood pressure dropping
  • Passing out

Are There Alternatives to EpiPen?

EpiPen is the brand name for epinephrine auto-injectors. The first generic alternative to the EpiPen was approved by the Food and Drug Administration in 2018. There currently are several generic epinephrine auto-injectors on the market. The EpiPen and generic versions all require a prescription from your doctor.

How To Use an EpiPen

Hold the tip of the pen at a right angle to the middle of the outer thigh. Push the auto-injector until you hear a click. The click indicates that the injection has started. Stay still and slowly count to three, then remove.

Best practices include injecting into the thigh and avoid injecting through clothes when possible.

Newer EpiPens, such as the Auvi-Q, will talk to you. These models even include a timer that tells you how long to inject and when to remove the pen. However, these cost more.

Many EpiPens are also packed with practice, sample pens. Mark the fake one before using it to avoid a mix-up.

Check expiration dates. EpiPens expire one year from when filled. An expired pen delivers medicine that is less potent, which is better than none at all.

Two Kinds of EpiPens

  • The regular EpiPen delivers a standard dose is designed for adults and children heavier than 65 pounds. The weight cutoff falls, on average, between ages 9 and 10 in children. If you are unsure, it’s best to deliver a smaller dose.
  • EpiPen Jr. is for kids weighing 65 pounds or less and delivers half a regular dose.

Biggest Mistake People Make

EpiPens save lives, but only if readily available. Adults and children with known allergies need to have an EpiPen in the places they spend the most time. Adults with allergies should keep one at work, one in the car, perhaps one in a purse and one at home. Kids need one at school and one at home, at minimum.

Don’t forget to take your EpiPen when traveling, especially when abroad. Language and cultural differences may make it hard to confirm that there are no peanuts in your meal, for example.

Much of the U.S. has become aware of allergies, with hotels, restaurants and resorts making special efforts around allergies. Other countries largely don’t have this level of awareness, in part because their residents don’t suffer the high number of deathly allergies that are present in the United States.

When Not To Use an EpiPen

Under no circumstances should you administer an EpiPen to:

  • Someone for whom it is not prescribed
  • Someone who is only experiencing a rash as the result of an allergy

With older adults who have heart disease or arrhythmia, you must be more careful when administering an EpiPen because the medicine will cause a sudden rise in blood pressure or aggravate heart disease.

What an EpiPen Will Not Do

An EpiPen will not save you a visit to the ER. The EpiPen essentially buys you time to get to the hospital. The epinephrine from the pen may last 30 minutes to a couple hours, which should be enough time to get medical care.

Most allergic reactions will return within 72 hours, at which point it’s best to be under doctor care.

Even if you think you’re fine after allergic attack, you still need to be observed by hospital staff until the epinephrine has worn off. Doctors will likely administer a different anti-allergy medicine that is longer lasting to ensure airways stay open. They will also refill the EpiPen.

If you survive an allergic reaction without the need for an EpiPen, don’t assume your next allergic reaction will be a mild event. Not every allergic reaction will be the same. Once you have one allergic reaction, your body is primed. It has learned to recognize that allergy as a big threat and develops a greater immune response to launch a bigger attack next time, which could lead to a much more severe allergic reaction.

If you are unsure if you or your child have any allergies, consider food allergy testing as the percentage of the population suffering life-threatening food allergies is rising.