Epinephrine is a potentially life-saving medication for allergic anaphylaxis
Epinephrine is considered the first-line medication for allergic anaphylaxis, which is a potentially life-threatening medical emergency. Antihistamines like Benadryl, Claritin, or Zyrtec may be helpful at relieving some symptoms during an allergic reaction, but they do not act swiftly to reverse anaphylaxis like epinephrine does, and should not be relied upon to save a life.
An epinephrine autoinjector is a device that makes it easy for a person who is not familiar with giving injections to inject a pre-measured dose of epinephrine quickly and safely in an emergency. It is easier, faster, and safer for someone who is not a healthcare professional to use an autoinjector than a needle and vial.
Epinephrine is a form of a natural hormone that is already in your body– adrenaline. At the dose used in epinephrine autoinjectors, it is a very safe medication with few side effects. In the case of a suspected severe allergic reaction in someone who has been prescribed epinephrine, it is far safer to use epinephrine when not needed than to need it and not use it.
If you have a life-threatening food allergy, you should have a prescription for epinephrine
Anyone who has been diagnosed with a true food allergy– meaning not an intolerance to a food, but an IgE mediated food allergy that could result in allergic anaphylaxis– should be given a prescription for a set of epinephrine autoinjectors.
If you or someone you care for has been diagnosed with a food allergy that could potentially result in allergic anaphylaxis, and you haven’t yet been given a prescription for epinephrine, please contact your allergist or primary care doctor and ask why. If you feel that your current health care provider may not be taking your allergy seriously, please consider seeking a second opinion.
Epinephrine autoinjectors come in sets of two for good reasons
There are two very important reasons why epinephrine autoinjectors sold in the United States come in sets of two, instead of being sold separately. The first reason is that, in some very severe cases of anaphylaxis, a second dose of epinephrine is needed to get potentially life-threatening symptoms under control. If a person experiencing anaphylaxis is not able to get to a hospital in time to receive that second dose of medication, having as second autoinjector ready could be life-saving.
The second reason is that having a second injector offers a backup plan if the first injector is misused or malfunctions.
Anyone who has been prescribed epinephrine for food allergy needs quick and easy access to that epinephrine at all times
Food allergens can hide in unexpected places– and not always on your plate! Cosmetic products, cleaning products, and many other common items may contain food, so people with food allergies have to be prepared to handle a reaction even when they are not eating. Allergic reactions to food can happen suddenly, and symptoms can progress very quickly. It is very important for a person with a food allergy to have quick, easy access to their epinephrine autoinjectors. They need to be able to find and use their rescue medication quickly at home, at school, at work– everywhere they go. A food allergic person may find they need multiple sets of epinephrine autoinjectors, stored safely in different locations, to make sure they have constant access. They may find they need to consider the size and shape of an injector, and how well it fits into a backpack, purse, or pocket.
If epinephrine needs to be stored in a school or workplace environment, it should be kept in a place where someone who needs it can access it immediately. An anaphylactic allergic reaction is an emergency and time is of the essence. Any delay caused by the need to find a specific staff member to ask for the location of the medicine, search through piles of other medications, or look for a cabinet key to open a locked cabinet could result in tragedy.
Ambulances are not always equipped with epinephrine in the correct dose to treat anaphylaxis, and emergency medical personnel are not always trained on how and when to administer epinephrine to treat anaphylaxis. People with food allergies cannot rely on emergency medical personnel to administer epinephrine in the event of a reaction.
People who might need to use an epinephrine autoinjector should practice using a trainer device
Most brands of epinephrine autoinjectors come with a trainer in the box. The trainer is the same size and shape as the real epineprhine autoinjector, but does not contain a needle or medicine. The trainer can and should be used repeatedly to practice activating the autoinjector.
Epinephrine autoinjectors are easy to learn how to use, but in an emergency, it’s best not to have to pause to read the directions. Anyone who might need to use an epinephrine injector– a person with a food allergy, their family members, friends, caregivers, teachers, etc– should practice using one until they feel comfortable they can do it quickly and easily.
Different brands of autoinjectors work differently. It is important to train on the specific brand of autoinjector you might need to use, before you might need to use it. Sometimes pharmacies fill epinephrine prescriptions without telling their patients that the brand and type of injector is different than the one they have used before. Check carefully any time you pick up a new epinephrine prescription to make sure that you know which type of device you are getting.
Extreme temperatures can damage epinephrine autoinjectors
Long term storage in high heat conditions can cause epinephrine to degrade in quality and lose potency. If you have to carry epinephrine in hot conditions for a long time, you may want to use an insulated or chilled medication case or an evaporative cooling case, like the Frio. Cold temperatures do not affect the quality of epinephrine in the same way that very hot temperatures can, but if the liquid inside your autoinjector freezes, there is a chance of damage to the device, so avoid keeping it in a freezer or leaving it outside unprotected in freezing temperatures.
Consult the manufacturer directions that come with your autoinjector to make sure you are keeping it safe. If you have any questions about whether your autoinjector needs to be replaced after exposure to extreme temperatures, contact the manufacturer or your doctor.
Types of epinephrine autoinjectors
EpiPen
The EpiPen is the original epinephrine autoinjector, and for many years was the only type available on the market. This means that a number of people who need to use epinephrine autoinjectors are already familiar with the EpiPen and have been trained on how to use it. It is shaped like a large pen or marker. It does not fit easily in a pants pocket, but will fit easily in a backpack or purse.
The EpiPen comes in two dose sizes, the EpiPen for adults and older children, and the EpiPen Jr. for small children. The size and function of the EpiPen and EpiPen Jr. are the same; the only difference is the dose of medication inside. The EpiPen has a spring-loaded needle hidden inside it and features a safety cover that pops out to cover the needle after the device is used. A note for those with needle phobia: if you use the EpiPen correctly, you will never see the needle, since it is inside the device before use, and covered with the needle cover after.
The EpiPen comes with a trainer included in every package.
Note that the EpiPen looks very similar to the Teva autoinjector, and comes in similar packaging, but they are different types of autoinjectors that have different instructions for use.
Find instructions on how to use the EpiPen epinephrine autoinjector at the EpiPen website.
Mylan Generic
The Mylan generic epinephrine autoinjector is the same device as the EpiPen, manufactured under the same label. The design and function of this device is identical to the EpiPen, and the directions for using it are also the same. Anyone who has already been trained to use an EpiPen should not have any problem using this identical generic version. The Mylan generic epinephrine autoinjector comes with a trainer in every box.
Find instructions on how to use the Mylan generic epinephrine autoinjector at the EpiPen website.
Auvi-Q
The Auvi-Q has some innovative features that set it apart from other epinephrine autoinjectors. The first is the shape and size: an rather than being shaped like a large pen, an Auvi-Q injector has a rectangular shape and is roughly the size of a small wallet. This allows it to fit easily in a pants pocket.
Secondly, the Auvi-Q plays recorded audio instructions whenever someone uses the trainer or the device itself. This makes the Auvi-Q incredibly easy to use, especially for a child or an untrained bystander.
The Auvi-Q also has a slightly smaller needle than other autoinjectors and many users report it is less painful to use than other types. Unlike other autoinjectors that use a spring-loaded needle, the Auvi-Q injector uses a gas canister to deploy its needle. This design makes its compact rectangular shape possible. The Auvi-Q needle is hidden inside the device before activation, and is designed to retract back into the device after use. Just as with the EpiPen above, if you use an Auvi-Q correctly, you will not see the needle.
The Auvi-Q comes in three dose sizes: a dose for adults and older children, a dose for small children, and an infant dose. The devices for all three dose types are the same size and shape, and the instructions for using them are the same. The Auvi-Q comes with a trainer in every box.
Find instructions on how to use the Auvi-Q epinephrine autoinjector at the Auvi-Q website.
Teva Generic
The Teva generic epinephrine autoinjector is similar in size and shape to an EpiPen– about the size and shape of a large marker– but the way you open and activate the Teva injector is different from an EpiPen.
These two devices look very similar and come in very similar looking boxes, so it’s very important to make sure you know which type you are getting when you pick up an epinephrine prescription at your pharmacy. Training using an EpiPen trainer will not prepare you to use the Teva autoinjector, and training using a Teva trainer will not prepare you to use an EpiPen. You must be sure to read the directions and practice with the trainer for the specific device you have.
The Teva injector comes with in two dose sizes, one for small children and one for larger children and adults.
Find instructions on how to use the Teva epinephrine autoinjector on the Teva website.
Adrenaclick Generic
The Adrenaclick generic epinephrine autoinjector, made by Amneal, is another pen-shaped autoinjector. It has a very simple springloaded needle design. Unlike the EpiPen, there is not an automatic needle cover that pops out after use, nor does the needle retract after use like it does with the Auvi-Q. The needle can be manually covered after use by returning the Adrenaclick generic to its case.
The Adrenaclick generic comes in two dose sizes, one for adults and older children and one for small children.
An important note: The Adrenaclick generic does not come with a trainer in the box! This is unlike the other types of epinephrine autoinjectors listed above, which always come with a trainer included. A trainer can be ordered directly from the Adrenaclick generic manufacturer, but it does not automatically come with the medication.
The lack of a trainer in the box can be a serious issue for people who have never trained on the Adrenaclick autoinjector before. If your pharmacy offers you this autoinjector, and you are not already familiar with it, you may want to request another brand. If this is the only type of autoinjector that is affordable or available for you, make sure to order the trainer. And while you wait for it to arrive, ask your pharmacist or your allergist if they have a trainer you can borrow to practice with.
The packaging for the generic Adrenaclick is very similar to the packaging for the Mylan generic and the Teva generic. It is very easy to pick this device up from the pharmacy without immediately realizing that it is not your usual type of autoinjector, or that it does not come with a trainer in the box, and your pharmacist may not warn you. Always check at the pharmacy to make sure you know which type of epinephrine autoinjector you are getting.
Important things to check when you pick up your epinephrine autoinjectors at the pharmacy
Here are some important things to remember to check for when you get your epinephrine prescription. Check before you leave the pharmacy.
Check to make sure you know what kind of epinephrine autoinjectors the pharmacy is giving you
As noted above, many different types of epinephrine autoinjectors come in similar packaging. It can be easy to pick up a new set without realizing you have picked up a type you have not received before and are not trained on, and your pharmacist may not think to warn you that you are being given a different type of autoinjector than usual.
Check carefully to make sure you know what kind of epinephrine autoinjectors you are getting before you leave the pharmacy. If the type of autoinjector new to you, make sure you are prepared to familiarize yourself with the device before you need to use it in an emergency. If you do not feel comfortable using a different type than you are already trained on and used to, talk to your pharmacist and your doctor and see if you can keep using the epinephrine autoinjector you prefer.
Check the expiration date
Many allergists and allergy groups recommend that patients ask for epinephrine autoinjectors with an expiration date at least one year from the date of purchase. Some schools also specifically require that epinephrine autoinjector sets stored at school have an expiration date that is at or after the end of the current semester or the current school year, to prevent school staff from having to remind students and parents to replace expired medication in the middle of a term.
Epinephrine autoinjectors can be expensive, and you should not have to replace them more frequently than you need to. If a pharmacy tries to give you an epinephrine autoinjector set with an expiration date that is only a few months from the date of purchase, there is nothing wrong with you asking them to get you a set with a longer shelf life.