You may never need to use an epinephrine auto-injector on yourself or your child, but it’s critical to be prepared just in case. Allergic reactions are unpredictable and can progress to life-threatening anaphylaxis rapidly. Knowing how and when to administer epinephrine can mean the difference between life and death.
This article covers what epinephrine is and the symptoms of anaphylaxis to look out for. It also includes step-by-step instructions on how to use an EpiPen epinephrine auto-injector, as well as several safety tips for anyone with severe allergies.
How to Use an EpiPen on Yourself
Remove the EpiPen From Its Package
Unscrew the yellow cap from the container and slide out the EpiPen.
Remove the Gray Safety Cap
Take off the gray safety cap from the back of the EpiPen. It won’t work unless this cap is removed.
Inject the Epinephrine
Grasp the EpiPen in your fist. Do not put your fingers on either end of the EpiPen. Position the black, rounded tip of the EpiPen against the middle of the outer thigh (upper leg).
To deliver the medicine, swing your hand outward then jab the EpiPen into the thigh. Push it into the thigh firmly. Listen for a click. The click signals that the epinephrine is being delivered.
Hold the EpiPen in place while slowly counting to three. After three seconds, the injection is complete and you can remove the EpiPen from your thigh.
If you do not hear a click, the EpiPen may have failed to deliver epinephrine. All people with severe allergies should carry two EpiPens at all times. This way, if an EpiPen fails to deliver medicine, you will have a backup ready.
Call 911 and Discard the EpiPen
Once the EpiPen is used, call 911. Anaphylaxis is a life-threatening condition, and using epinephrine is only a temporary fix.
It may be necessary to take a second dose of epinephrine. However, you must wait at least five minutes before taking a second dose. Taking two doses back-to-back can lead to dangerously high blood pressure, stroke, or death.
Do not attempt to reuse the EpiPen. The used EpiPen must now be properly discarded. The ambulance crew will be able to throw the used EpiPen away in their sharps container, or you may need to discard it in its original container.
How to Use an EpiPen on a Child
Remove the EpiPen From Its Package
Remove the cap from the container and slide out the EpiPen.
Remove the Gray Safety Cap
Remove the gray safety cap from the EpiPen. It won’t work unless the cap is removed.
Position the Child to Receive the Injection
If the child is older, you can have them sit or lie on the ground. If the child is younger, you can seat them in your lap. You will be injecting the EpiPen into the outer part of their upper thigh, so you need to position the child in a way that allows you to jab their thigh.
Inject the Epinephrine
Grasp the EpiPen in a fist. Do not put your fingers on either end of the EpiPen. Position the rounded tip of the EpiPen against the middle of the child’s outer thigh (upper leg).
Hold the child’s leg firmly in place, then deliver the medicine by jabbing the EpiPen into their thigh. Push it into the thigh firmly. Listen for a click. The click signals that the epinephrine is being delivered.
Hold the EpiPen in place while slowly counting to three. After three seconds, the injection is complete and you can remove the EpiPen from their thigh.
Again, you do not need to remove the child’s clothes to administer the EpiPen. The EpiPen’s needle can penetrate clothing.
Call 911 and Discard the EpiPen
Once the EpiPen is used, call 911. Do your best to keep the child calm while you wait for the ambulance. To prevent shock, you can have the child lay on the ground with their feet elevated.
Do not attempt the reuse the EpiPen. The used EpiPen must now be properly discarded. The ambulance crew will be able to throw the used EpiPen away in their sharps container, or you may need to discard it in its original container.
Symptoms of Anaphylaxis
Anaphylaxis is a severe allergy. Symptoms can begin suddenly and progress rapidly. If the victim is unconscious, call 911 immediately. Look for several telltale signs that indicate anaphylaxis:
Difficulty breathing Swelling of the face, throat, or lips Hives or itching Clammy skin Rapid heart rate Lightheadedness Low blood pressure Nausea or vomiting Shock
EpiPen vs Antihistamines
Antihistamines will not prevent, relieve, or stop anaphylaxis symptoms and are not a substitute for epinephrine.
Epinephrine is the only first-line treatment for anaphylaxis, and the only medicine that can prevent a potentially fatal outcome.
Antihistamines are drugs that relieve mild allergy symptoms caused by hay fever (seasonal allergies), indoor allergies (such as house dust and dog dander), and mild food allergies. Common brands of over-the-counter antihistamines include Benadryl, Zyrtec, Claritin, and Allegra.
Antihistamines work by blocking your body’s response to histamine—a substance your body normally releases when it detects something harmful.
Although histamines are involved in anaphylaxis, antihistamines cannot relieve or prevent the life-threatening symptoms of anaphylaxis, such as difficulty breathing, low blood pressure, and shock.
Furthermore, antihistamine tablets can take at least 30 to 60 minutes before their effects set in, whereas epinephrine begins to work immediately.
If you or your child has made contact with an allergen that you know will trigger a severe reaction, you should administer the EpiPen even if symptoms seem mild at first.
Allergy Safety Tips
Unfortunately, you can’t always prevent anaphylaxis, and a day may come when you or your child needs to use their epinephrine auto-injector.
Epinephrine saves lives when it is used properly and in a timely manner. That said, once you or your child has been prescribed an epinephrine auto-injector, you still need to be active and consistent with it in order to stay safe.
Be active by checking your auto-injectors regularly, staying on top of your refills, and avoiding known allergens. Be consistent by doing these things routinely, because anaphylaxis usually happens unexpectedly.
Stay prepared for an anaphylactic event by following these safety tips:
Always carry your epinephrine injector with you or ensure that your child keeps theirs on them at all times. Many schools require that EpiPens be kept with the nurse, in the classroom, or at the front desk. But if possible, children should keep their EpiPen on their person throughout the school day. If they play sports, the EpiPen should be kept in a bag on the sidelines. You or your child should also keep a spare epinephrine injector close by as well. Keep a backup where you or your child can quickly access it in case the first EpiPen malfunctions or a second dose is needed. The most common cause of death during an allergic reaction is waiting too long to administer epinephrine or not having the auto-injector with you. Have an action plan in place. If you are unsure about when to use your EpiPen, talk to your healthcare provider. Auto-injectors must be kept at room temperature. Do not keep it in your refrigerator, or in your car on an especially hot or cold day. Check your auto-injectors regularly. The liquid inside of them should be clear. If they are cloudy, discolored, or have floating specks, they need to be replaced. Check the expiration date on all your auto-injectors. Set a notification in your phone or write the expiration date in your calendar so that you can have them replaced before they expire. Children who have had a severe allergic reaction should wear a medical ID bracelet or necklace, which you can buy at most pharmacies. Each EpiPen comes with a Trainer auto-injector that contains no needle or medication. Use it to practice and encourage your child to practice too. Last but not least, avoid known allergens as much as possible. Teach your children about the dangers of those allergens. Make sure their teachers, coaches, and other caretakers are informed, and encourage your child to speak up about their allergies whenever they feel they are at risk.
Summary
Epinephrine auto-injectors, such as the EpiPen, should be used at the first sign of anaphylaxis. The medicine works immediately to reverse the symptoms of this life-threatening allergic reaction. However, it must be used properly and without delay in order for it to work.
Because anaphylaxis can be very unpredictable, you (or your child) should have at least one EpiPen on your person at all times. Be sure to check your EpiPens regularly to ensure they are not expired and that the liquid in them is clear. Refill your auto-injectors before they expire, and practice with your trainer auto-injector as often as necessary to stay prepared.
