Anaphylaxis and Epinephrine

Katelyn Chu is a high school student from Northern Virginia and an advocate for food allergy awareness and safety. Despite being severely allergic to peanuts, tree nuts and soy, she loves to bake when she's not at school, playing softball or volunteering. 

When was the last time you ate a peanut butter and jelly sandwich, fried an egg, or drank a cup of milk? While these foods are staples for many, each can trigger potentially fatal reactions for millions of Americans. 

I was two years old when I was diagnosed with food allergies to peanuts and tree nuts. Unfortunately, my family and I found out the hard way: after an unexpected and severe allergic reaction called anaphylaxis. As I got older, I developed more allergies, including to soy, a food that I had regularly consumed my whole life. However, I adapted to these differences and instated standard precautions. I brought my own cupcake to birthday parties, triple checked every label on new foods, and even spent a night with my friend injecting expired EpiPens into grapefruits, in case I had a reaction at her house. But the most significant lesson that life-threatening food allergies has taught me is, no matter the precautions one takes, there is always a risk for a reaction, which is why it’s important to be prepared and to make sure others around you are prepared.

Over the past thirty years, anaphylactic food allergies have been on the rise. As a result, teachers, babysitters, coaches and camp counselors should be knowledgeable about how to treat a reaction. Anaphylaxis is a serious type of allergic reaction that is severe and life-threatening, and understanding how to act in an emergency could save lives. 

How to identify anaphylaxis

An allergic reaction is called anaphylaxis when any part of your body has a severe symptom or when two or more different parts of your body have mild symptoms. Examples of mild and severe symptoms are listed on FARE’s Food Allergy & Anaphylaxis Emergency Care Plan. Symptoms can include but are not limited to:

• Pale or flushed skin
• Hives and/or rashes
• Low blood pressure, faintness, dizziness
• Vomiting and/or nausea
• Constriction of airways and/or a tightening feeling of the throat

Children may have difficulty expressing their symptoms, so descriptions such as “the food makes my mouth spicy” or even “something doesn’t feel right” can be a child’s way of communicating a reaction.

For a more interactive look at reaction symptoms, watch this animation.

How to react in an emergency 

Left untreated, anaphylaxis can result in unconsciousness and even death. If you, your child or anyone else exhibits symptoms of anaphylaxis, inject epinephrine if an epinephrine device is available and call 911 immediately. In the U.S., epinephrine devices may be labeled as an EpiPen auto-injector, an Auvi-Q auto-injector, a generic device based on the EpiPen or Adrenaclick auto-injectors, or a SYMPJEPI pre-filled syringe. Some injectors have instructions written out on the side of the medication, or even emit a voice with instructions.

Here are general tips to safely inject an epinephrine shot:

• Remain calm during the emergency. Especially with children, heightened panic of those around them may lead to increased fear or hysteria, which can worsen symptoms.
• Quickly look for instructions as each device is made with slight differences. Instructions for each type of epinephrine device can be found on the back of FARE’s Food Allergy & Anaphylaxis Emergency Care Plan, and links to information including epinephrine device training videos can be found here.
• Follow instructions on the medication, and carefully take note of the time. If symptoms worsen, or if they persist after 5 minutes, inject another dose of epinephrine. 

If there are no medication instructions:

• Remove the epinephrine device from any outer packaging. For some devices, you must open a protective outer shell or case before you can access and use the medication.
• If the epinephrine device is an auto-injector, remove any cap or caps. There is a safety cap at the tip of the device that prevents the needle from delivering the medicine until it is removed. Some devices have a second restraining cap at the other end that must also be removed. Make sure not to touch the tip where the needle is located. If the epinephrine device is a SYMJEPI pre-filled syringe, leave the cap on for now.
• Find the middle region of the patient’s outer thigh; this is where you will be aiming.
• You may hold the patient’s thigh or kneecap in place with one hand, but avoid accidentally injecting yourself. With the other hand, grip the epinephrine. For auto-injectors, hold the middle of the device. For the SYMJEPI pre-filled syringe, place your middle and index fingers on the finger guards and your thumb on the syringe plunger, then remove the needle cap with your other hand before holding the patient’s leg in place.
• Quickly swing the auto-injector so that the tip pushes firmly into the patient’s outer thigh and the needle enters the thigh muscle. For a SYMJEPI, insert the needle downward into the upper outer thigh and use your thumb to press the plunger through the barrel of the syringe to inject the epinephrine dose. Typically, a device will “click” when its dose has been delivered.
• For an auto-injector, hold the device in place for no more than 10 seconds. Depending on the brand of epinephrine, 2 to 10 seconds are needed to fully deliver the dose. For a SYMJEPI, hold for 2 seconds.
• Keep track of symptoms, both ongoing and new. If reaction symptoms persist after 5 minutes, or if they worsen, deliver a second dose, as stated before.

Individuals and families managing food allergy should work with an allergist to develop an individualized Emergency Care Plan, but being prepared in the case of anaphylaxis is a vital life-saving skill that everyone can learn. You don’t have to have food allergies to lift up the food allergy community; your support and advocacy serve as sources of encouragement and strength to those with food allergies.

For more on how to recognize anaphylaxis and respond to this emergency, take FARE’s Save a Life: Recognizing and Responding to Anaphylaxis online training course, available for free at FARE Food Allergy Academy.