Understanding Anaphylaxis: Don't Let It Shock You
Medically reviewed on Jul 24, 2017 by L. Anderson, PharmD.
Anaphylaxis: Not Your Average Allergy
You know the question, because you get it every time you go to the doctor - "Do you have any allergies?"
Many of us do, especially allergies to things like springtime pollen, cats or dogs, or even latex. And for most of us it's controllable. Allergen avoidance and seasonal or year-round allergy treatment usually takes care of the problem.
But for some, severe allergies can be a life-threatening and severe reaction called anaphylaxis (pronounced "ana-fi-LAX-is"). Learning about anaphylaxis and treatments ahead of time is key to a successful outcome.
How Do I Recognize Anaphylaxis?
Anaphylaxis, also known as anaphylactic shock, is a medical emergency. Anaphylaxis is the most severe of all allergies, usually occurs in minutes (but can be delayed for hours), and may be fatal if not promptly treated. A mild allergy such as hay fever is the result of a release of histamine that can lead to a runny nose, watery eyes, or mild rash. However, with anaphylaxis, immune chemicals can lead to a more severe reaction that affects the whole body, such as:
- Hives and swelling
- Severe breathing or swallowing problems due to throat swelling
- Drop in blood pressure (hypotension), fainting
- Chest tightness
- Nausea, vomiting, stomach cramps
- Pale or red color to skin
Common Allergens Leading to Severe Allergy
You are probably familiar with common allergens that can lead to life-threatening anaphylaxis such as peanuts, bee stings, and penicillin. But there are many other causes of severe allergic reactions, including:
- Food: Eggs, shellfish and other seafood, tree nuts (such as walnut, cashew, Brazil nut), grains, milk
- Drugs: including other penicillin-type drugs called cephalosporins; "sulfa" antibiotics like Bactrim, NSAIDs, or lidocaine
- Insects: Wasps like yellow jackets, paper wasps, and hornets; fire ants
- Certain X-ray contrast dyes (iodine, barium) and industrial/household chemicals
- Latex rubber
- Allergy shots
- Exercise-induced anaphylaxis
How to Prevent or Treat Anaphylaxis?
Prevention of an anaphylactic reaction by avoiding the allergen is key.
However, when contact does occur with an allergen, auto-injectable epinephrine (adrenaline) should be given quickly to help stop or slow down the reaction. Epinephrine is the first-line treatment for anaphylaxis.
People with a history of anaphylaxis should carry epinephrine such as EpiPen, other brands, or the generic versions with them at all times. Most U.S. schools now either require or allow school access to epinephrine for those who do not have their own supply. Keep a supply of epinephrine auto-injectors at home, work AND at school, and remember to refill your prescription before your epinephrine auto-injector has expired.
Can a Mild Allergic Reaction Become a Severe One?
Possibly, although it's not common. If you had a previous mild reaction to an allergen, in most cases you will continue to have the same type of reaction in the future when exposed to that allergen.
However, according to the American Academy of Allergy, Asthma & Immunology, a mild reaction does not guarantee that your next reaction won't be more serious.
If you have a severe allergy that can result in anaphylaxis, you need to be prepared with an Anaphylaxis Action Plan. Learn more about an Anaphylaxis Action Plan on the next slide.
What Is an Anaphylaxis Action Plan?
Talk to your doctor about developing an Anaphylaxis Action Plan that you can utilize day-in and day-out. Think about places and times away from home where you might be at bigger risk for exposure to allergens -- such as at restaurants, school, summer camp, planes, or other places where you might be exposed to your allergen.
Work with your child's school and school nurse to determine their policies, and teach and regularly review how to use the epinephrine auto-injector (Epi-Pen, Adrenaclick, Symjepi, Auvi-Q, available generics) for emergencies.
Always have two doses of an epinephrine auto-injector as a second dose may be needed in cases of an extended or recurrent reaction. You might consider a medical alert identification necklace or bracelet to alert first-responders to your severe allergy.
The Gold Standard: Epinephrine Auto-Injectors
Without the immediate delivery of epinephrine, those who are having a severe allergic reaction can go into anaphylactic shock. If untreated, anaphylaxis can lead to death; therefore, quick access to epinephrine is needed. There are several names for epinephrine auto-injectors you can get with a prescription at the pharmacy.
- EpiPen/EpiPen 2-Pak and EpiPen Jr/Epi-Pen Jr 2-Pak
- Adrenaclick (and its authorized generic from Impax, available at CVS)
The price of EpiPen is often out of reach for many patients, at about $600 per 2-pack if paying cash. However, Mylan also offers the authorized generic for Epipen for roughly $300 for a two-pack. Epinephrine autoinjector is available in a generic form (the authorized generic for Adrenaclick) from CVS Pharmacy for about $110 for a two-pack; there may even be additional discount coupons to lower the price. Auvi-Q returns to pharmacies on February 14th, 2017 and is expected to be free for some consumers. Cheaper options are now available after much controversy about the price of this life-saving drug.
What Are EpiPen and EpiPen Jr?
EpiPen and EpiPen Jr contain epinephrine (also called adrenalin), and doses are based on a patient's weight.
EpiPen is available from the pharmacy in two different strengths: The EpiPen Auto-Injector (0.3 mg) is for patients who weigh 66 lbs. (30 kilograms [kg]) or more. The EpiPen Jr Auto-Injector (0.15 mg) is for patients who weigh 33 to 66 lbs. (15 to 30 kg). A doctor must determine the dose in children weighing less than 15 kg.
EpiPen and EpiPen Jr also come in 2-Paks for ongoing anaphylaxis. Repeat injections with an additional EpiPen or EpiPen Jr may be necessary. Only a healthcare provider should give additional doses of epinephrine if you need more than 2 injections for a single anaphylaxis episode.
What's Contained in an EpiPen Package?
EpiPen 2-Pak and EpiPen Jr. 2-Pak cartons come with a free auto-injector trainer that contains no medication and can be used multiple times for training. Be sure to have a healthcare provider teach you and your child when and how to inject using the EpiPen the first time you receive it. Always carry your EpiPen or EpiPen Jr with you because you may not know when or where anaphylaxis may happen.
Each device that contains medication is for one single use. EpiPen should be injected into the middle of the outer thigh (through clothing, if necessary). You may need to use a second EpiPen or EpiPen Jr if symptoms continue or recur. Printed instructions are found in the package as well as on the surface of the Epipen. Seek immediate medical care, such as calling 911, in conjunction with administration of EpiPen.
The Auto-Injector: How To Use?
- Form a fist around the auto-injector with the black tip pointing down. Pull off the blue safety cap by pulling straight up.
- Place the black tip against the fleshy portion of your outer thigh or inject directly through clothing. Do NOT put your thumb over the orange end of the unit. For a young child, hold the leg firmly in place while administering an injection.
- With a quick motion, push the auto-injector firmly against the thigh to release the needle that injects the medicine. Hold the auto-injector in place for 3 seconds after activation.
- Remove the auto-injector from the thigh; the orange tip will cover the needle. Massage the injection area for 10 seconds.
- Get emergency help now. Take your used auto-injector with you when you go to see a healthcare provider.
What is Symjepi?
In the summer of 2017 the FDA approved Symjepi (epinephrine), a new, single-dose, prefilled syringe of epinephrine used for the emergency treatment of severe allergic reactions and anaphylaxis, a potentially life-threatening type of allergy.
The product provides two, single dose syringes of epinephrine which is considered the drug of choice in acute anaphylactic reactions involving insect stings such as bees, food allergies like peanut butter or shellfish, or medications, among others allergens.
The manufacturer reports that Symjepi is a more affordable product, smaller in size, and has a more user-friendly design than EpiPen. Unlike most auto-injectors, Symjepi's needle is not spring-loaded; instead, the needed is first inserted in the thigh, then the top plunger is depressed until it clicks to release the medicine. This may require holding a small child's leg in place while the medication is injected.
Do I Need to Be Concerned About Epinephrine Side Effects?
The benefit of using life-saving epinephrine for anaphylaxis far outweighs any potential side effects. The most common side effects that might be encountered include:
- Anxiety, Apprehensiveness
- Restlessness and tremor
- Weakness, Dizziness
- Sweating, Fast heart beat
- Nausea and vomiting
- Trouble breathing
Join Forces to Lessen the Shock
The thought of going into anaphylactic shock can be scary. But you and your doctor can manage your risk. Be sure to follow your doctor's recommendations for an Anaphylaxis Action Plan, have your quick-acting epinephrine pen immediately available at all times, and remember to stay educated on your severe allergy. You may also want to join the Drugs.com support groups for Anaphylaxis or Allergic Reactions to ask questions, express concerns and stay up-to-date with the latest news. Other areas where you can learn related information include:
Finished: Understanding Anaphylaxis: Don't Let It Shock You
- EpiPen. Prescribing Information. Mylan. Accessed January 12, 2017 at https://www.epipen.com/
- Epinephrine auto-injector. Product Labeling. 2016 Impax Laboratories. Accessed January 12, 2017 at http://epinephrineautoinject.com/
- American Academy of Allergy, Asthma & Immunology. Anaphylaxis Overview. Accessed January 12, 2017 at http://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis.
- Kelso J, et al. Patient information: Anaphylaxis treatment and prevention of recurrences (Beyond the Basics). UpToDate. Accessed January 12, 2017 at http://www.uptodate.com/contents/anaphylaxis-treatment-and-prevention-of-recurrences-beyond-the-basics.
- American Academy of Allergy, Asthma & Immunology. Anaphylaxis Quiz. Accessed January 12, 2017 at http://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis/anaphylaxis-quiz