Understanding Anaphylaxis: Don't Let It Shock You
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Aug 24, 2020.
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; bees
- Certain X-ray contrast dyes (iodine, barium) and industrial/household chemicals
- Latex rubber
- Allergy shots
- Exercise-induced anaphylaxis
How to Prevent and Treat an Anaphylactic Reaction
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. Prevention is key to avoiding life-threatening allergies, but is not always possible.
People with a history of anaphylaxis should carry epinephrine such as the EpiPen or the generic, authorized generics, or other branded versions with them at all times. Today there are many options available for epinephrine auto-injectors, and the prices are coming down.
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?
Yes, a mild allergic reaction can become severe, 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 and 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 what an Anaphylaxis Action Plan is 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 for emergencies.
- EpiPen 2-Pak
- Available generics, for example authorized generics or the generic for EpiPen or EpiPen Jr. from Teva Pharmaceuticals. Teva launched a generic for EpiPen Jr. in August of 2019.
Always have two doses of an epinephrine auto-injector as a second dose may be needed in cases of an extended reaction. If you have life-threatening allergies, you should wear 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 and its authorized generics
- Adrenaclick (and its authorized generic)
The price of EpiPen is often out of reach for many patients, at over $600 per 2-pack if paying cash. However, the authorized generic for Epipen for roughly $150 to 300 for a two-pack. Prices can vary widely so use online coupons and shop around.
Epinephrine autoinjector is available in a generic form (the authorized generic for Adrenaclick) for about $109 for a two-pack from CVS Pharmacy; there may even be additional discount coupons to lower the price. In August 2018, the FDA approved Teva Pharmaceuticals generic form of EpiPen and EpiPen Jr. Again, prices vary so be sure to check online prices for the best option.
Auvi-Q is back on the market and may be affordable only when obtained directly from the manufacturer for some consumers. Check with your insurance to see if this product is covered, as well. Paying cash for this drug will run you over $5,000.
EPIsnap is an epinephrine convenience kit that contains epinephrine, needles, alcohol wipes, and syringe labels for preparation of subcutaneously or intramuscularly administered syringes of epinephrine. It is specifically for clinical use.
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. However, only a healthcare provider should give additional doses of epinephrine if more than 2 injections are needed for a single anaphylaxis episode.
What's Contained in an EpiPen Package?
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.
How To Use an Auto-Injector
- 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.
Symjepi provides two, single dose syringes of epinephrine for 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.
The cash price of Symjepi is about $240 for 2 prefilled syringes using an online coupon. Check with your insurance or the manufacturer for coverages.
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 can manage your risk, with your healthcare provider's direction and the right medication.
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
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- FDA Approves First Generic Version of EpiPen. Drugs.com. August 16, 2018. Accessed August 24, 2020.
- EpiPen. Prescribing Information. Mylan. Accessed August 24, 2020 at https://www.epipen.com/en/
- Epinephrine auto-injector. Product Labeling. Impax Laboratories. Accessed August 24, 2020 at https://epinephrineautoinject.com/
- American Academy of Allergy, Asthma and Immunology. Anaphylaxis Overview. Accessed August 24, 2020 at https://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis
- Kelso J, et al. Patient information: Anaphylaxis treatment and prevention of recurrences (Beyond the Basics). Up To Date. Accessed August 24, 2020 at https://www.uptodate.com/contents/anaphylaxis-treatment-and-prevention-of-recurrences-beyond-the-basics
- American Academy of Allergy, Asthma & Immunology. Anaphylaxis Quiz. Accessed August 24, 2020 at https://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis/anaphylaxis-quiz
- EPIsnap: FDA Prescribing Information, Uses and Side Effects. Accessed August 24, 2020 at https://www.drugs.com/pro/episnap.html