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4:11 PM Thu, Nov. 15th

Do not get caught without EpiPen

EpiPen is used to treat anaphylaxis. Anaphylaxis is an acute systemic allergic reaction that could potentially result in death.

The symptoms of anaphylaxis include itching; flushing; hives and angioedema; cough; wheezing; difficulty breathing and tightness of the chest; swelling and tightness of the throat; nausea; vomiting; abdominal pain or cramps and diarrhea; and low blood pressure which results in dizziness or fainting. It is not necessary for a patient to experience all symptoms during an allergic reaction.

The reactions when they appear progress quickly and could end fatally if suitable action is not taken.

Every patient who is prone to anaphylaxis from foods, medications and insects, latex or from other reasons should have a written anaphylaxis action plan always available and it should be followed quickly following the onset of anaphylaxis.

EpiPen counters anaphylactic symptoms by opening your airways (both upper and lower airways) so you can breathe normally, and by increasing blood flow to the heart and by making the heart pump blood normally which in turn brings up your blood pressure.

Anaphylaxis could be biphasic

Anaphylaxis at times could have a biphasic reaction. This means after the acute onset of symptoms and after the right treatment, the symptoms may subside. Then the symptoms could come back after several hours. That is why it is important for the patient to be watched in an emergency room setting for several hours after the onset of anaphylaxis to make sure the symptoms do not come back.

Sometimes it may be necessary even to admit the patient in a hospital or to keep the patient in the emergency room for 24 hours or longer.

EpiPen is the mainstay of treatment for anaphylaxis and therefore it should be used properly as soon as possible. Proper and prompt use of EpiPen often could make the difference between life and death. The patient, as well as other family members, should be well versed in using EpiPen. The patient should ask the pharmacist for a trainer EpiPen [without medication and needle] and practice with it periodically. If you are not sure, please ask your healthcare provider or the pharmacist to show you the proper use of EpiPen.

How to use it

EpiPen should be used intramuscularly and not subcutaneously. The best location for using EpiPen is the middle part of the outer thigh. In an emergency, it can be used through clothes. Under no circumstance should the black tip of EpiPen be touched or pressed on; otherwise, one may get an accidental injection in the finger which would be painful.

I do not recommend a jabbing motion be used when giving EpiPen. The recommended procedure is placing the black tip against the middle part of the outer thigh after removing the gray cap and pushing the whole unit (not the white end) toward the thigh until one hears a click. One would simultaneously feel the pain of the needle going through the skin at the same time.

The injection should be held firmly for 10 seconds after this before removing the unit. Small children should be held firmly before giving the injection so they do not break the needle while fighting it. The used EpiPen should be discarded safely and 911 should be called.

The injection works only for 15- 20 minutes, and after this, the allergic reaction could potentially come back. The patient should always go to the hospital in an ambulance and not by private car because the symptoms could occur during the travel and it would be much more difficult to treat the patient on the road.

For some reason, if the ambulance does not arrive on time and the anaphylactic symptoms recur after 15-20 minutes, a second EpiPen should be used in a similar fashion. Therefore, it is important that every patient carry two EpiPens at all times.

The heat in Arizona can destroy the medicine, therefore, the injections should never be left in places such as cars. They can be kept at room temperature and there is no need for refrigeration.

Seven out of 10 times the EpiPens will not work if they are expired. Therefore, it is important to check the expiration date and replace the units suitably. Visit to learn more. Most insurances pay for it.

Natarajan Asokan, M.D., F.A.A.P. is a board-certified allergist and immunologist and a board-certified pediatrician. He can be reached at 1739 Beverly Ave., Suite 118, Kingman, AZ 86409, or (928) 681-5800.