Self-administrated shots of epinephrine (often referred to by their brand names: EpiPen and Twinject) are life-saving devices which can halt an allergic reaction and give a patient time to get to a hospital. For children and adults who experience anaphylaxis, an epinephrine shot is a matter of life or death. But it’s important for patients and caregivers to know how to properly work an automatic epinephrine shot. An incorrect or accidental administration can have dangerous consequences.

Accidental Epipen Injections & the Consequences:

In order for epinephrine to work properly, it must be injected into the thigh muscle. The greatest risk of an accidental or an incorrect injection is that injecting the epinephrine elsewhere can delay or impair the effectiveness during a time-critical emergency.

Aside from this, there are also risks of an accidental injection in and of itself. An accidental intravenous injection (which is very rare and would be fairly difficult to do on accident), is especially dangerous and can lead to hypertension and/or heart problems[1]. Most accidental injections (an estimated 94%) occur when a patient or someone trying to help them accidentally jabs their finger or thumb[2]. An accidental injection to the hands or feet can impair blood flow to these areas and can potentially cause tissue death. This however, is the worst-case scenario.

Symptoms of an accidental injection are not usually so severe and may include temporary numbness or tingling, pain and swelling at the injection site, elevated heart rate and/or heart palpations. Regardless, you should always seek medical attention in the event of an accidental injection; it’s better safe than sorry!

Know How To Use the Epipen:

It never hurts to refresh your memory on how to use your child’s epinephrine shot. You may even want to print out the instructions and keep them in a handy place (for example, fold it up and keep it with the epinephrine shot). Both EpiPen and Twinject have several resources to teach patients about the proper use of epinephrine shots.

• EpiPen
  • Downloadable instructions
  • Demonstration video

• Twinject
  • Downloadable instructions
  • Demonstration video

For best results, ask your child’s health care provider to demonstrate how to properly use an epinephrine shot[3]. Research shows that parents who receive hands-on training are better able to properly demonstrate how to use their child’s epinephrine shot[4]. Remind them to be careful! An ironic side note: An estimated 10% of accidental epinephrine injections occur in health care providers when demonstrating to their patients how to use it!

How many of you carry Twinject or EpiPens for your children? Have you ever had to deal with an accidental epinephrine injection?

-Mallory

[1] Epinephrine. Drug Facts and Comparisons. Efacts [online]. 2008. Available from Wolters Kluwer Health, Inc.
[2] Accidental EpiPen injections becoming more common. Annals of Allergy, Asthma and Immunology, April 2009.
[3] Pediatr Pharm.2008;14(5)©2008Children's Medical Center, University of Virginia.
" [4] Arkwright PD, Farragher AJ. Factors determining the ability of parents to effectively administer intramuscular adrenaline to food allergic children. Pediatr Allergy Immunol 2006;17:227-9.

As the weather warms up and school lets out, many of you are likely planning a summer vacation with your family. When you have a child with food allergies, traveling can be stressful because you are out of your comfort zone. By planning ahead, you can ensure that the trip goes smoothly and that your child gets to experience all of the fun. It will also take away a lot of your anxiety so that you can relax and enjoy your vacation time too! Here are some tips for planning your next vacation.

Automatic Epinephrine Injectors (EpiPens)

If your child has an automatic epinephrine injector (or EpiPen), make sure it isn’t expired and consider packing an extra just in case. Have it handy at all times and get an insulated carrying case to prevent it from getting too hot or cold.

Air travel

Traveling by plane can be incredibly stressful for those with food allergies, especially those with peanut allergy and anaphylaxis. However, there are steps you can take to minimize the risk for an allergen exposure.

• Ask ahead if you can pre-board so that you can clean the area around your child’s seat.
• Bring a sheet or cover for the seat. You can buy washable or disposable covers from Plane Sheets.
• Call ahead to alert the airline of your child’s food allergies and find out about their policies. Some airlines are more allergy-friendly than others so do your research. For example, Continental does not hand out snacks that contain peanuts. Delta will create a “buffer zone” of 3 rows where they will not serve snacks containing peanut ingredients.
• Request a special meal that accommodates your child’s dietary restrictions if you are flying on an extended flight where a meal is served.
• Prepare for anything! Even when all precautions are taken, you can never completely eliminate the risk for allergen exposure. Have emergency plans and medication handy at all times.

Road trips

Road trips are generally less stressful because you have control over what comes into the car. However, it still requires a lot of planning to ensure you bring along enough safe foods for the trip. Check out Kids with Food Allergies for some great tips on how to plan effectively for your vacations & road trips.

Amusement Parks

In addition to being the happiest place on earth, Walt Disney World in Orlando, Florida is also perhaps the most accommodating place on earth. With ample notice, Dining Services can accommodate just about any dietary restriction. Disney Land, in Anaheim, California, also strives to accommodate dietary restrictions. Other parks, like Six Flags and Busch Gardens, will usually provide an exception to the rules about bringing food into the park when a person has a food allergy or intolerance.

More articles on travel with food allergies

• Camping with food allergies
• Trouble-free travel
• Allergy and asthma travel tips check-list
• Cruises with food allergies

Resources

• Chef cards
• International chef cards (translations for your food allergies)
• Food allergy t-shirts

Based on your experiences, what tips can you offer other parents about traveling with a child with food allergies?

- Mallory

EpiPens, for any child with allergies, can be a huge life saver. However, sending your little one to school with their EpiPen can be rather stressful for a parent. There are a thousand questions that might go through your mind, “Will they be safe even with the EpiPen?” or “Will someone know how to use the EpiPen?”.

EpiPen and Anaphylactic Shock Basics

For those of you who don’t know, anaphylaxis or anaphylactic shock can be a life-threatening allergic reaction to specific triggers, such as food proteins and medication. This results in hives or swelling of the throat or tongue, which can lead to constricted airways and/or a dramatic drop in blood pressure.

An injection from an EpiPen is imperative when anaphylactic shock occurs and can save a person’s life. An EpiPen is a premeasured dose of epinephrine, which is injected into someone’s body during a severe allergic reaction to avoid or treat the onset and symptoms of anaphylactic shock, which provides a window of time to seek further medical attention. ¹

EpiPens at Schools

If you are a parent of a child who is at risk for anaphylactic shock, you probably carry his or her EpiPen with you at all times, in case they are exposed to an allergen to which they are allergic. This is excellent for when you are with your child; however, your child could be exposed to many more allergens at school when you and your EpiPen aren’t there!

In fact, one study of children and adolescents found that 10 out of 13 fatal or near fatal anaphylactic reactions occurred outside the home. All the fatalities did not have an EpiPen and those who survived received an EpiPen shot before or within 5 minutes of developing severe symptoms.²

So, what does this mean? EpiPens can save lives! You need to ensure that the other adults who spend time with your child are trained and able to assist in any situation if you’re not around.

Don’t worry, this isn’t as difficult as it sounds! I suggest sitting down with your child’s teacher in the beginning of the school year to set up a 504 plan. This will ensure he or she receives proper care and attention when you aren’t there and that all adults that are around your child have the proper training to use an EpiPen if an emergency situation arises.

Also, there is good news for all you Massachusetts residents! Thanks to your persistent neighbors, starting March 2010, all newly hired school bus drivers in the state of Massachusetts will be required to have EpiPen training. Unfortunately, the law doesn’t mandate the existing school bus drivers to be trained; however, it’s a step in the right direction. Hopefully the other 49 states will follow suit. Good work Massachusetts!

How have you been able to ensure that your child is safe and can receive the proper care if they go into anaphylactic shock? Did it involve a 504 plan or EpiPen training?

- Nita

References:

1. www.epipen.com/
2. Sampson H, Mendelson L, Rosen J. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327:380-384.

The EpiPen. According to an article on MSNBC.com, doctors prescribed 1.9 million EpiPens in 2007, a 36 percent increase from 2003, when 1.4 million were prescribed. Since food allergies are on the rise, this comes as no surprise.

The pocket-sized, life-saving EpiPen has cultivated quite a following. It “auto injects a pre-measured dose of epinephrine to someone experiencing anaphylaxis, a severe whole-body allergic reaction.” Some parents have 10 or more EpiPens around the house at all times, as well as at school, in the car and on their allergy-prone little one.

Stylish EpiPen carriers and portable pouches have even emerged. There are carriers covered in cartoon characters for the younger kids and discreet leg straps for the older kids that might be a bit self-conscience.

For many years, the EpiPen was one-of-a-kind. Currently, there is another company that makes a similar product, but the EpiPen has maintained 97 percent of the market.

For the entire EpiPen article, click here.

- Nita

While we usually write about common food allergy symptoms, such as diarrhea or eczema, more severe reactions like anaphylaxis are possible for many children and adults with allergies. Allergens that cause anaphylaxis include food, insect stings, drugs, latex, and even exercise.  When anaphylaxis happens as a result of contact with an allergen, a rapid immune reaction occurs that can quickly make breathing very difficult.  For those patients an immediate injection of epinephrine can prevent very serious complications.  Sometimes even the few minutes it takes emergency medical care to arrive is too long, and a personal device with automated injectable epinephrine, an auto-injector, such as the EpiPen® Auto-Injector, is essential.

The EpiPen, made by Dey Pharma, works by delivering a quick shot of epinephrine to the thigh.  There are also similar devices available, such as the Adrenaclick® and TwinJect®, both made by Shionogi Inc. Twinject is unique in that it has a built-in backup dose of epinephrine, which can take the place of two auto-injectors in an emergency.

Epinephrine helps the body to keep the airway open so that breathing does not become as difficult, allowing time for emergency medical care to arrive. But many parents worry that one auto-injector might not be enough or that something might go wrong that could require additional auto-injectors. For instance, someone nearby might experience a severe allergic reaction and need to use your child’s auto-injector. Or what if your child’s only auto-injector was unknowingly broken? What if the auto-injector were accidentally put in the fridge or left in the sun? What if the contents were cloudy? Or if it had expired? So many scary possibilities!

So, what is the right number of auto-injectors? The answer to that question depends on a number of factors. Bear in mind that the Twinject has two doses of epinephrine, but according to the company the second dose should only be used as a backup to the first dose and should not be saved for future allergy emergencies.

How Many to Carry?

On their websites, Dey Pharma and Shionogi recommend that patients at risk for allergic emergencies carry two doses of epinephrine. This is because up to 20% of patients who have an allergic emergency requiring epinephrine will require a second dose. At all times the injector should be kept close to room temperature, out of sunlight, and replaced by the expiration date. You can even sign up for an expiration date reminder on either of the websites. It’s a good idea to occasionally check the solution in the auto-injector to make sure it hasn’t discolored, which can be a sign of a possible loss of effectiveness.

If a long trip is planned, especially one overseas where similar products may not be readily available in pharmacies; two auto-injectors (or one that contains two doses) may not be enough.

Should you or your child carry more than two auto-injectors? Not necessarily. Additional backups would likely be for peace of mind. A second dose of epinephrine may be needed in an emergency, but more than two doses during an emergency should only be given with medical supervision. Some caregivers choose to carry two auto-injectors from different lots for added precaution.

Multiple Locations

Some patients who use auto-injectors prefer to carry the standard two with them and also keep backup injectors in one or more strategic locations. These might include an extra one or two at work, school, daycare, and/or a relative’s house. These are great because they can serve as backup in case someone forgets their daily go-everywhere auto-injectors. Just make sure you follow the recommended storage instructions everywhere you keep an auto-injector and check your backups for discoloration and expiration dates. Knowing that you have extra auto-injectors in places like this, in addition to the daily carry-with auto-injectors you have, may bring you more comfort.

How about you? How many auto-injectors does your family keep on hand, and where? Please share your thoughts in the comment section of this blog post.

- Rob

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