Saturday, January 29, 2011

Epi-Pen Primer

I remember when my daughter was first diagnosed with allergies. I remember how overwhelming it was to think about the ways this would effect what we eat at our house. And I remember how very little help or guidance was offered by the allergist, and how few questions I had, largely because I did not know enough to understand how little I really knew.

I had a new set of restrictions around what we would eat, and an epi pen. I knew that the epi pen could save her life if she ate something she shouldn't.

I did not know that anaphylaxis does not need to be the dramatic gasping for breath as your airways close that I envisioned. In fact, it was much later when my allergist was listening to me describe a very scary reaction to accidental ingestion that I found out anaphylaxis can take many forms. He looked at me at said so matter of factly, "You should have used your epi-pen." What?! Really?! Crap. I didn't know. Her airways did not appear to be effected. Crap crap crap.

If you have recently been gifted with a life saving epi-pen, talk to your allergist about when to use it. Be specific. Make sure you feel comfortable with the answer you get. Understand what anaphylaxis can look like. For my daughter it was blistering lips, 'burning' tongue, vomiting, diarrhea, and extreme fatigue that my allergist thinks was most likely a blood pressure drop. I knew it was a horribly bad reaction. I was terrified watching her. I did not know that the epi was the thing to do. Now I understand so much more. Talk to your doctor, google it, and know what to watch for and how to treat it.

Next, make sure you get a two pack. Do NOT split them up. Those pens are clipped together for a reason! You need to carry two epi-pens at all times for several reasons.
  1. In case of a misfire. You don't want to have a faulty pen with no back-up.
  2. In case of a bi-phasic reaction. This is when the initial shot works to calm the reaction, but the reaction starts again without warning. This can happen up to 8 hours later.
  3. In case one shot is not enough medicine to stop the reaction. You can give the second shot if the reaction has not stopped progressing within 5 minutes. This is especially important if you have an epi jr and a child who is approaching the upper limit of the weight boundary.
Determine who needs to carry the epi-pens, and how many sets you need. When my daughter was little I carried a set in the diaper bag, because it went with her everywhere, and had an extra set at home. Now that she is older I have a set at home, a set in my purse, a set in the nurse's office at school, and she wears a set. I know that no matter where she is she will be covered, even if she forgets to wear her epi. You may need one at the sitter, one with carpool, one with Grandma, whatever. You determine where they need to be to keep yourself, or your little one, covered.

If you use your epi go directly to the ER. You want to be in a place with the resources to treat a bi-phasic reaction. They can also treat the many complications that can arise from a severe allergic reaction and administer additional medicine as needed to help control the many systems that can be involved in a reaction. Expect to stay a minimum of 6 hours, often 8-10. Do not let the ER staff send you home after an hour. You are the expert, you live with and deal with allergies everyday, and you know that a longer period of observation is needed. Insist. And make sure to leave with a script for a refill.

When in doubt, get the epi out. Really. The epinephrine in a single shot will not hurt your child. It will make them jittery for 15-20 minutes if it was not needed. It wears off quickly and there are NO contraindications for giving it. Relief starts immediately when the epi is given. If you wait, the allergic reaction can sometimes be managed without the epi, but the reaction will drag on for much longer than it would if the epi had been utilized.

Hopefully you have lots of unused expired epi-pens. What to do with them? My favorite solution is to use them for training anyone and everyone who might have a reason to use it. Buy a bag of oranges and let the teachers, the in-laws, the best friends, and the neighbors all practice using a real epi-pen with an orange. For those of you who have used a live epi you know it feels different from the trainer. It sounds different. An orange makes a great simulator for practice so no one will be surprised by the difference if they need to use the real thing.

This should cover the basics. You now have rudimentary epi-pen know how. Let me know what questions you have, I'll try to answer. Let me know what details I forgot to mention. Mostly make sure you feel comfortable with that pen, it is the most important thing you can do for yourself and your loved ones.


  1. Thanks for this great post on Epi-pens, just in time for our yearly appointment with the allergist! Now I am armed with all the material I need to ask the right questions ;o)

  2. Wow - so glad I read your post! We've been to the allergist twice in the past year and have never been given this thorough of a primer on the epi pen! I had no idea that I should keep the 2 pens together at all times, and honestly I would have been annoyed if we went to the ER and were kept there for 8 hours for monitoring. Awesome, super helpful info, thanks for posting this!

  3. So I glad I could help you ladies increase your knowledge and confidence with your epi! It is amazing how little guidance most allergists really provide, and how we as parents don't realize the knowledge gap that exists.


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