Factsheet - Allergy - EpiPen® Use
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EpiPen® Use
Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.
What is an EpiPen®?
EpiPen® is an emergency device that can inject adrenaline. It is used to treat severe allergic reactions (anaphylaxis). Adrenaline, (a naturally occurring hormone) reverses the severe allergic reaction and can be lifesaving.
Should my child have an EpiPen®?
All allergists agree that children who have had a serious allergic reaction with involvement of the breathing passages should have an EpiPen® or other adrenaline auto injector if there is the possibility that re-exposure to the allergen can occur. The need for other children to have an EpiPen® depends on a number of factors which should be discussed with your doctor. If you have an EpiPen® it is very important that you understand how to use it and that you have a written ASCIA action plan for anaphylaxis provided by your doctor.
What is an Anaphylaxis action plan?
An ASCIA Action plan for anaphylaxis describes what to do if your child has an allergic reaction and when to give the EpiPen®.
Australian allergists have designed an action plan for use throughout Australia. A copy of this Action plan can be found at www.allergy.org.au. If you have an EpiPen® you must also have an Anaphylaxis action plan signed by your doctor. This plan should be kept up to date.
When should I use the EpiPen®?
The anaphylaxis action plan tells you when you should give the EpiPen®. If your child develops an allergic reaction with any of the following symptoms you should use the EpiPen®;
- Difficulty/noisy breathing
- Swelling of tongue
- Swelling/tightness in throat
- Difficulty talking and/or hoarse voice
- Wheeze
- Persistent cough
Note an important feature of all of these symptoms is that they involve the breathing passages.
The EpiPen® should be used if collapse or loss of consciousness develops in an allergic reaction.
Young preschool age children may become pale and floppy without other symptoms and in this case the EpiPen® should be used.
If you are in doubt it is better to use the EpiPen® unnecessarily rather than not treat a serious reaction.
What is an EpiPen® trainer?
An EpiPen® Trainer is a device that looks like an EpiPen® but which does not have a needle or contain medicine. It is used for practice in giving the EpiPen®.
Which end contains the needle?
It is very important that you remember that the black tip contains the needle. You should not touch the black tip with your fingers thumb or hand.
How do I use the EpiPen®?
There are 4 main steps.
- Remove the EpiPen from the yellow or green container by unscrewing the lid and sliding the EpiPen out.
Form a fist around the EpiPen® and pull off grey cap (do not twist). Before pulling off the grey cap you should check that your thumb is closest to the grey cap end, as in the picture, and not over the end of the EpiPen®, especially the black end. This will help prevent you from injecting your own thumb which may happen if you place your thumb over the black 'active' end.
- Place black tip against the outer mid-thigh of the child. The mid outer thigh is the 'fleshiest' part of the thigh, where the muscle is. (Note; there is no need to 'swing and jab') A sudden jab may cause the child to jump and the needle to be discharged before the adrenaline is injected. It is important to hold your child securely while administering the EpiPen®. Your doctor or nurse should show you the best way to do this).
It may be given through light clothing. If the clothing is difficult to remove you should not waste time attempting to do this. - Push HARD until a loud click is heard or felt and hold in place for 10 seconds
- Remove the EpiPen® and place it back in the yellow or green container with the needle pointing down, then call an ambulance. The EpiPen® can only be used once.
If necessary the EpiPen® can be given through clothing. If the clothing is difficult to remove you should not waste time attempting to do this.
What should I do after giving the EpiPen®?
You should always call an ambulance even if the EpiPen® relieves symptoms. Your anaphylaxis action plan provides the phone number. When an EpiPen® has been used the patient should remain under medical observation for at least 4-6 hours after the symptoms have resolved.
Is a further dose of adrenaline ever necessary?
A single dose of EpiPen is all that is required to treat an anaphylactic reaction in the majority of cases. If there is no response to the initial dose of adrenaline, the EpiPen dose can be repeated (if available) after 5 minutes.
What should I do if the symptoms look like Asthma?
If you are not sure if the symptoms your child is experiencing are due to allergy or asthma and you feel they may have been exposed to an allergen (e.g. food), then the safest and best course of action is to give the EpiPen. The adrenaline in the EpiPen will treat asthma or anaphylaxis and is safe to give. You can use a bronchodilator (asthma reliever) eg Ventolin after you use the EpiPen.
Can I use other medicines (antihistamines, cortisone) instead of the EpiPen®?
No. If symptoms indicating a severe allergic reaction develop you should not rely on these other medications to treat the reaction.
Are there side effects from using an EpiPen®?
It is very rare for children to suffer any serious side effects from administration of EpiPen®. The EpiPen® contains adrenaline which is a naturally occurring hormone. The skin around the injection site often becomes quite pale for a short period of time after the EpiPen is given. Other symptoms which may occur in some cases are tremor, anxiety, palpitations, headache and nausea. These symptoms only last for a short time and are not serious.
What strength EpiPen® should I have?
Australian allergists have recommended EpiPen® Jr for children between 10 and 20kg and EpiPen® for anyone over 20kg. An EpiPen® Jr is not usually recommended for children less than 10kg. Most children weigh 20kg before they turn 6 and school age children usually need the full strength EpiPen®
Who can prescribe an EpiPen®?
The first authority prescription needs to be given by an allergy specialist, emergency specialist or a paediatrician. Your family doctor can initiate treatment with an Epipen or can order a repeat prescription if he/she has information from a specialist indicating that the EpiPen® is necessary.
How many EpiPens® can I get?
The current Authority Scheme in Australia allows for provision of one EpiPen® at a time for adults and two EpiPens® at a time for children aged 17 years or less (one for school and one at home). An older child who is travelling to and from school independently should however carry the second EpiPen on their person.
What should I do if the EpiPen® is expired?
You should replace it with one that is not expired but keep the expired device until then.
If your child needs to use the EpiPen® and you only have an expired EpiPen®, use the expired EpiPen® as this may still work but not as effectively as an EpiPen within it's use by date. In an emergency it is much better to use an expired EpiPen® than no EpiPen® at all. The shelf life of the EpiPen® is normally 12-18 months from the date of manufacture. The expiry date should be marked on a calendar and the EpiPen® replaced prior to this date.
Should the EpiPen® go everywhere with my child?
Yes. Most reactions occur outside the home or school. Food allergy reactions often occur in restaurants. You should have the EpiPen® with you whenever you take your child out. When your child becomes old enough to go out alone he/she should carry the EpiPen® and know how and when it should be used.
If my child has an EpiPen® will they need it for the rest of their life?
Not necessarily. In some cases children can outgrow their allergy, or in the case of stinging insect allergy, the allergy may be successfully treated by desensitisation and eventually an EpiPen® may not need to be carried.
How should I store the EpiPen®?
Ideally the EpiPen® should be stored in a cool place at room temperature - but NOT refrigerated. It is important that you keep the EpiPen® in a place where it is readily available if you need to use it.
Where can I find more information on the Internet?
- The Australian Society of Clinical Immunology and Allergy (ASCIA) website contains useful information on EpiPen® use written by Australian specialists (www.allergy.org.au).
- It also contains a comprehensive on line education program which can be accessed by any individual in particular those who may be responsible for children including parents/carer's school staff and children's services staff.
- The patient support group Anaphylaxis Australia offers updates and tips (www.allergyfacts.org.au).
Written by the Department of Allergy and Immunology The Children's Hospital at Westmead.
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| The Children's Hospital at Westmead Tel: (02) 9845 3585 Fax: (02) 9845 3562 www.chw.edu.au |
Sydney Children's Hospital, Randwick Tel: (02) 9382 1688 Fax: (02) 9382 1451 www.sch.edu.au |
Kaleidoscope, Hunter Children's Health Network Tel: (02) 4921 3670 Fax: (02) 4921 3599 www.kaleidoscope.org.au |
& Kaleidoscope, Hunter Children's Health Network - 2005-2009.