When To Use The Epi-Pen

Like I have said many times before, when in doubt if the Epi-Pen should be used for an allergic reaction, err on the side of caution!

There has been a lot of this kind of discussion on the food allergy forum ‘Kids With Food Allergies’. The title of the discussion topic is Why Do We Hesitate?” The world of food allergies is very complex, and deciphering when an anaphylactic episode is beginning can be so as well. The key to saving a life from an anaphylactic reaction is using the Epi-Pen immediately. There is no room for hesitation!

I was reminded of this fact when I was reading another story on KWFA. Just recently, for their sons seventeenth birthday, a boys parents planned a special dinner for him at the Outback restaurant. They took the time to plan ahead. They contacted the Outback’s manager to explain the severity of their son’s food allergies, and to confirm how the restaurant handles these particular situations. The Outback has posted on their site their plan of prevention for patrons with food allergies and special diet needs. Based on all of this information, the family proceeded with their planned dinner.

Too make a long story short, their son did end up having an allergic/anaphylactic reaction and had to go to the ER. Luckily, he was saved. What struck me was that his symptoms didn’t start to occur until after they made it home and some time after opening birthday presents. The symptoms started with what sounds like hives, but by the time they made it to the ER their son’s body was covered with a bright red sunburn-like appearance! They did use the Epi-Pen, but not until the reaction progressed to this point. It sounds as though the epinephrine took longer to work, and many say that with each minute of hesitation, the epinephrine loses its power.

I have read other stories with the same similarity. I remember reading about Sabrina Shannon. She did end up getting a dose of the Epi-Pen after a reaction to dairy while she was at school, but it wasn’t until after her symptoms had progressed greatly. She ended up losing her life to the reaction.

Many other people have lost their lives to an anaphylactic reaction because of mistaking it for an asthma reaction, which reminds me of Emily Vonder Meulen. Of course, in this instance, a person would probably use the asthma inhaler and wait for the symptoms to go away. That, of course, only leads to a delay of the epinephrine they need and in turn horrible consequences.

Determining whether or not an anaphylactic episode is occurring is sometimes obvious, but can also be misleading. When asked about the symptoms of an anaphylactic reaction, most people will describe tightening of the throat, swelling, and itching. What most people don’t realize, though, is that cardio collapse can occur without respiratory symptoms, as stated here in the sixth paragraph.

Just remember, it might not always be obvious when the Epi-Pen should be administered, that is why I always say to err on the side of caution!

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14 Comments

Filed under always be prepared, Anaphylaxis

14 responses to “When To Use The Epi-Pen

  1. Elisa R Wing

    I was wondering if you could post what the risks are of using the Epi-Pen when it is not needed. This, I think, is why I would find myself hesitating. Since it is an unknown to me I would wait “just to be sure” it was needed.

  2. RandCsMommy

    I don’t believe there really are any risks, only side effects like hyperactivity. Keep in mind, I am not a doctor or medical professional, my information is based on what I have experienced and read first hand. I have provided access to Epi-Pen’s website through my list of links. They have all of the proper information listed there.

  3. Elisa R Wing

    Thanks for the link and your quick response :)

  4. Ryan Smith

    Thanks for the stories. The Fire Dept. just left the house. I felt all the warning signs, but they didn’t seem extreme or like they were getting worse. But I’ve never had an allergic reaction before (I’m 30) so I think I was more scared than in danger. After shooting myself with the epipen we called the nurse’s line on the back of our insurance card. She instructed us to call 9-1-1. I thought my wife could drive me, but she (nurse) insisted not. Anyways they checked me over and said they could tell I was coming down in the 10 minutes they were here. They said I would be fine staying home and to call again if any symptoms should return. It’s now been 1 hour since my symptoms began and 30 minutes since I used the epipen. I have tingling in my fingers and my eyelids are still pretty puffy but I’m breathing more comfortably and all the itching and hives are gone. F.Y.I. I had horrible itching first, then my left eye felt heavy, followed by my lower left lip feeling swollen. I take allergy drops at home, I had gone 7 days while on vacation without administering any drops and just started back up this morning (14 hours ago) with my regular amount. 3 hours ago I ate a handful of cashews as well. But I will mention I’ve eaten plenty of nuts in my life (including cashews) and I’ve never once had a reaction.

    • Amy

      Ryan, I hope you are doing better! How horrifying to have to experience a reaction like that one. I am assuming that you sat down to google after the fire dept. left to read more about food allergies and that is how you came across my blog. Thank you for sharing the details. I think it might prove helpful to someone out there who isn’t sure what to expect with a reaction.

      The one thing I want to point out to you is that if you ever have another reaction such as the one you just experienced, I would insist on going to the ER! It is possible to have a “second” reaction, called a bi-phasal reaction. I have not written about this, but I am sure if you go to the FAAN website or any of the others you can learn about it. I don’t know why EMS and even emergency room doctors sometimes don’t take this into account. I have read stories of people who have indeed lost their life after letting their guard down too early. And, ALWAYS have two Epi-Pens handy!

      I would love to hear your prognosis. Are you planning on visiting with an allergist for testing?

  5. Mark

    I was told by a doctor that hives are no reason to take an EPI-PEN, hives are normal and won’t harm you. You take an EPI-PEN when the allergic reaction starts to restrict your breathing, numbness of the tongue and mouth. These symptoms could result in breathing diffuculty and possible death and THAT is the reason for the EPI-PEN and NOT the hives. This just happened to me yesturday and I got hives all over my body, I never had breathing problems or tongue/mouth/throat swelling, but thought I had to take the EPI-PEN. The result for me was chest pains caused by the EPI-PEN, and maybe a bit of excitability and anxiousness. No big deal for me, but I learned when to take the EPI-PEN, and that is in the case of an emergency of throat constriction NOT hives all over the body.

    • Amy

      Hi Mark, thanks for stopping by.

      First of all, I would like to state here, as on my about page, that I am not a doctor or medical professional. I started writing on my blog to share our experience with our family and friends.

      With that being said, I would like to add that the information I have shared here about when to use an Epi-Pen was taken directly from our allergy doctor. She said specifically that,

      “…localized hives, such as just around the mouth and when they are the only symptom, should not be cause for the Epi-Pen. BUT, hives all over the body after eating a particular allergen would be considered systemic. Becuase your son (little R) has had a previous anaphylactic reaction, systemic hives would be cause enough to use the Epi-Pen.”

      I would like to also point out that there is a lot of debate between doctors as well about when to use the Epi-Pen. Each individual’s situation should be looked at differently based on previous experience. This is one reason I am so reluctant to trust others, such as the school nurse, to be left in charge of making decisions about my son in regard to his food allergies. In past allergy meetings with FAAST, it has been strongly advised to include a paper with instructions on what to do for my son in case of a reaction. But, there is not enough time to look up information, per se, in a situation like this.

      I hope I cleared that up for you Mark. Please make sure to follow your own doctor’s orders. :-)

  6. Hello i just wanted to say ty for the great info provided by everyone .My son is covered in hives from the top of his head to the tip of his toes and they are not getting better in fact they seem to be getting worse .I took him to the doctor and he said it was nothing to worry about , however i dont agree so a couple of days passed and they were geting almost blister looking so i made the decision to use the epipen , and he is still coverd and that was 2 days ago and r still getting worse went back to doctor and he was angry that i used it ….. not sure what my next step should be maybe im not taking it as serious as i should … HELP ME

    • Amy

      Hi Barb. You must be so worried and aggravated by your son’s situation. I have to say, though, that being covered in hives is sometimes NOT related to allergy. I wrote a post awhile back about my younger son, Little C, who experienced just this phenomenon.

      Obviously, because of knowing first hand how horrible an allergy reaction can be, I was overwhelmed with concern when this happened to him. I rushed him to the doctor, and even the doctor was amazed at the size of the hives covering my son’s body. I already have Epi-Pens on hand because of Little R, and our doctor told me that if Little C started to have any other signs such as respiratory distress that I could use one on him. Luckily, the Benadryl took care of the hives. We had a sleepless night of watching over him, and in the end it proved to not be an allergy reaction. Hives can occur as a symptom of a virus. Sometimes they are just not diagnosible.

      Please try to not beat yourself up over this! You used the Epi because you were worried. I know after Little R’s first horrible reaction, I ended up using the Epi about a week later. He had hives on his face and he sounded wheezy, though I wasn’t completely sure. All I kept thinking about was how I read, “You must not hesitate with the Epi. If truly needed, time is of the essence. Deaths from food allergy reactions happen because of failure to use the Epi-Pen either at all or not quick enough.” It is better to ere on the side of caution in my opinion. From here on out, though, I am sure you will have a better sence of when you would truly need to use it.

      I hope your son starts to get over his hives soon. Hang in there! I am interested in hearing how things end up.

  7. sarah-anne

    id like to say thank you for letting me know in your opinion when to use epi. i had my worst reaction today. i have a rare allergy to pineapple and most people forget even though i stress it time and time again when food is involved in say a pot luck.

    im almost done college for my course that im taking and today we had a pot luck for our class as a goodbye party kind of thing. i stressed to the class NO pineapple is to be brought or i will be at the hospital. what was brought, pineapple of course. i became irate but didnot show it.

    so as usual i started forming the hives on my chest which proceeded as normal to my face, then i turned red on my face as if i were sunburnt, and then i started feeling warm (which i have not experienced before), followed by difficulty swallowing (but was still able to breathe normally).

    i did leave school to go to the walk in clinic, on my way however, i did start to get shortness of breath so i decided to go to the hospital. im glad i made that choice.

    i have not had an epi pen before as my doctor thought i didnot “qualify” as i have not had an anaphalatic reaction before. but i begged the dr at the hospital for a prescription for an epi pen.

    i just thought i would share my experience.

  8. jodi

    hi there eveyone :)

    i wanted to start by telling ou how confused i am . i have had years and years of tryin to get help from my doctors who i feel neglected my sons halth for a long time .
    they dianosed him with athma and allergys . i told them how sever hs allergys were . if he was to go near a dog or a horse h would swell in his face eyes and start to have difficulty breathing never was i given the epi pen instead i was told to wash his hands ??? and to give him an astham pump this never woprked and we always end up in AnE with him on oxygen steroids and nebs for many days struggling .
    this would gt me so mad he has has sufferd lung collaps and many more things . he is seven now and has been doignosed with PCD . we have now been given the epi pen but i am still unsure after all the advice when to use it . i hve been told to give it if he collapses . just the other day he come in contact with a dog and spent the evening struggling while i gave him everything else but the epi pen . should i give the epi pen or not ?

    • Amy

      Hi Jodi,

      I feel your pain and confusion. The realm of allergies is very complex and confusing, to be sure. It doesn’t help that we sometimes get conflicting information from the medical community on the subject. It sounds like you are doing the right thing by not giving up in trying to figure it all out. I urge you to hang in there.

      I want to remind you that I am not a doctor or a medical professional, I am merely a mom like you who has a child with sever food allergies. Furthermore, my experience is primarily involved in dealing with food allergies, predominately peanuts, tree-nuts, and eggs. It sounds like your situation is a bit different in that his allergy symptoms are trigured by environmental factors- dogs and horses, for example. Epinepherine (the drug in epi-pens) is used to reverse the effects of an immune response reaction to an allergen (anaphylaxis,) and from my understanding, anaphylaxis is not usually trigured by these factors.

      I encourage you to visit the website hosted my the makers of the Epi-Pen. It is quite informative.

      • Brenda

        Amy’s answer is yes.
        Anaphylaxis can be triggered by any allergen.
        Beestings, medications, foods, contacts with plants, physical factors such as excercise, etc.
        All the conditions have to be right. The person has to first be exposed to the “matter” once. Then the body makes the signal if it is going to be allergic to that “matter” The allergic reaction will happen the second or future time. You can be stung by a bee on the second exposure have a severe reaction to it, get stung a third time and not be bothered. Each type of bee has different molecule makeup of venom, and each bee will sting individually and release a different dose of venom. And this is similar to any known allergen.
        What ever is in the proteins of the dogs and horses hairs, is probably what your son is allergic too, or the dander, or maybe something more environmental like the dirt, dust and pollen on these animals. It could be something they were exposed to.
        Go to a good allergist, or even try asking a rheumatologist. IF you are not happy with one, then go to another until you find satisfaction. Try your state children’s hospital.
        Just because you are not a doctor, doesn’t mean you don’t know more than your doctor about what happens to your son. Do research on the internet, go to Asthma and allergy support groups.

        If his exposure leaves him coughing or struggling to breath, give him the EPI pen, don’t hesitate.
        A good allergist should tell you that one injection at the onset is better than several days of severe breathing difficulties, even if the allergy doesn’t progress to respiratory failure.
        Also ask your doctor about a daily antihistamine. Carry benedry fast melts and try them at first contact, or even as a preventative

        Don’t think that any allergy is too weird. I have just had my first very close to anaphylactic reaction tonight. I have been an emt for 12 years. IF I were a patient I would have administered the epi pen. Being stubborn I waited it out with Benedryl it worked this time. I will see if there are the regular lingering results such as severe joint pain and fatigue that I usually experience.
        I have not been diagnosed officially, but my physician is treating me for a nightshade allergy. (potatoes, tomatoes, peppers, eggplants.) I kissed my boy good night, he must have had bbq sauce left on his lips. I felt immediate tingling in my lips with a sore throat. I went to bed and woke up coughing so hard I couldn’t stop.
        I also get the hives from excercise… walking, running, biking, sexual activity, and using vibrating power tools.. how weird is that.
        This is called excercise induced uticaria, and may actually be related to the recent onset of the nightshade allergy. I have had symptoms of nightshade intolerance for years and never knew it.

      • Amy

        Hi Brenda. Thank you for all the great information. Allergies ARE very complex. I believe that is why it is hard to find a doctor who appears confident. Each situation is different from the next. I have learned to use my gut instinct, and to ALWAYS err on the side of caution. Good luck with your allergies!

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