What a Pharmacist Wants You to Know About Anaphylaxis and Auto-Injectors

As temperatures begin to rise again, spring is here before we know it. Within a few more weeks, allergies season will be in full force.

The biggest allergy trigger for spring is pollen. As trees, plants, and grasses release these small particles into the air, people begin to show signs and symptoms of hay fever, also referred to as seasonal allergies. Seasonal allergies include runny nose, itchy eyes, and nasal congestion among others.

This happens because your body thinks of pollen as a dangerous foreign substance and activates the immune system to get rid of it. The trigger of the immune system leads to the release of histamine in the bloodstream, subsequently causing those common allergy symptoms.

Hence, treatments for hay fever include many over-the-counter (OTC) antihistamines. Some of the common ones include Claritin (generic loratadine), Allegra (generic fexofenadine), and Xyzal (generic levocetirizine).

Prescribers may order prescription options to help alleviate these symptoms as well if OTC items do not work adequately. Some prescription nasal sprays include Astelin (generic azelastine) and Nasonex (generic mometasone). Prescription eye drops are also available to help with watery or itchy eyes, such as Pataday (generic olopatadine).

How is an allergy reaction different than seasonal allergies?

But seasonal allergies symptoms are different from a severe allergic reaction, also called anaphylaxis. While the body also thinks of the trigger as a foreign substance, the response from the auto immune system is more severe, affecting multiple body parts at the same time. Anaphylaxis can be potentially life-threatening.

Triggers and symptoms of anaphylaxis

Triggers most commonly associated with an anaphylactic reaction include:

• Foods, such as peanuts, tree nuts, shellfish, eggs, sesame, and food additives
• Insect stings or bites, often associated with bees, wasps, mosquitos, ticks, and caterpillars
• Medications, such as penicillin, aspirin, sulfa-containing drugs, and non-steroidal anti-inflammatory drugs
• Rubber latex and adhesives

Anaphylactic reaction symptoms typically start within a few minutes after coming into contact with the allergen. However, in some instances, it may take more than an hour from exposure to the first sign.

Since anaphylaxis usually affects more than one part of the body, signs and symptoms may include:

• Hives
• Itchiness
• Swelling of the throat or other areas of the body
• Trouble breathing
• Chest tightness
• Weak pulse
• Fast heartbeat
• Feeling very anxious
• Diarrhea
• Faintness

If you have previously experienced some of these symptoms before, with or without association to a specific allergen, it is highly recommended that you make a visit with an allergist or immunologist for further testing and diagnosis.

It is important to know exactly what you are allergic to, how to prevent you from future exposure to that allergen, and what to do in an emergency.

What is the best way to treat anaphylaxis?

Currently, the best products available to patients to help with anaphylaxis are the epinephrine auto-injectors.

Epinephrine works by constricting the blood vessels to increase the blood pressure, relaxing the airway muscles to improve breathing, and increasing heart rate to keep the heart beating.

Current auto-injector products carry a single dose of epinephrine to be injected into the thigh during an emergency. The most common ones on the market include EpiPen and Adrenaclick.

Available Strengths and Dosing of Epinephrine

Both of these products are available as generics and come in a package of 2 injectors. They are both available at 0.15 mg and 0.30 mg per pen strength.

The dose for both EpiPen and Adrenaclick is based on weight. People who weigh between 33 lbs to 66 lbs would use EpiPen 0.15 mg or Adrenaclick 0.15 mg. Those weighing more than 66 lbs would use EpiPen 0.3 mg or Adrenaclick 0.3 mg.

Injection Techniques for EpiPen and Adrenaclick

While auto-injectors are designed as user-friendly, the products differ in how they are administered. It is important for patients or parents to go over the techniques with a health care provider at least once yearly to ensure proper usage in case of an emergency.

EpiPen:

1. Remove the blue safety cap.
2. Hold the auto-injector in your fist. The needle comes out of the orange end, so do not place the hand or finger over the orange end.
3. Put the end with the needle firmly against the middle of the outer thigh. The needle can go through clothing items.
4. Press down hard until the needle enters through the skin.
5. Hold the auto-injector in place for 3 seconds.
6. Remove the needle by pulling the pen straight out. The orange tip will extend and cover the needle.
7. Massage the injection area for about 10 seconds.

Adrenaclick:

1. Pull off the gray caps off both ends. The needle will come out of the red tip; so do not place the hand or finger over the red tip.
2. Place the red tip firmly against the middle of the outer thigh. The needle can go through clothing items.
3. Hold the auto-injector in place for 10 seconds.
4. Remove the needle by pulling the Adrenaclick straight out. Check the red tip—if the needle is exposed, then the dose was given. If the needle is not exposed, repeat steps 2 and 3.
5. Put the Adrenaclick, needle first, back into its case. Give it to the health care worker when they arrive for proper disposal.
6. Massage the area after the injection.

Special considerations for Auto-injectors

For both EpiPen and Adrenaclick, do not inject into a vein or the buttocks. If symptoms persist and recur, you may need to give a second dose. Any doses afterward should be given by a health care professional.

Always seek emergency medical help right away; you may need further medical attention after that first dose of epinephrine. Let the health care provider know the dose and timing of your injection.

Some of the most common side effects of both EpiPen and Adrenaclick include anxiety, restlessness, tremor, dizziness, palpitation, nausea, and vomiting.

As these products are used as precaution measures, be sure to inspect the expiration date regularly. When refilling a new set, ask the pharmacist for one with a longer shelf life.

If you are at risk for an anaphylactic reaction, speak to your provider about obtaining a prescription for an emergency auto-injector. RxSaverTM is here to help, check out the low pricing available for the generic epinephrine auto-injector.