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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 which injects a dose of adrenaline into the thigh muscle in the thigh. It is used to treat severe allergic reactions (anaphylaxis). It contains one dose of adrenaline. The drug adrenaline 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® 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 anaphylaxis action plan provided by your doctor.

What is an Anaphylaxis action plan?

An anaphylaxis action plan describes what to do if your child has an allergic reaction and when to give the EpiPen®. An action plan will contain the following information;

• Name of child
• Allergic triggers
• Carer contact details
• Symptoms and signs indicating when to use the EpiPen®
• Instructions on how to use 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.

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.

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. People have incorrectly held the EpiPen® with the black tip pointing away from the child and injected themselves instead of the child.

What is an EpiPen® trainer?

An EpiPen® Trainer is something that looks like an EpiPen® but which does not have a needle or contain medicine. These can be purchased from chemists. They are used for practice in giving the EpiPen®.

How do I use the EpiPen®?

There are 4 main steps.

1. Form a fist around 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, and not over the end of the EpiPen®, as in the picture. This will help prevent you from placing your thumb over the black 'active' end.
   
2. Place black tip against outer mid-thigh of the child. (Note; there is no need to 'swing and jab')
3. Push HARD until a click is heard or felt and hold in place for 10 seconds
   
4. Remove the EpiPen® and 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.

It is better to place the black tip on the child's thigh and then push rather than do a sudden jab which may cause the child to jump and cause the needle to be discharged before the adrenaline is injected. Remember that children may move or pull away when the EpiPen® is given and if the needle comes out of your child's leg before the full dose of adrenaline is administered it cannot be reinserted. Therefore 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.

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?

Occasionally, anaphylaxis symptoms may return after an EpiPen® is given. This is one reason why patients should attend hospital after the EpiPen® is used. In some cases a further dose of adrenaline is required.

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. Antihistamines will not treat a severe allergic reaction or prevent a severe allergic reaction from developing if given to someone once the reaction has started. Sometimes antihistamine medicines are prescribed for a mild reaction where there is just hives. If your child has asthma and has a reliever medicine (eg Ventolin) this should be given as well after using the EpiPen®.

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. Transient pallor is very common due to the medicine acting on the blood vessels. 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?

There are two strengths (EpiPen® Jr and EpiPen®) with different doses of adrenaline. Australian allergists have recommended EpiPen® Jr for children between 10 and 20kg and EpiPen® for adults and children over 20kg.Note that an EpiPen® contains only one dose of adrenaline and cannot be used again. An EpiPen® Jr is not usually recommended for children less than 10kg.

Who can prescribe an EpiPen®?

The first prescription needs to be given by an allergy specialist, emergency specialist or a paediatrician. Your family doctor 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 at school and one at home).

What should I do if the EpiPen® is expired?

The expiry date is found on the side of the EpiPen®. You should keep the expired EpiPen® and replace it with one that is not expired. If your child needs to use the EpiPen® and you only have an expired EpiPen® use the expired EpiPen® as this will still have a lot of activity. 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. Your doctor has prescribed an EpiPen® because he/she believes there is some risk of a severe allergic reaction. These reactions often occur outside the home or school. With food allergy restaurants are a place where reactions can occur. 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 be strongly encouraged to 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. In other cases (for example bee sting allergy) the allergy may be successfully treated by desensitisation and an EpiPen® will not need to be carried. However, most EpiPens® are prescribed in children for food allergy and at present desensitisation is not available for food allergy.

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).
• 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.

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