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Avoidance is crucial.

Anaphylaxis is unpredictable.1,2 When it comes to being prepared, avoidance of potentially life-threatening allergens is the critical first step to managing a life-threatening allergic reaction; however, accidental exposure can still happen.1,3-5

Common anaphylaxis triggers

Allergens that induce anaphylaxis include food, biting or stinging insects, medications and latex. Additionally, anaphylaxis is occasionally reported after direct exposure to radiocontrast media and can also occur after exercise (Table 1).3,6,7

Table 1. Causes of anaphylaxis3,6,7

Foods*

  • Peanuts
  • Tree nuts (e.g., walnuts and pecans)
  • Fish
  • Shellfish
  • Cow's Milk
  • Soy
  • Eggs
  • Wheat

Biting or stinging insects

  • Stinging insects (e.g., honeybees, fire ants, yellow jackets, yellow hornets and paper wasps)
  • Less commonly, biting insects

Medications

  • β-lactams (e.g., penicillin)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin and ibuprofen)
  • Biologic modifiers (e.g., cetuximab, infliximab and omalizumab)

Latex

Exercise§

Radiocontrast media§

A diagnosis of idiopathic anaphylaxis is made when no allergic triggers can be identified based on history, negative skin tests and absent or undetectable serum-specific IgE levels. Every possibility of a hidden or previously unrecognized trigger should be ruled out before a diagnosis of idiopathic anaphylaxis is made.3,6,7

Certain risk factors may increase the likelihood and severity of an anaphylactic reaction; they are discussed in the “Identifying Anaphylaxis” section.6

*Peanuts, tree nuts, fish, shellfish, milk and eggs account for the greatest number of anaphylactic reactions in children; shellfish is the most common trigger in adults.8
Anaphylactic reactions induced by biting or stinging insects are more common in adults than in children.9
Anaphylaxis in response to a medication can occur in patients of any age, but is particularly common in middle-aged and older adults.5
§In some people, exercise and exposure to radiocontrast can cause non-immune perturbations of mast cells and basophils, leading to anaphylaxis.6

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There’s only one recommended first line treatment for anaphylaxis.

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Important Safety Information (the following information applies to both EPIPEN and its Authorized Generic)

EPIPEN (epinephrine injection, USP) 0.3 mg and EPIPEN JR (epinephrine injection, USP) 0.15 mg Auto-Injectors are intended for immediate administration as emergency supportive therapy only and are not intended as a substitute for immediate medical or hospital care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. More than two sequential doses of epinephrine should only be administered under direct medical supervision.

Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection.

Important Safety Information (the following information applies to both Epipen and its Authorized Generic)

EPIPEN (epinephrine injection, USP) 0.3 mg and EPIPEN JR (epinephrine injection, USP) 0.15 mg Auto-Injectors are intended for immediate administration as emergency supportive therapy only and are not intended as a substitute for immediate medical or hospital care. In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care. More than two sequential doses of epinephrine should only be administered under direct medical supervision.

EPIPEN and EPIPEN JR should only be injected into the anterolateral aspect of the thigh. Do not inject intravenously, into buttock, or into digits, hands, or feet. Instruct caregivers to hold the leg of young children firmly in place and limit movement prior to and during injection to minimize risk of injection-related injury.

Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection. Advise patients to seek medical care if they develop symptoms of infection such as persistent redness, warmth, swelling, or tenderness at the injection site.

Epinephrine should be used with caution in patients with heart disease, and in patients who are on drugs that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported, particularly in patients with underlying cardiac disease or taking cardiac glycosides, diuretics, or anti-arrhythmics.

Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Common adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.

Indications (the following information applies to both EPIPEN and its Authorized Generic)

EPIPEN and EPIPEN JR Auto-Injectors are indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging insects (e.g., order Hymenoptera, which include bees, wasps, hornets, yellow jackets and fire ants) and biting insects (e.g., triatoma, mosquitoes), allergen immunotherapy, foods, drugs, diagnostic testing substances (e.g., radiocontrast media) and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis. EPIPEN and EPIPEN JR Auto-Injectors are intended for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including individuals with a history of anaphylactic reactions.

Click here for Full Prescribing Information for EPIPEN.
Click here for Full Prescribing Information for the Authorized Generic for EPIPEN.

References

  1. Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 suppl):S1-S58.
  2. Simons FE. Anaphylaxis: recent advances in assessment and treatment. J Allergy Clin Immunol. 2009;124(4):625-636.
  3. Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis—a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384.
  4. Nguyen-Luu NU, Ben-Shoshan M, Alizadehfar R, et al. Inadvertent exposures in children with peanut allergy. Pediatr Allergy Immunol. 2012;23(2):133-139.
  5. Simons FE, Ardusso LR, Bilὸ MB, et al; World Allergy Organization. World Allergy Organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37.
  6. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010;125(2)(suppl 2):S161-S181.
  7. Volcheck GW. Clinical Allergy: Diagnosis and Management. Rochester, MN: Mayo Foundation for Medical Education and Research; 2009.
  8. Cianferoni A, Muraro A. Food-induced anaphylaxis. Immunol Allergy Clin North Am. 2012;32(1):165-195.
  9. Golden DB, Moffitt J, Nicklas RA, et al. Stinging insect hypersensitivity: a practice parameter update 2011. J Allergy Clin Immunol. 2011;127(4):852-854.e1-23.
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