What to expect from patients
In the event an individual experiences anaphylaxis, it is recommended that patients inject EpiPen® (epinephrine injection, USP) or EpiPen Jr® (epinephrine injection, USP) Auto-Injector or their authorized generics immediately and seek emergency medical attention.1-3 The Patient Information for EpiPen® Auto-Injector(and its authorized generic) recommends that patients take the used Auto-Injector with them to the emergency room for inspection and disposal.1,2 Patients are then instructed to ask for a new prescription and EpiPen® Auto-Injector replacement, if needed.1,2
The continuum of anaphylaxis
The progression of anaphylaxis is not absolute.7 The signs and symptoms can arise within minutes of exposure to an allergen, but can also develop 30 minutes or more after exposure.3,7 Moreover, symptoms that do not initially appear to be life-threatening may progress rapidly unless proper treatment is given.3,7 In some cases, a second allergic reaction occurs 1 to 72 hours (usually within 8 hours) after initial recovery despite no further exposure to the trigger.3,7,8 This is known as a biphasic reaction, and it can occur in up to 20% of all anaphylactic reactions.3,8 Because biphasic reactions are unpredictable (even while administering immunotherapy), it is important that observation periods in the office be individualized for each patient.4,7
Guidelines from the National Institutes of Health and National Institute of Allergy and Infectious Diseases (NIH-NIAID) recommend that patients who were seen in the emergency department for anaphylaxis be discharged with a prescription for epinephrine so that they have access to two doses of epinephrine at all times.5,6
- EpiPen [prescribing & patient information]. Morgantown, WV: Mylan Specialty LP; 8/2018.
- Epinephrine Injection, USP [prescribing & patient information]. Morgantown, WV: Mylan Specialty LP; 8/2018.
- Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010;125(2)(suppl 2):S161-S181.
- 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.
- 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.
- Dinakar C. Anaphylaxis in children: current understanding and key issues in diagnosis and treatment. Curr Allergy Asthma Rep. 2012;12(6):641-649.
- Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis—a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-384.
- Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report—second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391-397.