All About Epinephrine
Patients, caregivers and schools can turn to various resources to increase confidence in using auto-injectors and managing anaphylaxis. Goldenberg worked with an allergist to create an online training course, available at epipentraining.com, using the World Allergy Organization guidelines for managing anaphylaxis. Goldenberg says the course helps people feel comfortable following the protocols for recognizing and treating anaphylaxis, regardless of the brand of auto-injector.
Often caregivers wait too long, monitoring symptoms instead of giving epinephrine, she says.
“When an emergency happens, panic sets in and you’re not sure what to do. It’s so easy to make mistakes,” Goldenberg says. “I want people to feel extremely well-rehearsed, that they know exactly what to do in an allergic emergency.”
The course provides guidance on the stages of allergic rescue, including how to recognize anaphylaxis, how to treat it and what to do after the injection—like having the patient lie down with his or her feet elevated above heart level until emergency help arrives.
Pistiner explains that this position helps the blood flow where it should (even if epinephrine is not available). Anaphylaxis makes blood vessels floppy and leaky. If the patient remains upright, the fluid can pool and not go where it’s needed. Keep in mind that trouble breathing or vomiting may necessitate finding an alternative position, such as lying on the side, Pistiner says.
Another essential step is to call 911 when giving epinephrine. Even if epinephrine is administered promptly, symptoms can return later and further treatment and care may be necessary. Observation in the emergency department for at least 4 to 6 hours is recommended.
It is essential for patients to talk to their healthcare providers to develop a good allergy action plan and receive proper training on how and when to use their auto-injectors, Pistiner says. “Every allergic child should have an emergency care plan created by their healthcare provider specifically for them.”
Epinephrine is the drug of choice for anaphylaxis. Antihistamines, such as Benadryl, are not effective tools to stop anaphylaxis, Pistiner cautions. Antihistamines, which treat mild skin symptoms, target only histamine receptors. In contrast, epinephrine stabilizes cell walls of mast cells and basophils (allergy cells) and works on the lungs, heart, blood vessels and gut —the organs affected by system-wide anaphylaxis.
To help people understand why epinephrine is so important for the treatment of anaphylaxis, Pistiner compares anaphylaxis to water damage. The longer it goes on, the harder it is to clean up. For example, if your sink faucet is wide open and the water is pouring all over your floor, using antihistamines is like trying to clean up with a mop instead of fixing the faucet. Epinephrine acts like a wrench to turn off the faucet and then it acts like the sump pump and the mop, attacking the entire problem, Pistiner says.
“Studies show that delays in treatment with epinephrine are associated with an increase in mortality,” he emphasizes, adding that 10 to 20 percent of anaphylactic reactions do not include the skin.
“This is important because if people are waiting to see hives or some other skin rash, they may delay administering epinephrine,” he says. “Families should become very familiar with their emergency care plans so they can promptly recognize the symptoms that require treatment.”