Anaphylaxis is a severe allergic reaction to a normally harmless substance, called an allergen.  It is often associated with insect stings (bees, wasps, hornets), foods (tree nuts, peanuts, shellfish), latex and other chemicals. 

Mild allergic reactions produce symptoms such as rash, itchy skin, hives, flushed appearance, swelling skin or lips, nausea and/or abdominal cramps.  These common symptoms of allergic reaction alone do not necessarily indicate a life-threatening emergency.

Severe allergic reactions may include any of the mild symptoms plus difficulty breathing and/or signs of shock.

Call 911 whenever somebody is experiencing difficulty breathing and/or symptoms of shock.

Epinephrine is a medication that works inside the body to counteract the allergic reaction. A person diagnosed with a severe allergy may be prescribed an epinephrine auto-injector (EpiPen) by his or her doctor. In the case of an anaphylactic reaction, timely administration of the EpiPen may be necessary to save a life. 

EpiPens are available by prescription only. They come in adult and child prescriptions. Each injector contains only 1 dose though some prescriptions may contain a second injector. Prescriptions should be stored in a cool dark place and replaced prior to their expiration date.

EpiPens are designed to be self-administered by the person experiencing anaphylaxis.  Sometimes that person is incapacitated and will need assistance administering the epinephrine.

Prior to assisting a person in anaphylaxis, first CHECK to ensure the scene is safe.  Second CALL 911. In order to then give CARE, you must:

• Confirm a history of severe allergies (ask the person, check for medical alert bracelet/necklace, or refer to medical information sheet if appropriate);
• Look for signs and symptoms of anaphylaxis;
• Look for evidence of exposure to the allergen;
• Find out if the person needs help administering the auto-injector; and
• Check that you have the person’s own prescribed auto-injector, that it has not past the expiration date and that the fluid is not cloudy.

If a person has no history of severe allergic reaction, has not been prescribed an EpiPen or has not been exposed to the allergen, do not administer epinephrine.  Provide other first aid and monitor the person while you await emergency medical assistance.

Instructions for use of EpiPen are included on and with the device. Generally the steps include:

1. Once you’ve confirmed the auto-injector is prescribed for the person, remove the device from its carrier tube or package, if it has one. Check the expiration date. If it has expired, do not use the auto-injector. If the medication is visible, make sure the liquid is clear. If it is cloudy, do not use it.
2. Have the person sit down and lean slightly forward. Have the person lie down if they show signs of shock.
3. Determine if person has already administered a dose of epinephrine. A second dose is called for only if symptoms worsen and EMS is delayed.
4. Before giving the injection, you should put on gloves. Then, locate the outside middle of the person’s thigh. If you are giving the injection through clothing, make sure there are no obstructions at the site (cell phone, wallet, things in pocket).
5. Grasp the auto-injector firmly in your fist with the needle end—the orange tip—pointed down. With the other hand, pull straight up on the blue safety cap without bending or twisting it. Do not put your thumb, fingers or hand over the ends.
6. Hold the auto-injector with the needle end perpendicular to and near the outer thigh. Quickly and firmly push the tip straight into the outer thigh. You will hear a click indicating that the spring mechanism has been triggered. Hold the auto-injector firmly in place for 10 seconds to deliver the medication. Then, remove the auto-injector from the thigh and massage or have the person massage the injection area. Once the injection has been given, you’ll need to recheck the person’s breathing and watch to see how the person responds to the medication.
7. You should also try to reassure the person to help him stay calm while waiting for the EMS team.

If EMS is delayed and the person’s symptoms do not improve or improve and then get worse again, administer a second dose of epinephrine using the same method. Remember a second device is needed.

Once you’ve used the auto-injector, be sure to carefully place it in a safe container. Give it to EMS personnel when they arrive. You’ll also want to be ready to report the following information to EMS:

• What happened
• The signs and symptoms you observed
• The care given and what time you gave the injection
• The location of the injection
• And how the person responded to the medication