Epinephrine is the only way to stop a severe food allergic reaction. Learn when and how to give epinephrine to your food allergic child.
Epinephrine is a vital medicine for children with food allergies. It is the only way to stop a severe allergic reaction. Here’s what your family needs to know about epinephrine, including when and how to give it to your food allergic child.
**If you need to give epinephrine immediately, scroll down to the video and skip to 2:52.
What is epinephrine?
Epinephrine is also known as adrenaline. It is actually a hormone that the body produces naturally, but it can also be used as a medicine.
Epinephrine is used as a medicine for people with food allergies, to stop severe allergic reactions, called anaphylaxis. In fact, it is the only medicine that can stop severe allergic reactions, including life-threatening anaphylaxis.
For people with food allergies, epinephrine comes in an auto-injector, designed to be injected into a person’s thigh in case of an allergy emergency. Common brands of auto-injector include the EpiPen, the Auvi-Q, and the Adenaclick.
When the epinephrine is injected, it causes the blood vessels to narrow, blood pressure to raise if it has dropped, and breathing to improve. It also helps stop widespread hives and serious swelling anywhere on the body. These effects act quickly to help reverse the symptoms of a severe allergic reaction. Epinephrine is life-saving!
Epinephrine vs. antihistamines
Antihistamines like Benadryl and Zyrtec cannot stop anaphylaxis. Only epinephrine can stop anaphylaxis (and stop any severe allergic reaction). So, never use any other medicine in place of epinephrine.
The American College of Allergy, Asthma, and Immunology (ACAAI) reports that antihistamines like Benadryl and Zyrtec “are not adequate substitutes” for epinephrine during a severe reaction, “as they do not reverse swelling of the airways or raise low blood pressure" - the most dangerous symptoms of anaphylaxis. Only epinephrine is life-saving during a severe allergic reaction.
As food allergy activist The Grateful Foodie explains, trying to treat a severe allergic reaction with antihistamine is like tossing a cup of water on a burning building. It just won't work. Rather, you need the proper treatment --- the epinephrine injection. Epinephrine is like using the firefighters’ hose on a burning building, as it’s the only way to stop the “fire” of the reaction at a crucial time.
When to give epinephrine: For severe allergic reactions
Give your child an EpiPen any time they develop severe symptoms of an allergic reaction. Epinephrine is your child’s first line of defense when such a reaction occurs, because it is the only way to stop the reaction. Waiting to give an EpiPen increases the risk of an anaphylactic reaction becoming serious.
Dr. Brian Shroer, a pediatric allergist at the Cleveland Clinic uses this analogy, “Anaphylaxis is like an allergic fire spreading throughout the body. Epinephrine puts out the fire.”
Severe symptoms of a food allergy reaction may appear seconds to minutes after your child eats a food they are allergic to, and almost always within two hours.
Severe allergic reaction symptoms may include:
Skin symptoms:
- Hives that spread to many areas of the body
- Pale appearance
Throat and tongue symptoms:
- Swelling of the throat
- Tightness of the throat
- Swelling of the tongue
- Difficulty swallowing
- Change in voice or cry (e.g. a hoarse-sounding or squeaky voice)
- Slurred speech
- Difficulty vocalizing
Respiratory symptoms:
- Difficulty breathing
- Noisy breathing
- Shortness of breath
- Persistent, significant coughing
- Wheezing
Digestive symptoms:
- Chest pain
- Diarrhea
- Repeated vomiting
Cardiovascular symptoms:
- Drop in blood pressure
- Rapid heartbeat
- Dizziness
- Fainting/collapse
- Loss of consciousness
Other symptoms:
- Sense of impending doom (feeling like something very bad is about to happen)
- Feeling floppy (only in babies and younger children)
Give an EpiPen for anaphylaxis
When the symptoms of a food allergy reaction are severe, and involve more than one organ system, this is known as anaphylaxis.
Anaphylaxis is a life-threatening allergic reaction that requires prompt emergency attention.
Inject epinephrine immediately. Then, call 911.
Remember: severe symptoms that affect at least two organ systems = anaphylaxis. If you think your child has anaphylaxis (even if you have some doubts), inject epinephrine right away!
Let the emergency operator know that your child is experiencing anaphylaxis, and ask for an ambulance with epinephrine inside.
Stay with your child until the ambulance arrives, to make sure their symptoms don’t get worse. Keep them lying on their back if possible (or lying on their side if they’ve fainted or are vomiting.)
If your child’s anaphylaxis gets worse or doesn’t improve within 15 minutes of the first EpiPen, give your child a second EpiPen injection from a different EpiPen.
Have two or more EpiPens ready at all times, in case your child would ever need a second dose in an emergency. This applies at home, at school, and anywhere your child goes outside the home, in case of a food allergy emergency.
In rare cases, anaphylaxis could also potentially return after 4-24 hours, even after you’ve given your child epinephrine. This returning severe reaction is called a biphasic reaction. If this happens, your child will need a second dose of epinephrine.
A biphasic reaction is another reason why it’s vital to have at least two Epi-pens ready for your child at all times.
Remember: Always carry two [or more] auto-injectors!
Give an EpiPen for other severe allergic reactions
But what if your child develops only one severe symptom of an allergic reaction, or severe symptoms in only one organ system?
In this case, you should still inject the EpiPen, because epinephrine is the only way to stop the severe symptoms of an allergic reaction. There’s a risk that other severe symptoms could develop (meaning your child will have anaphylaxis), and epinephrine will help reverse this process when your child needs it most.
Give an EpiPen for any severe food allergy reaction symptoms.
Keep monitoring your child’s symptoms. If they worsen or don’t improve 15 minutes after the first EpiPen, inject a second EpiPen.
If your child’s symptoms develop into anaphylaxis, call 911 right away!
EpiPens Are Safe
An epinephrine auto-injector is always safe to give your child if they’re having a severe allergic reaction, because it contains the exact dose of the medicine your child needs.
Even if you think your child "doesn't need" the EpiPen at this time, it still won't do any harm to inject. The benefits of injecting always outweigh potential risks. EpiPens save lives!
Follow this rule: If your child shows any severe allergic reaction symptoms, use the Epi-Pen immediately! Remember “Epi first, Epi fast!”
How to use an EpiPen
If you need a visual on how to use an EpiPen, watch this video from Nationwide Children’s Hospital.
If it is an emergency, and you need to give epinephrine immediately, skip to 2:52 for instructions.
Otherwise, here are written instructions for how to give epinephrine to babies and older children:
Giving epinephrine to a baby (under 2 years old):
1. Lay your child flat in your arms.
- Do not hold them upright. Do not let them stand or walk.
- If they are having difficulty breathing, sit them up.
- If they are vomiting, or have fainted, lay them on their side.
2. Pop the safety cap off of the EpiPen. Then, make a fist as you hold the EpiPen.
- Don’t place your thumb on either end!
- You can inject the Epi-pen through clothing --- no need to remove any of your child’s clothes before you continue.
3. Hold your child and their leg still.
4. Locate the biggest muscle in the outer thigh. This is the best place to inject an Epi-pen.
- This is about halfway between the hip and knee, on the side of the leg that faces out.
5. Push the needle end of the EpiPen down on the middle of baby’s outer thigh, so the needle goes into the thigh muscle. Listen for the click.
6. Hold the Epi-pen down on their thigh for 10 seconds, then release.
- Some other epinephrine brands require you to hold the auto-injector down on the thigh for different amounts of time. Follow the exact instructions that came with the auto-injector.
7. Massage your child’s thigh (where you injected the EpiPen) for 10 seconds.
8. Write down the exact time you used the Epi-pen.
Giving epinephrine to a child (2 years old or older):
1. Have your child sit or lie down on their back. Make sure they will stay still during the injection process.
- You can also have a toddler or younger child sit in your lap, if that’s easier for holding them still.
- If your child is vomiting, or has fainted, lay them on their side.
2. Pop the safety cap off of the EpiPen. Then, make a fist as you hold the EpiPen.
- Don’t place your thumb on either end!
- You can inject the Epi-pen through clothing --- no need to remove any of your child’s clothes before you continue.
3. Hold your child’s leg still.
4. Locate the biggest muscle in the outer thigh. This is the best place to inject an Epi-pen.
- This is about halfway between the hip and knee, on the side of the leg that faces out.
5. Push the needle end of the EpiPen down on the middle of your child’s outer thigh, so the needle goes into the thigh muscle. Listen for the click.
6. Hold the Epi-pen down on their thigh for 10 seconds, then release.
- Some other epinephrine brands require you to hold the auto-injector down on the thigh for different amounts of time. Follow the exact instructions that came with the auto-injector.
7. Massage your child’s thigh (where you injected the EpiPen) for 10 seconds.
8. Write down the exact time you used the Epi-pen.
Keep in mind that each auto-injector brand may have slightly different instructions for injecting epinephrine. Make sure your family, your child’s teachers, and anyone who cares for your child outside the home knows how to use the auto-injector, following the exact instructions included with it.
You can also practice the injection process with a training Epi-pen. A training EpiPen doesn’t contain epinephrine and is only for practice, so you can get familiar with how to use the EpiPen before you might need it for an emergency. The more you practice, the more ready you’ll be to immediately inject epinephrine if a severe reaction occurs.
As with all aspects of food allergy management, ask your doctor if you have any questions about using epinephrine. They’re here to help protect your child!
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