The ultimate guide to your emergency medication for severe allergic reactions
Have you or has someone you care for been prescribed an EpiPen for treating severe allergic reactions? We have lots of EpiPens. With potentially life threatening allergies to foods (milk, egg, peanut, tree nuts and sesame) and antibiotics, our family needs them always at the ready.
Being prescribed an EpiPen is just the beginning. There is quite a bit to learn about the medication that is going to be your constant companion. What exactly is it? How does it work? How do you use an Epipen? When should you use one. How many do you need? Where should you store them?
Here are some practical tips and helpful resources.
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What is an EpiPen?
EpiPen is the brand name of a medical auto-injector device which delivers an injection of a measured dose of epinephrine. Epinephrine (adrenaline) is a medication that is used to reverse the effects of a severe allergic reaction, known as anaphylaxis.
The device is designed to be able to be used by anyone to treat an allergic reaction in an emergency. It is simple to use and you do not need to be medically trained.
An EpiPen comes inside a protective outer case. The device inside the case has a blue safety cap at the top end and an orange plastic tip. These colours are important when it comes to remembering how to use it.
It looks big on the outside, but the needle concealed inside the EpiPen casing is actually quite small.
EpiPen’s come in two different dose sizes: the EpiPen Jr prescribed for children under 20kg and the normal EpiPen which is prescribed for adults and older children.
In Australia, we don’t have a choice. The only auto-injector available to people with severe allergies at the moment is an EpiPen. Hopefully this might change in the future. (It would be great to have something that was easier to carry!)
Who should have an EpiPen and how do I get one?
Not everyone with food or other allergies needs an EpiPen. Your allergy specialist will consider your personal risk of a severe reaction (anaphylaxis) and decide if it is appropriate to prescribe this medication for you.
You are more likely to be prescribed an EpiPen if you have a history of severe reaction (anaphylaxis) or a history of generalised allergic reaction with other factors involved. This could include if you have other medical conditions like asthma, your age, the type of allergy (eg nuts or insects) or if you live a long way from medical care.
If you have only had a positive skin prick test or blood test for allergens, you might not be prescribed an EpiPen. Your allergy specialist is the best person to decide.
Once you have an authority prescription for EpiPen from your speciliast, you can fill it at your pharmacy for the cost of a normal prescription (in Australia).
If you have been prescribed an EpiPen, you should have it with you at all times.
#Tip – If your EpiPen has been prescribed for a food allergy, then the best rule is: no EpiPen, no eat. It isn’t worth the risk.
When should I use it?
In Australia, when your allergy specialist prescribes an EpiPen, they will provide you with an Anaphylaxis Action Plan. This will list your allergies and your treatment plan for mild to moderate reactions, or a severe reaction (anaphylaxis). You can see what an Action Plan looks like on the ASCIA website.
An EpiPen isn’t needed for a mild or moderate reaction. Symptoms of a mild or moderate reaction include:
- swelling of lips, face or eyes
- hives or welts
- tingling mouth
- vomiting or abdominal pain (*this can be a sign of a severe reaction to insect stings)
However, if someone is experiencing these symptoms and has an EpiPen, you should locate it and monitor their symptoms closely. A severe reaction might start with moderate symptoms and get worse. Or it may come on suddenly.
An EpiPen should be used when someone is experiencing any one of the following symptoms of a severe reaction:
- difficult or noisy breathing
- swollen tongue
- swelling/tightness in throat
- wheezing or persistent coughing
- difficulty talking or hoarse voice
- persistent dizziness or collapse
- pale and floppy (young children)
What about if someone is wheezing and coughing and they also have asthma? How do you know if it is asthma or an allergic reaction? If someone with both asthma and known allergies has sudden breathing difficulties, you should use the EpiPen first before their asthma reliever medication.
#Tip: If in doubt about whether it is anaphylaxis, use the EpiPen anyway. It is better to use it for what turns out to be only a moderate reaction than to delay in using it when you need to.
How do I use it?
Hopefully your specialist showed you how to use your EpiPen when it was prescribed for you. Or organised some training. In South Australia, the Women & Children’s Hospital runs a monthly EpiPen Education Clinic for parents and carers of children who have been prescribed an Epipen. Ask your allergist if there is something similar where you live.
The Australia Society of Clinical Immunoilogy and Allergy (ASCIA) offer a free online training course for anyone in Australia and New Zealand too.
Instructions for using your Epipen can be found:
- on the label of the Epipen itself;
- on your Anaphylaxis Action Plan.
Allergy & Anaphylaxis Australia even have a short video that you can watch on their website with the essential steps for autoinjector use.
It’s a good idea to practice regularly so that using your EpiPen is easy in an emergency. We do a practice run when we visit the allergist for annual allergy testing.
What to do:
- Follow instructions on the Action Plan
- Lay the person flat
- If breathing is difficult they can sit up, but do not stand or walk
- Form a fist around the EpiPen, keeping fingers and thumbs away from the ends
- Remember: “blue to the sky, orange to the thigh”
- Take off the blue safety release
- Place the orange end against the outer mid thigh (about half way between knee and hip)
- You can use an EpiPen through clothes, but not very thick seams (for example seams on denim jeans)
- Hold the leg still and push down hard with the EpiPen until you hear or feel a click
- Hold firmly in place for 3 seconds
- Remove the EpiPen – the orange end will cover the exposed needle
What do I do after I use the EpiPen?
Call an ambulance! Even if you or the person experiencing the allergic reaction seems to be better after using the EpiPen.
Then phone the person’s emergency contact to let them know what has happened.
Don’t allow the person to stand or walk after using an EpiPen, even to the ambulance or into hospital. (You might even need to remind the ambulance officers about this. We experienced a situation where someone was made to walk down a flight of stairs to an ambulance whilst experiencing analphylaxis. It is extremely dangerous and can cause a drop in blood pressure, worsening the reaction.)
If there is no improvement while you are waiting for the ambulance, you may need to use a second EpiPen (5 minutes after the first one).
It is very important that the patient be monitored in hospital for at least 4 hours after using the Epipen, even if they seem better.
Sometimes you might experience a second wave of symptoms (called a biphasic reaction).
While it is still fresh in your mind, make some notes about what happened to help you remember when you speak to your doctor or allergic specialist about the reaction. You can complete the very handy Anaphylaxis Event Record for Allergic Reactions form available from ASCIA.
And make sure you organise a replacement EpiPen as soon as possible.
Teaching others how and when to use an EpiPen
Do your friends and family, or people who look after your child with allergies, know what to do in the event of a reaction?
As well as teaching other people how to use your EpiPen, it is really important to tell them about when to use it too. I think people are often too focused on the how, and leave it at that.
Firstly, tell them about your allergies. What your triggers are.
Do they know where you keep your EpiPen and Action Plan? Are they familiar with the symptoms of an allergic reaction? Would they hesitate to use the EpiPen thinking that the reaction might not be that bad? These are really important things to talk about.
Secondly, do they know how to use an EpiPen?
Even as an adult, if you are having a severe allergic reaction you might need someone else to help you administer your EpiPen.
As well as teaching friends and family, you should also seriously consider wearing an allergy medical alert ID. Have a read of our post about options for both adults and children here: Our pick of the latest Allergy Medical Alert IDs – Our pick of the latest Allergy Medical Alert IDs
Practise with a training device
A really good way to teach others is to use a training device. This looks just like an EpiPen and has the same mechanism, but does not contain the needle or epinephrine medication. You can practice with the trainer pen to demonstrate how to hold it, how to remove the blue safety cap and where to use it (mid outer thigh). When pushing down with the training pen, it gives a realistic click to demonstrate what it is like to use the real one.
Just be sure not to mix up your training pen with your real medicine: keep it separate and clearly marked as “trainer”.
Some people also practise with an expired EpiPen on an orange to experience how it feels to use. But a trainer pen is a much safer option because it doesn’t contain any needle or medication. The training pen can be reset and used over and over again too.
It is definitely worth practising yourself regularly as well as using the training pen to show others what to do.
How many EpiPens do I need?
The short answer is that you probably need more than the two you’ve been prescribed.
You should carry two with you at all times. Why? Sometimes one of them may not work or you might make a mistake when administering it. It isn’t unheard of for people who are under stress to hold the pen incorrectly and inject their own thumb! The other reasons – which isn’t nice to think about – is that sometimes one EpiPen won’t be enough. You might need to give a second dose before an ambulance arrives or before you get to the hospital.
#Tip: Always carry two EpiPens
In Australia your prescription will entitle you to two EpiPens funded by the Pharmaceutical Benefits Scheme.
How can I get more than 2 EpiPens?
What if you have to leave one EpiPen at childcare or school? Schools and preschools usually ask you to supply emergency medication including an EpiPen to leave at the school premises. This is a problem, because then you only have one to carry on you or keep at home.
You can buy another EpiPen over the counter without a prescription in Australia. However, we usually get our doctor to write a general or “private” prescription for another EpiPen. This way it will have the patient name and instructions for use on the label, which is required by school.
Either way, you will have to pay the full cost for any additional EpiPens over and above your PBS subsidised ones. In Australia this can range anywhere from about $80-$130 depending on your pharmacy. But spending this extra money means that you can leave one at school or work without being limited to only one device the rest of the time. Some private health insurance policies will cover part of the price of an additional EpiPen on a general prescription, so make sure to get a receipt and check with your insurer.
#Tip: Ask your pharmacist to supply EpiPens with a long expiry date (more than 10 months)
We carry two with us at all times, with the EpiPen bag going wherever we do.
And if we are travelling somewhere that is a bit further away from a hospital or we are flying somewhere, we usually pack 4!
Always carry a copy of your Anaphylaxis Action Plan with you too. This will help you or other people who might need to help you use the EpiPen in an emergency.
How do I look after my EpiPens?
Keep your Epipens at the right temperature. This is somewhere between 15 and 25°C. Sometimes it can be hard to avoid having your EpiPen in weather that it is too hot or too cold, but the aim is to keep the time exposed to temperatures outside the recommended range to a minimum.
Epinephrine/adreneline is sensitive to light, which can reduce its strength, So you should avoid direct sun exposure.
If your EpiPens get too cold, the auto-injector mechanics can be affected. So never put it in the refrigerator or freezer. Or even in a cooler with ice.
To protect your EpiPen and keep it at the right temperature:
- keep it away from direct sunlight
- try and keep it in the shade if you are outside on a hot day
- never leave it in the car
The best way to look after your EpiPens when you are out and about is to get an insulated carrying case. These come in different shapes and sizes. We use one that fits 2 EpiPens, a small bottle of antihistamine, an asthma spacer and inhaler.
A dedicated emergency pack for your EpiPen and other medicines makes it easy to take your EpiPens with you everywhere as part of your daily routine.
You can shop for insulated EpiPen carry bags o Amazon here*.
Keeping track of expiry dates
Always make sure your EpiPens are in date and haven’t expired. The expiry date is listed on the outer box as well as on the device itself.
As soon as we get new EpiPens, I take a permanent marker and write the month and year of expiry on the cap of the outer protective case. That way I can always see at a glance what the expiry date is.
#Tip – Write the month and year of expiry with permanent marker on the container cap so you can see it at a glance.
Another way to make sure you always have EpiPens that are in date is to join the EpiClub. Once you join, you can register for the reminder system. You can choose to get an email, SMS or postal reminder that your EpiPen is coming up to its expiry date.
If your EpiPens have expired, don’t just throw them away. For a start, you should return expired medication to your local pharmacy for safe disposal. But you can actually keep a recently expired EpiPen as an emergency backup. Look through the window on the device to check if the liquid is still clear and not cloudy first. Obviously it is important to make sure that you have enough current EpiPens, but if you are having trouble getting hold of a replacement or have had to use one to treat a reaction, the recently expired device can be a backup until you can get a replacement.
#Tip – You can keep recently expired EpiPens as an emergency backup if necessary. Be sure to check that the liquid is still clear and not cloudy.
You should organise a new EpiPen prescription before your current devices expire, if you have used one, or if the liquid inside looks cloudy or discoloured. You can get a repeat prescription for EpiPens from your allergist or your usual doctor.
Important things to remember
- Learn when and how to use your EpiPen
- Teach your family and friends when and how to use one too
- Always carry 2, with a copy of your Anaphylaxis Action Plan
- Store your EpiPens at the right temperature
- Make sure they are in date
References and more information
You can find out more about EpiPens and anaphylaxis from: