Anaphylaxis Management with EpiPen

Indications for EpiPen Prescription

The American Academy of Allergy, Asthma, and Immunology recommends prescribing an EpiPen for any patient with a history of anaphylaxis involving respiratory or cardiovascular symptoms, or for high-risk patients with confirmed food/insect venom allergies combined with risk factors such as asthma, remote location, or beta-blocker use 1
Patients with prior anaphylaxis characterized by respiratory compromise or cardiovascular symptoms should be prescribed an EpiPen, as should children with generalized acute urticaria after insect stings, who have approximately 10% risk of more severe future reactions 1, 2
The American College of Allergy, Asthma, and Immunology suggests that patients with confirmed food or insect venom allergies who have additional risk factors, such as asthma requiring preventer medication, remote location, or use of nonselective β-blockers, should be prescribed an EpiPen 1

The American Academy of Pediatrics recommends that children 10-25 kg should be prescribed EpiPen Jr (0.15 mg), while children ≥25 kg and adults should be prescribed EpiPen (0.3 mg) 1, 2
Infants and children <15 kg, especially those ≤7.5 kg, present a clinical dilemma, as the lowest available EpiPen Jr dose (0.15 mg) may be too high for many infants and some young children, but the benefit of having epinephrine available outweighs the risk of slight overdosing in life-threatening anaphylaxis 1, 2

The American College of Allergy, Asthma, and Immunology recommends providing patients with a written, personalized anaphylaxis emergency action plan that includes specific symptoms to watch for, as well as training on injection technique and instructions to inject at first signs of anaphylaxis 1, 3, 4
Patients should be educated on allergen avoidance specific to their trigger, and should have a plan for monitoring autoinjector expiration dates 1, 2
The American Academy of Allergy, Asthma, and Immunology suggests that patients should self-carry and self-administer epinephrine, and that epinephrine may be repeated every 5-15 minutes if symptoms persist or recur 2, 3, 4

The American College of Obstetricians and Gynecologists recommends that epinephrine is safe and indicated for pregnant patients, as maternal hypoxia poses a greater fetal risk than epinephrine administration 5
Patients on beta-blockers may require glucagon 1-2 mg IV as rescue medication if epinephrine fails, as epinephrine may be less effective in beta-blocked patients 5

The American Academy of Allergy, Asthma, and Immunology recommends informing school personnel about the child's anaphylaxis history and specific allergens, ensuring an allergen-free environment at mealtime, and providing a written response plan to school that can be initiated immediately 6
Children with food allergies are covered by the Americans with Disabilities Act, which facilitates emergency medical response arrangements 6

The American College of Allergy, Asthma, and Immunology recommends not delaying prescription waiting for "severe enough" reactions, and always prescribing two EpiPens, as approximately 6-19% of patients require a second dose 1
Verbal instructions alone are insufficient, and a written action plan should be provided to patients, with explicit teaching on when to use the EpiPen 1, 2