Epinephrine Auto-Injector Prescription Guidelines for Drug Allergies

Indications for Prescription

The American Academy of Pediatrics recommends that patients with a history of drug-induced anaphylaxis or systemic allergic reactions should be prescribed an epinephrine auto-injector 1
Patients with a previous systemic allergic reaction to a drug should receive an epinephrine auto-injector, as recommended by the American Academy of Pediatrics 2
The American Academy of Pediatrics also recommends that patients with drug allergy combined with asthma should be prescribed an epinephrine auto-injector, due to the increased risk of fatal anaphylaxis 2
Patients with idiopathic anaphylaxis require immediate access to epinephrine, as recommended by the American Academy of Pediatrics 3

Patients who experienced respiratory or cardiovascular symptoms during a drug reaction should be prescribed epinephrine, according to the Journal of Allergy and Clinical Immunology 1
The decision to prescribe epinephrine involves assessing the severity of the previous reaction and the likelihood of re-exposure, as recommended by the Journal of Allergy and Clinical Immunology 1

The American Heart Association recommends that patients should carry two auto-injectors, as 7-18% of anaphylaxis cases require more than one dose 6
The American Academy of Pediatrics recommends weight-based dosing for epinephrine auto-injectors: 0.15 mg for patients 10-25 kg and 0.3 mg for patients ≥25 kg 2
A written anaphylaxis emergency action plan should be included with the prescription, specifying when to use the device and emphasizing the need for emergency department evaluation after use, as recommended by the American Academy of Pediatrics 2

Patients prescribed epinephrine must receive education on recognition of anaphylaxis symptoms, including respiratory distress and cardiovascular symptoms, as recommended by the American Academy of Pediatrics 2
Patients should be educated on when to inject epinephrine, at the first sign of systemic symptoms after known allergen exposure, erring on the side of early administration, as recommended by the American Academy of Pediatrics 2
Patients should receive instruction on proper injection technique, including administration in the anterolateral thigh, as recommended by the American Academy of Pediatrics 2
Patients should be informed of the need for emergency care after using epinephrine, including 4-6 hours of observation due to biphasic reaction risk, as recommended by the American Academy of Pediatrics 2