September 22, 2023

Doctor Squashes Fears About Others Administering Auto-Injectors When Necessary

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Dr. Scott Russell, at the Medical University of South Carolina, conducted a webinar concerning epinephrine use. The webinar is called Epi First. Epi Fast. Ask Questions Later.

During his talk, Dr. Russell addressed the reasons people – patients, and caregivers – report for not utilizing epinephrine auto-injectors (EAIs) when symptoms warrant their use. Dr. Russell wants people to know that when EAIs are used as directed they are safe and beneficial, and he explained why:

  • Therapeutic Effects vs Side Effects. People worry about the apparent side effects of using EAIs, such as shaking, pale skin, palpitations, headache, and dizziness. However, these symptoms actually indicate that a therapeutic dose of epinephrine has been administered.
  • Serious side effects (e.g., arrhythmias, hypertensive crisis, pulmonary edema) typically occurs when too much epinephrine is given intravenously and goes directly into the bloodstream. These life-threatening side effects have never been reported following intramuscular injections via auto-injectors.
  • Unpredictability. People may assume that if a person’s last allergy reaction were mild, and improvement occurred without epinephrine, that future reaction will be the same. However, food allergy reactions are unpredictable, and a significant number of subsequent reactions are severer than the previous one. This means each reaction should be treated separately from those that occurred before, and that every reaction is potentially a life-threatening one.
  • Biphasic Prevention. People might wait until symptoms escalate before using an EAI. However, a delayed administration of epinephrine increases the likelihood of a biphasic reaction, and this is a factor associated with life-threatening anaphylaxis.
  • A biphasic, or two-phase reaction occurs when anaphylaxis is successfully treated, but following an asymptomatic period the symptoms return—without re-exposure to the allergen. The second part of a biphasic reaction can be less, equal to, or severer than the initial response.
  • Time Matters. People often choose to administer antihistamines (e.g., Benadryl) instead of epinephrine, but antihistamines take longer to work—as much as one to two hours. Within ten minutes of using an EAI, the recipient will undergo a peak therapeutic response to the epinephrine.
  • To drive home the difference between giving antihistamines and epinephrine, Dr. Russell shared a quote that made an impression on him:
  • Dose Concerns. People may worry about an EAI dose being too large, especially with small children. However, the effects of IM (intramuscular) epinephrine are mild, and giving children a bigger-than-ideal dose via an auto-injector is better than not administering it when needed. Also, using EAIs is generally safer than caretakers trying to dose accurately with an ampule and syringe.

For those interested in more detail about physician and consumer epinephrine use, Dr. Russell’s webinar can be viewed without charge at the Food Allergy Research & Education website.

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