Living With Food Allergies
Epinephrine Is the First Line of Treatment for Severe Allergic Reactions (Anaphylaxis)
Epinephrine is the only treatment for a severe allergic reaction known as anaphylaxis (anna-fih-LACK-sis). Epinephrine comes in the form of easy-to-use auto-injectors. It is only available through a prescription by your doctor.
Children or adults who have severe food allergies need two of these auto-injectors with them at all times. For children, this might mean having more than one set of medicine. For example, the child may need to keep one set at school and one set at after-school care. Another set typically remains at home. For adults, two auto-injectors might be enough.
Use these links to jump to the information you need:
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Comparison of the epinephrine options available
What types of auto-injectors are available?
What are the differences between the different brands?
What are other epinephrine options available? -
Everything you need to know about epinephrine
How does it stop anaphylaxis?
What is the role of antihistamines in treating anaphylaxis?
How do you inject epinephrine?
What if you accidentally inject yourself?
What do you need to know about temperature storage? -
What do you do if you can’t afford epinephrine?
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Do schools stock epinephrine for emergencies?
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Related resources for epinephrine
Epinephrine Auto-Injectors Available With a Prescription in the United States
Epinephrine auto-injectors are the treatment for anaphylaxis. Several epinephrine auto-injectors are now available in the United States. There are also generic versions. Each contains the drug epinephrine. But, each device has its own unique set of instructions for use. Understanding the differences is important so that you get the device you want and you know how to properly use it.
The chart below summarizes the key facts about each of the available epinephrine auto-injectors. More details are available at the manufacturers’ websites. These websites also have patient instructional videos.
Pharmacists must follow state and federal regulations when filling your prescription for epinephrine. You should keep this in mind when filling your prescription.
There are many states in which the pharmacist can substitute a generic form of the prescription. This must be on the prescription in writing. The pharmacist must also get a verbal approval from the doctor. If you or your doctor prefer to receive a specific brand name, your doctor must write the brand name and “DAW” (dispense as written) or “do not substitute” on the prescription. This notation prohibits the pharmacist from dispensing a generic form of the prescription. Before you leave the pharmacy, make sure the pharmacy fills your prescription exactly as you and your child’s doctor expects.
Remember to speak to your child’s doctor to determine which epinephrine product is best for your child. Each device operates differently. Make sure that you have been trained to use the device that you leave the pharmacy with. Also, you should review the training video for that device.
auvi-q.com
Training video
UPDATE: The November 2017 update to the AUVI-Q (epinephrine injection, USP) label included a change in hold time from 5 seconds to 2 seconds.
0.1 mg, 0.15 mg and
0.3 mg
kaléo
No
after injection
Yes
Yes
No
No
0.15 mg and
0.3 mg
Mylan Inc.
Yes, see below
Copay card provides maximum
benefit of $300 per EpiPen®
two-pack and can be redeemed up to six times. The site states the savings card expires Dec. 31, 2018. But according to a Mylan representative, you can still download and use the savings card. If your pharmacy does not accept the card, your pharmacist can call Mylan to confirm at 800-657-7613 (8 am-8 pm EST, Monday-Friday). Mylan also has a Patient Assistance Program.
after injection
Yes
No
No
Patients can register on the product website for an e-mail reminder when their medicine will expire
https://www.epipen.com/en/about-epipen-and-generic/what-is-an-authorized-generic
Training video
0.15 mg and
0.3 mg
Mylan Inc.
**
Copay card provides maximum benefit of up to $25 off in savings per two-pack and can be used up to three times. The site states the savings card expires Dec. 31, 2018. But according to a Mylan representative, you can still download and use the savings card. If your pharmacy does not accept the card, your pharmacist can call Mylan to confirm at 800-657-7613 (8 am-8 pm EST, Monday-Friday).
after injection
Yes
No
No
Patients can register on the product website for an e-mail reminder when their medicine will expire.
0.3 mg
0.15 mg available in 2019
Teva Pharmaceutical Industries
**
Savings card for up to $30 off
a two-pack with
commercial insurance,
maximum of three cartons
per prescription
after injection
Yes
No
Yes
Yes
epinephrineautoinject.com
Training video
0.15 mg and
0.3 mg*
Distributed by Lineage Therapeutics
**
Copay card provides maximum benefit of $25 per two-pack.
after injection
Training devices are available for free via web or telephone.
No
Yes
No
*Available as a single injection or a two-pack.
** Epinephrine, USP auto-injector is the authorized generic of Adrenaclick (not currently available).
Other Epinephrine Options
There are other options that do not auto-inject the epinephrine. Glass vials of epinephrine with needles/syringes may be in emergency kits as seen on airplanes. There is also a new pre-filled syringe device that you can use to inject epinephrine. This device works differently than the auto-injectors. Be sure to have your doctor, nurse or pharmacist demonstrate how to use your device.
0.15 mg and 0.3 mg
Sandoz Inc., a Novartis Division
No
With insurance, SYMJEPI Savings Program covers up to $300 per prescription, up to $1,000 per year. Eligible patients may pay as little as $0. People without insurance coverage receive $100 off each prescription.
after injection
N/A
N/A
Yes
N/A
Everything You Wanted to Know About Epinephrine
Kids With Food Allergies (KFA), a division of the Asthma and Allergy Foundation of America, hosted a free educational webinar on Feb. 26, 2014, featuring two of our medical advisors, Michael Pistiner, MD, and Angela Nace, PharmD. They discussed:
- How epinephrine treats anaphylaxis
- Antihistamines
- Accidental injections
- Key facts about the drug including storage temperature recommendations and more
What If You Can’t Afford Your Epinephrine Auto-Injectors?
Unfortunately, some people cannot afford to buy this potentially life-saving medicine. If this is the case for you, there are options to help. On our blog, we offer up-to-date details about:
- Savings programs
- Pharmacy differences
- Insurance preferences
- Other sources of assistance
Blog: What to Do If You Can’t Afford Epinephrine
Stocking Epinephrine in Schools and Public Places
Up to 25% of severe allergic reactions that occur on school campuses happen to people who are experiencing their very first anaphylaxis reaction. Since these people (children, staff and visitors) have not been previously diagnosed with allergies, they may not have their own epinephrine auto-injectors on hand. Most states have passed legislation to allow schools to stock undesignated epinephrine as a part of their emergency medical kits. This allows specified staff to treat someone suffering anaphylaxis, even for their very first allergic reaction. Many states are looking beyond the classroom to other areas where food allergy triggers could be present. In any public space where food is present – such as sports and recreation venues, summer camps, amusement parks, movie theaters – there is a risk for an allergic person to come in contact with their allergen. To find out the status of epinephrine laws in your state, visit www.aafa.org/epinephrine.
Children show their support for Pennsylvania’s epinephrine stocking bill.
Related Epinephrine Resources
- Researchers Review Effects of Heat, Cold on Epinephrine
Researchers looked at what is known about the effects of extreme temperatures on epinephrine.
- Guidelines for the Diagnosis and Management of Food Allergy in the United States (Leave KFA website)
The NIH guidelines provide steps for parents and medical providers on how to manage and treat food allergies and severe allergic reactions.
- Severe Allergy / Anaphylaxis Emergency Action Plan Samples
- Epinephrine Resource School Nurse Program (Leave KFA website)
Find the ERSN in your state if your school needs assistance in epinephrine or food allergy training for staff. The National Association of School Nurses offers a “Get Trained” program to teach school staff how to respond to allergic emergencies, and will answer questions and provide support.
- EpiPen4Schools Program (Leave KFA website)
Qualified schools can obtain up to four free EpiPen® or EpiPen Jr® auto-injectors.
- What is Anaphylaxis? Take Steps to Prevent Allergic Reactions
Learn how to recognize symptoms and treat anaphylaxis.
- Self-Injectable Epinephrine for First Aid Management of Anaphylaxis (Leave KFA website)
Reference mentioned in the video presentation on the recommended doses of epinephrine per weight.
REFERENCES
1. Product information for AUVI-Q. kaléo, Richmond, VA 23219. July 2019.
2. Product information for EpiPen. Mylan Inc. Basking Ridge, NJ 07920. July 2019.
3. Epinephrine Injection, USP auto-injector, the authorized generic (AG) of EpiPen®, Mylan Inc. Basking Ridge, NJ 07920. July 2019.
4. Product information for Epinephrine Injection, USP autoinjector, the authorized generic (AG) of Adrenaclick™. Lineage Therapeutics. Horsham, PA 19044. July 2019..
Medical review February 2014, June 2014, January 2015. Updated January 2016, August 2016, December 2016, January 2017, February 2017 and July 2019.