Epinephrine Auto-Injector and Anaphylaxis

Allergic Emergency – If you think you are having a serious allergic reaction, use your epinephrine auto-injector and call 911.

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death.

Symptoms usually involve more than one organ system (part of the body), such as the skin or mouth, the lungs, the heart, and the gut. Symptoms may include:

• Skin rashes, itching or hives
• Swelling of the lips, tongue or throat
• Shortness of breath, trouble breathing or wheezing (whistling sound during breathing)
• Dizziness and/or fainting
• Stomach pain, bloating, vomiting or diarrhea
• Uterine cramps
• Feeling like something awful is about to happen

Ask your health care provider for a complete list of symptoms and an anaphylaxis action plan. Without immediate treatment, anaphylaxis may cause death.

Anaphylaxis occurs when the body’s immune system is triggered by something as harmful and reacts. Your immune system tries to remove or isolate the trigger. The result is symptoms such as vomiting or swelling. The most common triggers of anaphylaxis are allergens. Medicines, foods, insect stings and bites, and latex most often cause severe allergic reactions.

• Medicines - Common culprits are penicillin and other antibiotics, aspirin and aspirin-related products and insulin.
• Foods - Common food allergies are peanuts, tree nuts, shellfish, fish, milk, eggs, soy and wheat. In children, the most common food allergies are milk, eggs, peanuts, soy and wheat. In adults, the most common food allergies are shellfish, tree nuts and peanuts.
• Insect stings and bites
  Stinging insects such as bees, wasps, hornets, yellow jackets and fire ants can cause anaphylaxis. Certain tick bites can cause a person to develop severe allergic reactions to meat. Bites from the "kissing bug" and deer fly also cause a local allergic reaction.
• Latex
  Natural rubber latex may cause a mild skin irritation or it can trigger a severe allergic reaction. Direct contact with latex items (latex gloves, condoms and balloons) can cause a reaction. Inhaling small latex particles that have become airborne can trigger latex allergy. Putting on and removing latex gloves can release small latex particles into the air.
• Physical activity
  Exercise-induced anaphylaxis is a rare allergic reaction that occurs after vigorous physical activity. Temperature, seasonal changes, drugs, alcohol or eating certain foods before exercise may be co-factors. In other words, both exercise and this other factor have to be present for a person to have the severe allergic reaction.

With proper evaluation, allergists can identify most causes of anaphylaxis. People with asthma often have allergies as well. This puts them at higher risk of developing anaphylaxis, which also can cause breathing problems. For that reason, it is important to manage your asthma well. Some of the symptoms of a severe allergic reaction or a severe asthma attack may seem similar.

Epinephrine (adrenaline), a self-injectable medication, is the first-line treatment for severe or life-threatening allergic reactions (anaphylaxis). Epinephrine is a highly effective medication that can reverse severe symptoms. However, it must be administered promptly during anaphylaxis to be most effective. Delayed use of epinephrine during an anaphylactic reaction has been associated with deaths.

Epinephrine auto-injectors operate in different ways, so it is important to discuss your options with your doctor and be properly trained to use the device.

1. Talk with your doctor about which product is best for you
2. Make sure you are trained on your chosen device before leaving your doctor’s office
3. Ask your doctor to write your prescription specifically for the product you chose, either one of the brand names or the generic
4. Talk to your pharmacist about the epinephrine auto-injector you want when dropping off your prescription
5. Before leaving the pharmacy, double-check the product you were given to make sure it is the one that you wanted and that was prescribed by your doctor.

Ask your healthcare provider for training on how to use the auto-injector that has been prescribed for you. In addition, the manufacturers’ websites provide detailed information, including instructions for using the device. It’s important to become familiar with these instructions. Practice using the auto-injector until the process becomes second nature. Teach family members and caregivers how to use it as well.

An injection of epinephrine should be given in the outer thigh. Injecting the medication intravenously or into the buttocks is not recommended. Auto-injectors can usually be used through clothing. Be sure to check the manufacturer’s instructions for details.

Once the device is injected, follow the instructions provided by the manufacturer regarding how long to hold the device in place to ensure all of the medication has been delivered.

Once epinephrine is administered, you should call 911 immediately and advise dispatchers that you have just used epinephrine for a suspected anaphylactic reaction. Make arrangements to be transported to an emergency room for additional treatment and for observation.

Epinephrine is sensitive to light and should be stored at room temperature. Do not refrigerate epinephrine, and take precautions to prevent the device from freezing. Epinephrine should never be stored in a vehicle, where temperatures can climb to triple digits, causing the medication to become less effective.

Periodically check the epinephrine solution for discoloration. If the solution becomes slightly pinkish in color, or darker than slightly yellow, the medication may be less effective; call your doctor for a replacement device.

Public Act 099-0711 or the allows a health care practitioner to prescribe epinephrine auto-injectors in the name of an authorized entity for use in accordance with the Act. Pharmacists and health care practitioners may dispense epinephrine auto-injectors pursuant to a prescription issued in the name of an authorized entity.

An authorized entity, meaning any entity or organization other than a school covered under the School Code (Section 5), may acquire and stock a supply of undesignated epinephrine auto-injectors for immediate administration on someone experiencing anaphylaxis. The epinephrine auto-injector may be provided to a parent, guardian, or caregiver and may be administered to any individual regardless of whether the individual has a prescription for or has been previously diagnosed with an allergy.

Public Act 099-0711 allows an authorized entity to identify employees or agents or other individuals who have completed training (subsection d of the Act) to provide or administer an epinephrine auto-injector. Employees, agents or other authorized individuals must complete an anaphylaxis training program before they are able to provide or administer an epinephrine auto-injector under the provisions of the Act. Training shall be valid for a period of two years and shall meet the following requirements:

• Is conducted by a nationally recognized organization experienced in training laypersons in emergency health treatment;
• Is conducted either online or in person;
• Includes, but is not limited to:
  • How to recognize signs and symptoms of an allergic reaction, including anaphylaxis;
  • Standard procedures for storage and administration of epinephrine auto-injector;
  • Steps to take to prevent exposure to allergens;
  • Emergency follow-up procedures; and
  • A test demonstrating competency of knowledge required to recognize anaphylaxis and administer an epinephrine auto-injector.

Authorized entities may include a review and understanding of high-risk areas on the authorized entity’s property and its facilities as part of the training curriculum.

If there is a training program which meets the criteria listed and it is not included here, please email information about the program to DPH.EpiPen@illinois.gov.

The following training programs meet the requirements of Public Act 099-0711 :

• American Red Cross: Anaphylaxis and Epinephrine Auto-Injector - Online Course
• American Heart Association: Heartsaver® Pediatric First AID CPR AED
• American Heart Association’s Heartsaver First Aid/CPR/AED course
• Code Ana Epinephrine Auto-Injector Training Course
• Food Allergy Research and Education Save a Life: Recognizing and Responding to Anaphylaxis Training Course

The training organization will provide a certificate of completion to each participant. There is no required form for the training certificate, but each certificate should contain at least the following information:

1. Name of the trainer or training organization.
2. Date training completed.
3. The topics covered in the training.

The following training programs meet the requirements of the Act and contain training components which are specific to school-based settings:

• National Association of School Nurses – GET TRAINED
• AllergyReady.com – Ready, Set, Go!
• Schools.AllergyHome.org – Foor Allergies & Anaphylaxis in School: What School: What School Staff Need to Know

A health care practitioner may prescribe epinephrine auto-injectors in the name of an authorized entity for use in accordance with the Act. Pharmacists and health care practitioners may dispense epinephrine auto-injectors pursuant to a prescription issued in the name of the authorized entity. Such prescriptions shall be valid for a period of two years.

An authorized entity should store the epinephrine auto-injectors in a location readily accessible in an emergency and in accordance with the device’s instructions. The authorized entity shall designate employees or agents who have completed required training to be responsible for the storage, maintenance, and control of epinephrine auto-injectors obtain and possessed by the authorized entity.

• Check the expiration date of the epinephrine auto-injectors every month, and replace units once they have expired.
• Do not store the auto-injector in a refrigerator. Keep it at room temperature.
• Epinephrine auto-injectors should not be exposed to extreme hot or cold temperatures and should be protected from light. Do not store the auto-injector in a vehicle glove box or trunk.
• The liquid medicine in the auto-injector should be clear. If it is discolored or has floating specks, get a new one.
• When disposing an epinephrine auto-injector, do not throw it into the household trash. Instead, take the used or expired auto-injector to a hospital, pharmacy or healthcare provider for proper disposal.

The use of an undesignated epinephrine auto-injector in accordance with the requirements of the Act does not constitute the practice of medicine or any other profession that required licensure.

No. The state health department is not keeping a list of organizations choosing to obtain epinephrine auto-injectors. If your organization is one of the authorized entity types listed in the Act, you can designate persons, get them trained, submit the training certificates to an authorized wholesale pharmacy and obtain the epinephrine auto-injectors.

• Illinois State Board of Education and Illinois Department of Public Health Guidelines for Managing Life-Threatening Food Allergi
• Centers for Disease Control and Prevention – Food Allergies
• Food Allergy Research & Education
• Food Allergy
• Kids with Food Allergies.org – Division of the Asthma and Allergy Foundation of America (AAFA)

• Public Act 099-0711 – Epinephrine Auto-Injector Act
• The State Police Act – Annie LeGere Law
• The School Code – Section 22-30