Epinephrine and EpiPens

Question 1

What does an EpiPen do?

Answer

Epinephrine, the medication in an EpiPen, is the only effective treatment for anaphylaxis. After epinephrine is injected into the thigh of someone experiencing anaphylactic shock, the medication immediately starts working to reduce their symptoms.

While antihistamines can treat mild allergic reactions, there's no life-saving substitute for epinephrine when multiple organ systems are involved.

Question 2

How much do EpiPens cost?

Answer

The cost of an EpiPen can vary widely depending on insurance coverage, pharmacy discounts, and whether you choose generic or brand-name medication. The U.S. Food and Drug Administration (FDA) approved generic EpiPen options in 2018, which lowered prices for many people at risk of anaphylaxis.

Question 3

What can trigger anaphylaxis?

Answer

The most common triggers of anaphylaxis are medications (like antibiotics or NSAIDs), stinging insects (like bees, wasps, or fire ants), and foods (like shellfish, peanuts, or tree nuts). But in up to 20% of cases, the trigger is unknown.

Anaphylaxis can happen quickly after exposure to the allergen, normally within one to two hours, and sometimes within minutes. It can also reoccur up to 3 days after exposure in what's known as a biphasic reaction, which is why people at high risk should be monitored closely after an initial allergic reaction.

Did you know?

• Up to 51% of anaphylactic reactions happen at home

• 60% of U.S. adults who experience anaphylaxis don’t have epinephrine available

Question 4

How do you recognize the signs of anaphylactic shock?

Answer

Someone with anaphylaxis might have a mild allergic reaction that rapidly gets worse, typically affecting their breathing. Most deaths from anaphylactic shock occur within the first hour. Multi-organ symptoms can include one or a combination of the following:

• Difficulty breathing

• Hives (skin rash with itchy bumps)

• Skin itching or flushing

• Swelling of the tongue, lips, or uvula

• Swelling or tightness in the throat

• Feeling like you have a "lump" in your throat

• Sudden persistent cough or throat clearing

• Wheezing

• Abdominal cramps or vomiting

• Incontinence

• Low blood pressure (systolic BP lower than 90 or at least 30% lower than usual)*

If you’re experiencing symptoms of anaphylactic shock, please call 911 or go to an emergency room (ER) as soon as possible.

*Low blood pressure (hypotension) can sometimes be the sole symptom of anaphylactic shock.

Question 5

What's the difference between EpiPen and EpiPen Jr.?

Answer

Both an EpiPen and EpiPen Jr. deliver the same active ingredient (epinephrine) in the same way, but they contain different doses in each injection. EpiPens deliver 0.3mg of epinephrine per injection while an EpiPen Jr., meant for smaller bodies, delivers 0.15mg.

A healthcare provider will prescribe an EpiPen or an EpiPen Jr. to your child based on their body weight.

Question 6

What is the weight cut off for EpiPen Jr?

Answer

The weight cut off for EpiPen Jr. is typically 66 pounds.

Question 7

When should a child learn to self-inject for anaphylaxis?

Answer

There is no guideline on when a child should learn to self-inject. The timing depends on the child’s ability after being trained on its use by the parent(s). Children have difficulties recognizing the symptoms of anaphylaxis (swelling of the lips/tongue/mouth, difficulty breathing, wheezing, difficulty swallowing, or rash), which is why parents of children who are at risk of experiencing ana[phylaxis should know how to properly administer an EpiPen.

If your child’s healthcare provider believes that your school-age child is too young to self-administer, it’s important to ensure that other adults at the school are aware of the possible risk of anaphylaxis in your child and how to properly administer an EpiPen.

Question 8

Do I have to be the parent or guardian of the child seeking care?

Answer

Yes. A parent or legal guardian must initiate the child's care and be present during their treatment.

Question 9

What type of healthcare provider will treat my child?

Answer

Children are treated by family practice physicians or licensed family nurse practitioners (FNPs). You'll be able to see the credentials of your child's provider after they're assigned to your child's treatment.

Question 10

Can I get a doctor's note for my child?

Answer

Yes. After your child completes their treatment, their One Medical provider can write excused absence notes, back-to-school notes, and no-play notes for sports or other activities if medically appropriate.

Question 11

What kind of online treatments can I request for my child?

Answer

At this time, parents and legal guardians can request treatments for their children aged 2 through 11 years old for the following health conditions through Amazon One Medical On-Demand Care (formerly Pay-per-visit):

• Head lice

• Pink eye

• Skin issue

• Eczema

• EpiPen prescription renewals

• Asthma prescription renewals

Question 12

Clinical sources

Answer

1. Brown, J. C., Simons, E., & Rudders, S. A. (2020). Epinephrine in the Management of Anaphylaxis. The journal of allergy and clinical immunology. In practice, 8(4), 1186–1195.

2. Pflipsen, M. C., & Vega Colon, K. M. (2020). Anaphylaxis: Recognition and Management. American family physician, 102(6), 355–362.

3. Wood, R. A., Camargo, C. A., Jr, Lieberman, P., Sampson, H. A., Schwartz, L. B., Zitt, M., Collins, C., Tringale, M., Wilkinson, M., Boyle, J., & Simons, F. E. (2014). Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. The Journal of allergy and clinical immunology, 133(2), 461–467.

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Epinephrine and EpiPens

How it works

Commonly prescribed EpiPens

Epinephrine auto-injectors

Can I get an EpiPen renewal for my child?

Who needs an EpiPen?

How are EpiPens prescribed?

Frequently asked questions

About EpiPens and anaphylaxis

About EpiPens for children