Anaphylaxis and Epi-Pen Inservice Joanna Drowos DO, MPH, MBA, CMQ, FACOFP Ruth and Edward Taubman Early Childhood Center B’nai Torah Congregation August 21, 2014 What is Anaphylaxis? • • • • • A severe systemic allergic reaction Results from exposure to allergens Rapid in onset Can result in a life threatening emergency UNPREDICTABLE! – Progression can vary, the signs and symptoms can arise within minutes of exposure to an allergen, but can also develop 30 minutes or more after exposure, symptoms that do not initially appear to be lifethreatening may progress rapidly Anaphylaxis Triggers FOODS • Peanuts • Tree nuts (e.g., walnuts and pecans) • Fish • Shellfish • Cow’s milk • Soy • Eggs • Wheat BITING OR STINGING INSECTS • Stinging insects (e.g., honeybees, fire ants, yellow jackets, yellow hornets and paper wasps) • Less commonly, biting insects (e.g., mosquitoes, ticks and flies) MEDICATIONS • β-lactams (e.g., penicillin) • Nonsteroidal antiinflammatory drugs (NSAIDs) (e.g., aspirin and ibuprofen)6 • Biologic modifiers (e.g., cetuximab, infliximab and omalizumab)3 LATEX EXERCISE RADIOCONTRAST IDIOPATHIC Identifying Anaphylaxis EpiPen and EpiPen Jr • EpiPen and EpiPen Jr are disposable, prefilled automatic injection devices (auto-injectors) that contain epinephrine • Epinephrine is the first-line treatment for lifethreatening allergic reactions (not antihistamines) • Only for patients who have been prescribed this medication by their healthcare provider EpiPen and EpiPen Jr Caring for EpiPen and EpiPen Jr • • • • Store at 68 degrees to 77 degrees Protect from light Do not expose to extreme cold or heat Examine contents in clear window of autoinjector periodically (should be clear, or replace) • Keep in carrier tube to protect from damage (not waterproof) • Keep blue safety release on until you need to use it • Expiration date Important Information for Use • Auto-injector designed to work through clothing • Only inject in to outer thigh – not veins, or buttocks • Never put your thumb, fingers or hand over the orange tip (where needle comes out) • Do not place anything else in carrier with Auto-Injector Video Demonstration • https://www.epipen.com/en/aboutepipen/how-to-use-epipen Common Side Effects • • • • • • Fast, irregular or pounding heartbeat Sweating Headache Weakness or shakiness Paleness Feelings of over excitement, nervousness or anxiety • Dizziness • Nausea/Vomiting • Breathing problems Why 2 Injectors? • A second dose might be needed during a lifethreatening allergic reaction • protracted reaction—where symptoms may persist even after a first dose of epinephrine is administered • biphasic reaction—where symptoms may appear to go away but then come back, typically within 8 hours (sometimes up to 72 hours) after the initial allergic reaction. Next Steps • • • • MEDICAL EVALUATION 2nd Dose? Look at avoiding trigger in future Replace EpiPen QUESTIONS? Thank you! Resources • https://www.epipen.com • Prescribing information https://www.epipen.com//media/files/epipen/prescribing%20information. pdf • Patient Information https://www.epipen.com//media/files/epipen/patient%20information.pdf • http://www.nationwidechildrens.org/epipenhelping-hand
