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Epinephrine Myths vs Facts

Epinephrine Myths vs FactsMyth: I have a mild food allergy and don’t need epinephrine.
Fact: A variety of factors contribute to the severity of allergic reactions to food. One is the strength of someone’s allergy, which may change over time. Additionally, certain conditions or co-factors may increase the likelihood and/or severity of allergic reaction. These include illness (especially fever), exercise, extreme heat, taking certain medications (e.g., NSAIDs such as ibuprofen) and menstruation. Since accidental ingestions, changes in the strength of the allergy and exposure to co-factors may all be unpredictable, it is typically recommended that patients with food allergy carry epinephrine at all times as a precaution.  
 
Myth: Babies can’t have epinephrine because their weight is less than that listed on the epinephrine autoinjectors/devices.
Fact: Epinephrine is prescribed by your allergist based on your child’s weight. Prior to 2018, epinephrine devices were only available in two doses: 0.15 mg (for people weighing 33-66 lbs/15-30 kg) and 0.3 mg (for those over 66 lbs/30 kg). Allergists have routinely prescribed epinephrine 0.15 mg for children weighing less than 33 lbs without adverse outcomes. Allergists prescribe epinephrine because anaphylaxis is a serious, life-threatening allergic reaction, and they consider the risks and benefits prior to prescribing any medications. This has become less of an issue since the availability of epinephrine 0.10 mg autoinjectors, which came on the market in 2018 for infants and children weighing less than 33 lbs who require epinephrine.
 
Myth: I’m just running out quickly; I don’t need to carry epinephrine.
Fact: It is typically recommended that patients with food allergies carry epinephrine at all times. Since not all allergen exposures are planned, carrying epinephrine is the best way to prepare for accidental allergen exposure/allergic reaction.  
 
Myth: I can use antihistamines or steroids instead of epinephrine.
Fact: Antihistamines never take the place of epinephrine. Anaphylaxis is a severe allergic reaction that can involve multiple or severe symptoms, including trouble breathing and low blood pressure. Antihistamines may be used to treat some milder symptoms that can affect the skin (e.g., hives, itching) but not severe symptoms. Epinephrine is the only medication that treats the serious symptoms that can affect breathing, blood pressure, throat tightness, voice changes, severe abdominal pain and repetitive vomiting. Epinephrine works very quickly, whereas antihistamines can take 30-60 minutes to start working.  
 
Many allergists provide patients with an allergy action plan that reviews the symptoms of anaphylaxis and when to use epinephrine. You should not delay using epinephrine if it’s needed. Studies show that administering epinephrine without delay decreases the risk of hospitalization and delayed reactions. Epinephrine, not antihistamines, should be given first if any of the severe symptoms occur. Antihistamines can still be used after epinephrine is administered for symptoms such as hives, itching and discomfort.  
 
Steroid medications have been prescribed in the event of anaphylaxis, but studies show they are not helpful in preventing a delayed reaction or treating the current symptoms of anaphylaxis. Steroids also take a long time before they start working; therefore, they are not useful for treating the immediate symptoms of anaphylaxis. Only epinephrine works quickly enough and addresses the serious symptoms.
 
Myth: One dose of epinephrine is always enough to treat the symptoms of a severe allergic reaction.
Fact: Anaphylaxis is a serious allergic reaction that can involve multiple parts of the body and is treated with epinephrine. Many factors can be associated with anaphylaxis and its severity. Although the majority of people experiencing anaphylaxis respond to one dose of epinephrine, there are circumstances when a second dose may be needed. Epinephrine is a quick-acting medication that lasts a short period of time in the body. Its half-life (the time it takes for half of the dose to be broken down in the body) is typically about 2-3 minutes. Therefore, one dose may help relieve the symptoms of anaphylaxis, but if these symptoms return, we recommend giving another dose of epinephrine to treat them. It is safe to repeat a dose within 5-10 minutes of the first dose if needed. Studies show that administering epinephrine without delay decreases the risk of hospitalization and delayed reactions.
 
Myth: I don’t need to practice how to use epinephrine.  
Fact: It is so important to practice how to use epinephrine using a trainer! Now more than ever, there are a variety of options for self-administered epinephrine. These include the new epinephrine intranasal spray as well as a variety of epinephrine auto-injectors. It is important to become familiar with the proper way to use your epinephrine device; proper technique for use is critical to make sure your epinephrine works when you need it. Additionally, allergic reactions can be stressful; practicing regularly will minimize the chance of making a mistake if you are frazzled.   
 
Myth: Using epinephrine will be painful and embarrassing.
Fact: People may feel hesitant to use epinephrine for a variety of reasons. Using the new intranasal formulation alleviates the need for injections. If intranasal epinephrine is not available, some epinephrine auto-injectors have an injection time of just two seconds, minimizing discomfort. Additionally, epinephrine is recommended for severe reactions; the discomfort of a severe, progressive allergic reaction is so much more than a quick injection! Most auto-injectors are designed to go through clothing, including jeans, so life-saving medication can be given without removing clothing.    
 
Myth: I have to go to the emergency room after administering epinephrine.  
Fact: In certain circumstances, it may not always be necessary to go to the emergency room (ER) after giving epinephrine. New guidelines about anaphylaxis suggest that people who have used epinephrine may not need to go to the ER if: 1) the symptoms have completely resolved, 2)  they are able to clearly and accurately report any symptoms,  3) they have additional epinephrine in case symptoms come back and 4) they can quickly and easily go to the ER if needed. Conversely, if symptoms persist or continue to worsen; the person is not able to report symptoms due to young age, disability, or symptom severity; no further epinephrine is available in case symptoms recur; or the ER is not easily accessible, it is strongly advised to call 911 and/or proceed to the nearest ER. If you are uncertain, it is safest to call 911 and proceed to the nearest ER. Additionally, since your allergist knows your individual circumstances best, it may be a good idea to discuss what to do in case of reaction with your allergist at your annual visit.
 
Myth: I need to refrigerate my epinephrine.
Fact: Epinephrine does not need to be refrigerated. It should be kept at a stable room temperature. Epinephrine devices should never be left in the car because temperature fluctuations can damage the medication. You should replace any devices left in a car, especially during warm weather.
 
Myth: I do not need to replace my devices since I have not used them.
Fact: Epinephrine has an expiration date. It’s important to check and keep track of your epinephrine's expiration date. Consider programming a reminder on your phone when you pick up your epinephrine from the pharmacy to alert you to refill them before they expire. It’s a good idea to regularly practice how to use your epinephrine so you are prepared in case you need it. There are several epinephrine options available, including a new nose spray version. It’s important to practice the proper technique for the type of device you have so you can use it correctly if it’s needed. You can go online to watch videos specifically for the type of epinephrine you have.  

Myth: I do not need to carry epinephrine if I am not going out to eat.
Fact: It’s important to always carry unexpired epinephrine with you, regardless of your plans, so you are protected in case of a reaction. Sometimes allergen exposure can occur even if you are not planning to eat out. It’s best to be prepared for an unexpected reaction in case you need epinephrine.  
    
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5/8/2025

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