The Australasian Society of Clinical Immunology and Allergy

Adrenaline (epinephrine) is a natural hormone released in response to stress. It is a natural "antidote" to the chemicals released during severe allergic reactions tiggered by drug allergy, food allergy or insect stings. It is destroyed by enzymes in the stomach, and so needs to be injected. When injected, it rapidly reverses the effects of a severe allergic reaction by reducing throat swelling, opening the airways, and maintaining blood pressure. Use of adrenaline for treating anaphylaxis is First Aid.   Final Version 25 November 2000

Since episodes of anaphylaxis are unpredictable, a well thought-out "Action Plan" is an essential part of management and should be practiced by the patient and caregivers. It requires the patient and their caregivers to recognize early warning symptoms, to carry appropriate medication and to be trained in its use.

Use of Adrenaline in Anaphylaxis assists the body's natural response
The body's response to anaphylaxis is to release adrenaline, a natural "antidote" to some of the chemicals released as part of a severe allergic reaction. It can not be given by mouth, and inhaled adrenaline is ineffective. Injected adrenaline works rapidly to reduce throat swelling, open up the airways, and maintain blood pressure. It is the only medication available for the immediate treatment of severe allergic reactions.

The potential risks of NOT giving Adrenaline far outweigh the potential risks of giving Adrenaline
Adrenaline is advised when you have evidence of a potentially life-threatening allergic reaction, such as inability to breathe or a drop in blood pressure. When administered as directed, the risks of not giving adrenaline far outweigh any potential side effects of the medication. Common side effects from adrenaline are increased heart rate, an increase in blood pressure, thumping of the heart, shaking, nervousness or a transient headache. Of course needles hurt, but you have to remember why you are using it!

Store Adrenaline at room temperature
Adrenaline is best stored at room temperature and does not need to be refrigerated. As long as it is clear (and not brown and cloudy), it is normally safe to use. The shelf life of adrenaline is normally 1 or 2 years from the date of supply. You need to check the expiry date from time to time. Automatic injector devices like "Epipen" have a clear window near the tip where you can inspect the drug.

Adrenaline is best injected into the muscle of the mid thigh
The adrenaline is best injected into the muscle of the mid thigh. Injecting here makes it extremely unlikely that damage to any nerves or tendons will occur, or that it will be inadvertently injected into an artery or vein. It is also the least painful part of the body to give an injection!

There are 3 commercial preparations of adrenaline available in Australia
Your doctor will advise which is most suitable for your needs, and the dose required.

• Needle and syringe
• Mini Jet device
• EpiPen auto-injectors. (The EpiPen autoinjector device was originally developed for military use to administer antidotes to poison gas attacks. Each EpiPen has only one dose of adrenaline. It is designed to be used as a First Aid device by people without formal medical or nursing training).

How to Use the EpiPen Autoinjector
 

		1. Remove the device from its protective container
		2. Then remove the grey cap from the fatter end of the device (this "arms the unit" ready for use)
		3. Hold the EpiPen in your fist with clenched fingers wrapped around it (NB: there is nothing to "push" at the white end) Press the black tip gently against the skin of the mid thigh, then start to push harder until a loud "click" is heard. This means that the device has been activated. Hold in place for 10-15 seconds (count "1 elephant, 2 elephants 10 elephants) while the adrenaline is injected under pressure. NB: The EpiPen "pop" is often quite loud.
		4. Remove the pen from the thigh; be careful with the needle that will now be projecting from the EpiPen when you dispose of the device. Massage in the adrenaline. There may be some slight bleeding at the injection site. Apply firm pressure with a cloth, tissue, clean handkerchief or bandage. Record the time that the EpiPen was given. Call for help. DISPOSE of the used EpiPen carefully.