EpiPen(R) (Epinephrine) Auto-Injectors 0.3/0.15mg
Expert Opinions
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Discussing severe allergies and epinephrine with Dr. Mack
Dr. Douglas P. Mack, M.Sc., M.D., F.R.C.P.C. | Pediatric Allergy, Asthma, and Immunology Specialist
Learn from Dr. Mack as he discusses severe allergies and offers tips on how severe allergy sufferers like you can be prepared.
Expert Opinions is a new series featuring interviews with leading Allergists in Canada, who will be providing their insights on topics affecting severe allergy sufferers and their caregivers.
In this newsletter, we share our learnings from Dr. Douglas Mack, an Assistant Clinical Professor in the Department of Pediatrics at McMaster University and an affiliate of Sick Kids Hospital, about severe allergies and tips on how to be prepared.
In your opinion, what do severe allergy sufferers and caregivers find most challenging about managing severe allergies?
Dr. Mack: One of the biggest themes that I hear from families is a sense of uncertainty. When they first come into our office, there is an uncertainty with what the diagnosis is, how to deal with it, and how to treat it.
And when families leave our office and encounter the world after the diagnosis, their uncertainty shifts to how, when, and where an accidental exposure can occur; for example, if it will occur even if they take all the steps they are supposed to be taking; and how they will be able to communicate an allergy to restaurants and family members.
They are also uncertain about the treatments that are available to them; how to use them; and being able to respond in a severe allergic emergency to help treat their symptoms or their child’s.
What can they do to help them overcome this challenge?
Dr. Mack: I think it would be ideal for any patient who has a potentially severe allergy to be seen by a board-certified allergist. We can help ensure that an accurate diagnosis is made. Once we have that diagnosis, we can develop an ongoing relationship where we reassess them and answer any questions they may have. We can also provide education to families to ensure that they know how to avoid the trigger, when to use an epinephrine auto-injector, and how to use it to treat a severe allergic reaction. Lastly, we can tell them about treatment options and, for families struggling with food allergies, offer additional food allergy counselling.
What three tips can you offer food allergy sufferers and caregivers to help them avoid triggers at home and when they go out?
Dr. Mack: I always tell families: read labels, don’t take risks, and carry your epinephrine auto-injector.
If you’re in doubt, don’t eat a particular food. If you’re ordering from a restaurant, I always tell them to be prepared and ask ahead. That may sound like a lot of work, but it’s not. It’s a matter of calling the restaurant, talking to the chef or manager, and asking them if they can: (1) accommodate food allergies like yours or your child’s, and (2) exclude allergens from your meal or your child’s to help ensure there is no cross-contamination.  And finally, carry your epinephrine auto-injector. Accidental exposure can occur even if we read labels, avoid high-risk foods, and communicate allergies to restaurants or family members, but having a plan in place and knowing how to treat a reaction is, in my opinion, vital.
Why should they carry an epinephrine auto-injector at all times?
Dr. Mack: It’s an effective medication that we can carry around with us. Therefore, families should have access to epinephrine and make sure that it’s given early. Any time spent waiting for an injection could be life-threatening.
When should they use an epinephrine auto-injector?
Dr. Mack: I tell families and patients that they are never wrong to use their epinephrine auto-injector. They should use epinephrine at the first signs of a reaction, especially if they know that they or their child has been exposed to their trigger. The severity of an allergic reaction cannot be predicted, so I recommend that they use it early rather than wait for symptoms to get worse. Epinephrine can help treat their symptoms until medical help arrives or they can get to the hospital.
Which signs and symptoms should severe allergy sufferers and caregivers watch out for?
Dr. Mack: When I talk about signs and symptoms, I like to break it down into organ systems and tell families that they may differ depending on the age, trigger, and allergic diseases that are present in a patient.
The organ system people often recognize is the skin, and symptoms like hives, redness, blotchiness, and swelling. Getting very, very itchy is also fairly common: Babies will often put their hand in their mouth and scratch their tongue or throat to indicate this.
When it comes to the respiratory tract, people may notice some hoarseness of the voice, which suggest that the airway is being compromised. They may also notice coughing, wheezing, and a struggle to breathe, particularly in patients with asthma for whom respiratory symptoms may be more common.
A lot of patients will also report symptoms related to the GI tract like nausea, vomiting, diarrhea, and abdominal pain, whereas others will report light-headedness and feel like they’re going to pass out. They will often feel a sense of impending doom or are very scared. They may go off-colour, or babies may become lethargic, quiet, or show a lack of interest in what’s going on around them.
How can severe allergy sufferers and caregivers be prepared to act quickly in a severe allergic emergency?
Dr. Mack: I can’t stress proper training enough, particularly on recognizing symptoms and on understanding how to treat them. An epinephrine auto-injector is an easy device to use, but you don’t want to learn how to use it in the middle of your very first allergic reaction or your child’s. We want families and patients to learn how in advance of that situation.
I know that using an epinephrine auto-injector can be intimidating at first. But once families have been given the opportunity to practice with trainers—devices that don’t contain epinephrine—in our office, the more comfortable they are with using epinephrine auto-injectors in a severe allergic emergency. Beyond that, families can also order a trainer for their home: Parents, kids, grandparents, and other family members can practice along with videos online that show you how to use the device if they need a refresher or if they weren’t present during the appointment.
Can antihistamines be used in a severe allergic emergency?
Dr. Mack: No, we don’t recommend antihistamines instead of epinephrine. Antihistamines have not been proven to stop a severe allergic reaction and should not be used as a first-line treatment. 
Thank you for your insights, Dr. Mack. Stay tuned for more Expert Opinions in future EpiPen® newsletters.
Visit EpiPen.ca for more information on severe allergies and tips on how you or your loved one can be prepared in a severe allergic emergency.
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EpiPen® and EpiPen Jr® (epinephrine) Auto-Injectors are indicated for the emergency treatment of anaphylactic reactions in patients who are determined to be at increased risk for anaphylaxis, including individuals with a history of anaphylactic reactions. Selection of the appropriate dosage strength is determined according to patient body weight.
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