International Journal of Allergy Medications Short Review: Open Access ClinMed International Library Citation: Ozbek OY (2015) Epinephrine Auto-Injectors. Int J Aller Medcations 1:006 Received: July 19, 2015: Accepted: August 30, 2015: Published: September 04, 2015 Copyright: © 2015 Ozbek OY. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Ozbek. Int J Aller Medcations 2015, 1:2 Epinephrine Auto-Injectors Ozlem Yılmaz Ozbek* Baskent University, Faculty of Medicine, Ankara, Turkey *Corresponding author: Ozlem Yılmaz Ozbek, Assoc. Prof. of Pediatric Allergy, Baskent University, Faculty of Medicine, 6. Cadde, No: 70/1, 06490, Bahcelievler, Ankara, Turkey, Tel: +90 312 2152114; Fax: +90 312 2157595; E-mail: ozlemyozbek@gmail.com Introduction Anaphylaxis is a systemic, potentially life-threatening allergic reaction that frequently involves severe respiratory symptoms and cardiovascular collapse [1]. Prompt injection of intramuscular epinephrine is essential. Without epinephrine injection, fatal outcomes can be more frequent; indeed, delayed administration of epinephrine has also been associated with increased mortality [2]. Epinephrine auto-injectors (EAIs) have been the corner stone in the emergency treatment of anaphylaxis since the 1980s [3]. Other drugs, such as antihistamines, corticosteroids or beta-agonists may be helpful, but should not be administered instead of epinephrine. Since anaphylaxis usually takes place remote from medical aid, people who are at risk of anaphylaxis should be educated about emergency treatment. An EAI should be prescribed and the patient should be informed how and when to properly use it [1, 4-6]. Indications for the prescription of EAI In order to prescribe EAIs, at least one of these absolute indications should be present [7-10]: 1. Previous anaphylaxis triggered by food, latex or aeroallergens 2. Previous exercise-induced anaphylaxis 3. Previous idiopathic anaphylaxis 4. Concomitant unstable or moderate to severe-persistent asthma and a food allergy (apart from oral allergy syndrome) 5. Venom allergy in adults with previous reactions (not receiving Abstract Anaphylaxis is a systemic, life-threatening reaction and immediate treatment is essential. The reaction can be fatal even with epinephrine injection. Epinephrine auto-injectors have been used in the emergency treatment of anaphylaxis since the 1980s. In this review, indications for the prescription, types, administration, and the problems with the use of epinephrine auto-injectors are discussed. The importance of patient and caregiver education is highlighted. Keywords Anaphylaxis, Epinephrine, Epinephrine Auto-Injector, Treatment maintenance venom immunotherapy) and children with more than cutaneous/mucosal systemic reactions 6. Mast cell disorders or increased baseline serum tryptase concentrations in addition to any previous systemic allergic reaction to insect stings, even in venom immunotherapy treated patients Prescribing at least one EAI with any of the following additional factors should be considered [11-12]: 1. Previous mild-to-moderate allergic reaction to peanut and/or tree nut 2. Teenager or young adult with a food allergy 3. Remote from medical help and previous mild to moderate allergic reaction to a food, venom, latex or aeroallergens 4. Previous mild-to-moderate allergic reaction to traces of food According to current guidelines, the weight-based dose of epinephrine (1:1000; 1 mg/ml) is the same in children and adults (0.01mg/kg). When using an EAI, children weighing 15-30 kg should receive a 0.15 mg dose and children over 30 kg or adults should be given 0.3 mg [13]. Consistent with the patient’s clinical status, such as incomplete resolution or recurrence of symptoms of anaphylaxis, further doses may be administered in every 5–15 minutes, or more frequently if needed [1,4-6]. Current data reveal that approximately 10–20% of anaphylaxis patients need repeated epinephrine injections due to biphasic reactions or inadequate treatment response to the initial dose. [14]. Terefore, it is recommended that all patients at risk for anaphylaxis always carry two epinephrine doses [6]. Types of EAIs Commercially, there are 6 diferent EAIs (Table 1). Among these, Epipen (Mylan Specialty L.P, USA) was the frst licensed and commonly used EAI since 1987. EpiPen is a single use, cartridge- based epinephrine auto-injector. Te device was released in the European Union (EU) in 1994 and is available in two forms; EpiPen and EpiPen Junior, which contain 0.3 mg and 0.15 mg of epinephrine, respectively. Recently, another commercial form of Epipen that contains double auto-injectors in one pack has been launched (Epipen 2-pak, Mylan Specialty L.P, USA). Another EAI, AnaPen (Lincoln Medical, UK) based on the subcutaneous insulin