Don’t let your worry about the side effects of epinephrine in children who use an auto-injector keep you from using it if they need it. Side effects can be managed, but allergic reactions can kill.
Epinephrine, also called adrenaline, is a hormone commonly prescribed as a treatment for severe allergic reactions (anaphylaxis). If you know people with serious allergies, some of them probably carry an epinephrine auto-injector, which is a syringe-like device that you jab into your outer thigh and hold for 10 to 15 seconds while the automatic injector does its work. Epinephrine has other medical uses too, for cardiac emergencies, but the reason for carrying pre-loaded, auto-injecting epinephrine is to treat yourself or your child for anaphylaxis while you are waiting for medical help to arrive.
You have probably heard of people who “will die in minutes if they are stung by a bee.” That’s death by anaphylaxis. Anaphylaxis occurs when your body’s responds to something you are allergic to, such as insect stings or foods, by releasing a substances called immunological mediators. These may cause your blood vessels to dilate, which lowers your blood pressure and makes you dizzy or may even make you lose consciousness. The lining of your bronchial tubes may swell, which makes it difficult or impossible to breathe. You may break out in hives or a rash, feel itchy and crawly sensations. If it is not promptly treated, anaphylaxis can kill you in a few minutes.
A dose of epinephrine rapidly constricts the blood vessels, relaxes the muscles in the bronchial tubes of the lungs to improve breathing, reverses tissue swelling, and stimulates the heartbeat. It reverses most of the symptoms of anaphylaxis, although more than one dose may be needed in severe cases. The instructions that come with the epinephrine auto-injectors specify that it is not a replacement for professional medical care, it is supportive care. If you have to use an auto-injector, you should also call 9-1-1- for emergency medical help. Keep the used injector so the medical staff will know exactly what you injected, and what the dose was.
Common Side Effects: The common side effects of epinephrine injections are not really side effects, they are what happens when your body gets a surge of epinephrine. The epinephrine can be produced by your adrenal glands in response to fear or anger, or it can come from an injection. The result is the same: you become pale, sweaty, shaky, nervous and your heart beats faster. Your blood pressure and blood glucose levels will rise. You may also have headache and nausea and even vomit.
I know from personal experience and from talking to co-workers who have used their injectors that the side effects of epinephrine are unpleasant, but the side effects are preferable to risking death from anaphylaxis. Side effects in children can be minimized by using an auto-injector with a dose appropriate for their size.
Uncommon Side Effects: Rarely, because of an overdose or accidental injection into a vein, the rise in blood pressure can cause cerebral hemorrhage. Overdoses can also cause pulmonary edema or cardiac arrhythmias. However, every source I found stated that the possibility of side effects is not a reason to avoid using epinephrine.
Accidental Injection: If you accidentally inject your hand or foot, the blood vessels will contract and you might lose blood flow. If you do this, go to the nearest emergency room immediately, because the tissues can be damaged from the lack of blood. From personal experience, I will tell you that it will be extremely painful. I was helping a pediatrician inject a toddler with epinephrine, the toddler decided to stop cooperating, legs and arms went everywhere, and the needle ended up in my hand.
Sources:
* Medical Physiology: A Cellular And Molecular Approach. Walter F. Boron, Emile L. Boulpaep (2005). Philadelphia, PA: Elsevier/Saunders
* EpiPen Jr versus EpiPen in young children weighing 15 to 30 kg at risk for anaphylaxis J
Allergy Clin Immunol. 2002 Jan;109(1):171-5.
* Package insert for EpiPen2; King Pharmaceuticals, Inc., Columbia, MD 21046, U.S.A.
