Be Prepared for an Allergy With the Right Number of EpiPens

Most people with food allergies have a hard enough time remembering to carry one EpiPen (epinephrine auto-injector), so the thought of carrying two may sound overwhelming. Unfortunately, many people with severe food allergies may need more than one dose of epinephrine if they accidentally eat the food to which they’re allergic.

Two EpiPens out of their package
Joe Raedle / Getty Images News 

Food allergies are a common and potentially life-threatening medical condition. Nearly 30,000 emergency room visits occur every year in the United States as a result of food allergies, and it is estimated that 150 people die from their food allergies every year. As a result, it is very important that a person is prepared to treat an allergic reaction from accidentally eating the culprit food and knows how to use an epinephrine auto-injector.

More Than One Epinephrine Injection Sometimes Needed for Anaphylaxis

Studies have shown that a significant percentage of people of with allergic reactions to foods require a second dose of epinephrine, especially those with reactions to shellfish, peanuts and tree nuts.

A study of hundreds of cases at two academic medical centers in the U.S. found that 17 percent of adults presenting at the emergency department with food-related anaphylaxis needed more than one dose of epinephrine. In conclusion, they recommended all patients at risk for food-related anaphylaxis carry two doses of epinephrine. In this study of adults, the most frequent foods that triggered anaphylaxis were shellfish, peanuts, tree nuts, and fish.

The researchers also looked at whether children also needed more than one dose. Their study of over 600 cases at Boston hospitals showed that 12% received at least two doses of epinephrine in the treatment of anaphylaxis. Three percent of the children had received a second dose before coming to the hospital. The researchers concluded that children at risk of food-related anaphylaxis should carry two doses of epinephrine. Peanuts, tree nuts, and milk were the most common triggers of the food-related anaphylaxis for these children.

Carrying Two EpiPens

People with severe food allergies should carry at least two epinephrine auto-injectors in case an accidental food exposure results in an allergic reaction. Check with your healthcare provider for instructions on when and if a second dose of epinephrine should be used for severe allergic reactions. Your healthcare provider will likely discuss possible scenarios that may require a second dose of epinephrine. These may include severe reactions that continue to worsen despite the first dose of epinephrine, as well as reactions that don't improve within five to 15 minutes after the first dose of epinephrine.

Be sure to check your epinephrine auto-injectors for their expiration dates. These devices usually have a one-year expiration date because epinephrine breaks down with exposure to light, air, and high temperature. You may want to prominently label them and set yourself a reminder to get them replaced each year.

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By Daniel More, MD
Daniel More, MD, is a board-certified allergist and clinical immunologist. He is an assistant clinical professor at the University of California, San Francisco School of Medicine and currently practices at Central Coast Allergy and Asthma in Salinas, California.