Allergy kits come pre-loaded with doses appropriate for the patient. Repeat doses may be administered as directed by the physician if symptoms do not subside. Depending on the type, kits contain either one or two injectable doses. Therefore, it is not uncommon for people to have more than one kit available.

The medication delivery system in allergy kits comes in one of two forms:

• Needle and syringe (Ana-Kit, Ana-Guard). The syringe is preloaded with two doses of epinephrine separated by a stop to prevent accidental overdose. Instructions will vary depending on the kit, but may include:
  
  
• • Cleanse injection site – either the outer thigh or upper arm – with sterilizing swab if possible.
    
    
  • Hold the syringe with the thumb on the plunger.
    
    
  • If instructed to do so by product packaging, press plunger until excess air is removed from the syringe (plunger will stop). Then rotate one-quarter turn to prepare for injection. NOTE: This is not necessary with all kits.
    
    
  • Inject drug into the outer thigh or the upper arm. Push plunger until it stops.
    
    
  • Prepare for second injection, in case it is needed. Be sure to wait the time period specified in the instructions before administering a second dose.
    
    
  • Call 9-1-1 or head directly to the emergency room. Be sure to take along the used medication.
    
    
• Auto-injector (Epi-Pen, Epi-Pen Jr.). Contains a single, premeasured dose of epinephrine. The auto-injector originally was developed by the military to deliver antidotes to nerve gas. Sometimes described as a “fat pen,” the auto-injector is very easy to use. Instructions for use are as follows: 
  
  
• • Cleanse injection site – upper outer thigh – with sterilizing swab if possible.
    
    
  • Hold the injector with the black tip pointing down. Do not touch the black tip. Remove the gray safety cap and firmly press the black tip at a 90-degree angle to the thigh. The injection can be done through clothing, if necessary.
    
    
  • Press hard into the thigh (through clothing if needed) and hold the auto-injector in place for 10 seconds. The medication is automatically injected after an audible “click” is heard. Do not press the top of the injector with a thumb – if the device is accidentally upside down, the epinephrine could be injected into the thumb. Epinephrine injected into the hand can cause tissue damage.
    
    
  • Massage the injection area for 10 seconds. This speeds absorption of the epinephrine into the body.
    
    
  • Carefully look inside the injector to make sure the needle is showing.
    
    
  • • If the needle is showing, the drug has been properly injected. It is normal for a lot of medication to be left inside the injector. Do not try to inject the remaining medicine.
      
      
    • If the needle is NOT showing, the drug has not been properly injected. Repeat the process.
      
      
  • Press the needle against a hard surface to keep the medication from leaking out. Return the device into its carrying tube.
    
    
  • Prepare a second auto-injector, in case it is needed.
    
    
  • Call 9-1-1 or head directly to the emergency room. Be sure to take along the used medication.

A product called an epinephrine trainer is available. This is an auto-injector device without a needle or dose of epinephrine. It can be used to train people on how to use the device. The more comfortable people are with the auto-injector, the more likely they are to use the medication in an emergency, and to do it confidently and effectively.

Many physicians will be able to provide a patient with an instructional DVD or VCR tape that explains how the allergy kit works. These are usually provided to the physician by the manufacturers of the kits. Patients can learn how to properly use the allergy kit by watching these videos until they feel comfortable with the process.

Patients should make sure that their family members, friends and coworkers know how to administer epinephrine in an emergency situation. Parents should confirm that staff member’s at their child’s school or day care center know how to administer the drug.

Studies show that some parents tend to avoid using epinephrine injections on their children because of a fear of hurting the child, uncertainty over the symptoms of anaphylaxis or insecurities with the injection process itself. Physicians urge parents to familiarize themselves with the proper use of an allergy kit so that the parents will not hesitate to administer the medication, should the need arise.

Recent animal research has suggested that it may be possible to administer epinephrine orally. Although recent human studies look favorable, a dissolvable oral form of epinephrine is still several years away.