Allergy kits are a form of emergency treatment prescribed for those with a history of severe asthma or anaphylaxis, a potentially life-threatening allergic reaction. The kits usually come in a carrying tube that contains a device called an automatic injector and a premeasured dose of the drug epinephrine (adrenaline). However, kits with a needle and syringe and two doses of epinephrine also are available.

The patient uses the auto-injector or syringe to self-deliver epinephrine into the thigh. This reverses airway narrowing, raises blood pressure and halts other symptoms of anaphylaxis that can lead to death if not treated.

Patients with a history of anaphylaxis should carry these kits wherever they go so they are immediately available in an emergency.  However, recent studies have indicated that patients often fail to carry their kits, are not confident about using them and frequently fail to replace their epinephrine dose after it expires.

Patients should receive a full explanation of how to use the kit from a physician and not be reluctant to ask any questions. In addition, patients should ask for a dummy injector to familiarize themselves with the device. Manufacturers provide VCR tape and DVD instructions on the devices. Patients should request one of these videos and everyone who may potentially use the device should watch it. These steps may help lower the likelihood of a patient, loved one or caregiver hesitating to administer the medication or using the kit incorrectly.

Allergy kits are prescribed by physicians to patients who have a history of severe asthma or life-threatening allergic reactions known as anaphylaxis. The kits usually contain at least one injectable dose of the drug epinephrine, which reverses anaphylaxis symptoms such as wheezing, breathing difficulties and intense itching. The drug works by constricting the blood vessels, preventing fluid leakage, opening the airways and raising blood pressure.

The medication delivery system in allergy kits is available in two forms: auto-injection or needle and syringe. Each allergy kit should contain the following basic supplies:

• Instructions for how and when to use the kit
  
  
• Sterilizing swabs to cleanse the skin before and after injection
  
  
• At least one dose of epinephrine
  
  
• Antihistamine tablets to relieve lesser symptoms associated with anaphylaxis (antihistamines are not included in all allergy kits, and some physicians do not consider them an essential component)

Patients who receive allergy kits must closely follow their physician’s instructions for use. In addition, loved ones and caretakers should be taught how to inject the medication in case circumstances prevent self-injection. It is especially important to replace the epinephrine dosage when the drug expires, usually after 18 months. Tips for storing epinephrine properly include:

• Store out of the reach of children.
  
  
• Store away from heat and direct light.
  
  
• Do not store in damp places, including bathrooms or near kitchen sinks.
  
  
• Keep medicine from freezing.
  
  
• Safely discard outdated medicine to ensure that children and pets cannot access it. Patients can take expired kits to their physician's office or a hospital for proper disposal.
  
  
• A dose of epinephrine should be clear. Patients should not use the medication if it is discolored (turns pinkish or brownish) or contains particles.

Because allergy kits contain only one or two doses of medication, it is not uncommon for people to have more than one kit available. People may also choose to keep allergy kits in multiple places, such as in the home and at the workplace. For children, a kit can be kept at school or day care, as well as in the home.

It is important to note that allergy kits should never be left in a car. The inside temperature of a car can soar to more than 100 degrees Fahrenheit (38 degrees Celsius) in the summer or dip well below freezing in the winter (depending on its location). High temperatures can destroy the epinephrine, leaving it ineffective, and low temperatures can cause the contents to freeze, also weakening the potency significantly.

Studies have found that injection into the muscle tissue is more effective than simply injecting the drug under the skin. Epinephrine also appears to be more effective when injected into the outer thigh than when delivered into the deltoid muscle of the shoulder.

Patients should refrain from injecting epinephrine into their hands or feet, where blood flow is naturally lower than in other areas of the body. Accidental injection into these areas requires immediate medical attention to prevent tissue damage.

Epinephrine doses may be repeated if necessary – with a waiting time between doses (usually 15 minutes). However, a patient should always head to an emergency room after self-administering a dose of the drug.

Allergy kits are available only through a physician’s prescription. Studies have shown that many patients complain of poor instruction about how to use auto-injectors. Patients should receive a full explanation of how to use the kit from a physician. Patients also should not hesitate to ask any questions about allergy kit use.

The effects of epinephrine on unborn and nursing children are unknown. Women who are pregnant or nursing should consult a physician before using epinephrine. Women who have been prescribed epinephrine should also inform their physician immediately if they discover they have become pregnant.

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.

Allergy kits are prescribed for those with a history of anaphylaxis, a rare, severe allergic reaction that affects two or more body systems and often begins immediately after an individual has been exposed to a particular allergen. Food allergies, reactions to the venom contained in insect stings and bites, latex allergies, and medication allergies are the most common anaphylaxis triggers. Patients with a history of severe asthma attacks also may benefit from having an allergy kit.

Without prompt emergency treatment, anaphylaxis can quickly progress to life-threatening anaphylactic shock, which is characterized by difficulty breathing and a dangerous drop in blood pressure. Epinephrine usually reverses these symptoms quickly. It should be administered at the first sign of anaphylaxis.

Patients, loved ones and caregivers should be familiar with the symptoms of a severe attack so they will know when use of the kit is necessary. Early delivery of epinephrine is recommended because it is associated with a greater chance for survival, as well as a quicker recovery.

Upon injection, the effects of epinephrine should be immediately apparent. Anaphylactic symptoms such as breathing difficulties, wheezing and intense itching should decrease.

Epinephrine doses may be repeated, if necessary and as directed by a physician. Because kits contain only one or two doses, it is not uncommon for people to have more than one kit available. However, a patient should always head to an emergency room after self-administering a dose of the drug. In about 10 percent of all cases, anaphylactic symptoms recur within four to 12 hours after an initial episode. This is known as a bi-phasic reaction. Those who experience anaphylaxis should stay under medical supervision for a minimum of four to six hours after the attack subsides.

Patients should inform their doctors or pharmacists if they are allergic to sulfites or other medications. Some rare individuals may be intolerant to epinephrine and have a stronger-than-normal reaction to the medication.  Because epinephrine can be life-saving, a physician may encourage self-injection in emergencies despite the accentuated reaction.  

Patients also should tell a physician if they previously have experienced chest pain or a heart attack, irregular heartbeat, diabetes, high blood pressure, or an overactive thyroid gland (hyperthyroidism). Women who are pregnant or plan on becoming pregnant should consult a physician with regard to how epinephrine may affect the fetus.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians. Patients may wish to ask their doctors the following questions about allergy kits:

1. Am I a candidate for an allergy kit?
   
   
2. Can you show me exactly how to use my allergy kit?
   
   
3. Where can I obtain an epinephrine trainer?
   
   
4. Do I need to carry my allergy kit wherever I go?
   
   
5. How should I store my allergy kit?
   
   
6. What side effects may I develop from using an allergy kit?
   
   
7. How often does my allergy kit need to be replaced?
   
   
8. Is it safe to use an allergy kit during my pregnancy?
   
   
9. Can I use epinephrine before showing signs of an allergic reaction?
   
   
10. Should I have additional kits of epinephrine?
    
    
11. Should I go to the hospital following an injection of epinephrine? What if I am feeling fine?