How To Use an EpiPen for an Allergic Reaction

An epinephrine auto-injector — more commonly known by the name EpiPen® — delivers medication for immediate treatment of a severe and potentially life-threatening allergic reaction (anaphylaxis).

“It’s really the first line of defense,” says allergist and immunologist Anuja Kapil, MD.

Using the device quickly and correctly is critical to administer the medication. EpiPens and other auto-injectors (such as Auvi-Q® and Adrenaclick®) are designed with simplicity in mind and work in similar ways. Follow the instructions on your specific device.

To use an EpiPen:

1. Remove the EpiPen from its carrier tube.
2. Hold the EpiPen with the orange tip ­(where the needle is) pointing downward and the blue safety cap pointing up. As a tip, remember this phrase: Blue to the sky, orange to the thigh.
3. Remove the blue safety cap. Pull straight up on it. Do not bend or twist it.
4. Place the orange tip against the middle of the outer thigh. Using a slight swing, jab the auto-injector into the thigh until you hear the device click. (The needle on an auto-injector is designed to go through jeans or pants.)
5. Hold the EpiPen firmly in place for three seconds to ensure the medication is fully delivered. Count slowly.

Auto-injectors are filled with prescribed amounts of medication for individuals. Dosages may differ (particularly between children and adults), but the delivery technique is the same for everyone. Just jab the thigh and let the epinephrine release.

When using an EpiPen on a child (or even adults), hold their leg firmly in place to limit movement while inserting the injector, advises Dr. Kapil. Keep the leg still for the three seconds needed to administer the epinephrine.

There’s no option to reinsert an EpiPen, so you’ve literally got one shot. Make it count.

“Minutes matter when you’re dealing with anaphylaxis,” she emphasizes. “Knowing what to do in the situation is important.”

What is an EpiPen?

An EpiPen is a one-use medical device that delivers a measured dose of epinephrine, typically into a muscle. Essentially, the medication is an adrenalin boost to help your body reverse an out-of-control allergic response.

But using an EpiPen or other auto-injector isn’t the end of medical care for a severe allergic reaction. It’s the start.

“Your symptoms can come back,” cautions Dr. Kapil. “It’s impossible to predict whether there’s going to be a second wave to the reaction. Given that, you need to be closely monitored in a medical setting.”

So, call 911 or emergency services immediately if a reaction is bad enough to require an EpiPen.

When to use an EpiPen

An EpiPen or similar auto-injector should be used at the first sign of a severe allergic reaction, says Dr. Kapil. Sound-the-alarm symptoms include:

• Swelling, which can lead to difficulty breathing or swallowing
• Shortness of breath or wheezing
• Belly pain
• Chest tightness
• Dizziness
• Vomiting
• Confusion
• Severe hives or rash

Many people with severe allergies also report a “sense of doom” as their body begins to react to an allergen, whether it’s a certain food, an insect bite, medication or other trigger. This feeling may start before symptoms become visible.

Take any symptom or sign of anaphylaxis seriously and don’t delay using an EpiPen. A dose of epinephrine can help keep airways open and reduce swelling while also halting the allergic response.

“We always suggest erring on the side of using it if there’s any hint that a serious reaction is underway,” states Dr. Kapil.

A second dose can be administered if the first injection doesn’t reduce symptoms within five to 15 minutes and the reaction continues to worsen. (This is why auto-injectors typically come in packs of two.)

Can you inject yourself with an EpiPen?

Absolutely. EpiPens and other auto-injectors are made for self-use.

But you may have difficulty administering the medication if a reaction is severe, notes Dr. Kapil. Make sure that people who are around you regularly — family, friends, coworkers, teachers, etc. — know how to use your auto-injector and where it’s located.

Can you use an expired EpiPen?

Prescriptions for epinephrine auto-injectors typically last a year and should be refilled before the medication expires. But it’s safe to say that sometimes, people don’t get that update when they should.

“If an expired auto-injector is all you have in an emergency situation, use it — but that should not be your plan,” says Dr. Kapil. “It’s not going to hurt you, but it might not help as much as it should.”