Anaphylaxis can be a matter of life and death. That's why carrying an EpiPen® is so crucial. But what if this emergency treatment fails to work?

First, the Importance of Anaphylaxis Treatment

"Anaphylaxis is a systemic allergic reaction that can involve swelling of the upper airway, which can cut off breathing, trigger severe asthma, or cause a life-threatening drop in blood pressure," explains Rauno Joks, MD, associate professor of Clinical Medicine and Chief of the Division of Allergy & Immunology for SUNY's Downstate Medical Center.

Dr. Jok says that EpiPens do usually work. During anaphylaxis, the blood vessels dilate and leak fluid in the airways causing swelling and a drop in blood pressure. The epinephrine then constricts the vessels and reduce leaking in your airways. The EpiPen® also stabilizes mast cells (the source of histamine and other chemical mediators released during anaphylaxis) and relaxes the smooth muscles of the airways, reducing the wheezing that can also occur in those with asthma.

Reasons EpiPens Fail

Joks says that, occasionally, this anaphylaxis treatment won't provide needed relief for the following reasons:

  • Taking beta-blockers or other medications.
  • Using expired medication.
  • Storing your EpiPen® in extreme temperatures (hot or cold) that allow the medication to break down.
  • Not administering the EpiPen® properly according to the manufacturer's instructions.

EpiPen® Use for Best Results

Here are some simple and important ways to help avoid these pitfalls:

  • Always review your medication list with your pharmacist to discuss possible interactions.
  • Check the expiration date on your packaging periodically to make sure it's current. The medicine usually lasts a year, but sometimes it's already been sitting on the pharmacy shelf for months before you receive it.
  • Avoid keeping your EpiPen® in your glove compartment, your garage, refrigerator, or other places with extreme temperatures.
  • Pay attention to how the medication looks. If you notice that the liquid inside the pen looks cloudy, it's time to get a replacement.
  • Communicate with your doctor to make sure you know how to use an EpiPen®. For best absorption, it's usually administered on the lateral thigh muscle, but it's important to be properly trained to achieve the best results.

What You Should Know About EpiPen® Use

Even when you know how to use an EpiPen® and it works properly, it's still just buying you the time you need to access emergency medical care. This means right after using an EpiPen®, call 911 or head to the nearest emergency room. There's always the danger that you can experience a second onset of symptoms afterward, and the latter bout can be even more severe than the initial round.

What Else You Can Do

As you wait for emergency medical care, Joks says there a few key things you can do to help yourself manage your reaction:

  • Take a second dose of your EpiPen® after five minutes if you don't feel any relief from the first dose. (EpiPens usually come in two's for this purpose.)
  • Put up your feet if you're feeling lightheaded.
  • Use your fast-acting relief inhaler to deal with asthma symptoms.
  • Bring your used EpiPen® with you to the ER so your doctor will know what you took and so the hospital can also dispose of the treatment tool properly.

A Final Note

When using epinephrine, it's important to be aware that the medicine is a stimulant, so even when it works to stop your anaphylactic attack, it could cause some secondary side effects, including heart palpitations and anxiety. Joks says these symptoms are expected and can be a small price to pay for the EpiPen's potentially life-saving effects.

Dr. Rauno Joks reviewed this article.



American Academy of Asthma, Allergy, and Immunology (AAAAI). "Anaphylaxis Overview." N.d. Web. 8 Oct. 2012.

Food Allergy and Anaphylaxis Network. "Treatment of Anaphylaxis." N.d. Web. 1 Oct. 2012.

Joks, Rauno MD. Associate Professor of Clinical Medicine. Chief, Division of Allergy & Immunology SUNY Downstate Medical Center. Email interview. 5 Oct. 2012.