Daily Nova: The One Thing You Need to Do Now With Four Epinephrine Auto-Injectors On the Market


Kids With Food Allergies Foundation (KFA) recently posted that there are now four different epinephrine auto-injector devices on the market. What does this mean for me, a parent whose child has life-threatening food allergies?

It means a few things. But most importantly, it means I need to educate and train myself on using the auto-injectors now, so I’m prepared and can respond promptly if my son or another child has a severe and life-threatening allergic reaction.

It also means I need to make sure that, in addition to family and friends, my son’s teachers know how to use his epinephrine auto-injector device.

KFA in its blog post stresses the importance of knowing the differences between the four commercially available epinephrine auto-injectors and making sure we get the one we want.

Generic Form of Adrenaclick Now Available

The recent availability of the Auvi-Q–an epinephrine auto-injector that is smaller than the other devices and provides voice instructions–has given patients, parents, and caregivers one new option.

According to KFA’s blog post, the FDA also has authorized a generic form of the Adrenaclick auto-injector. The four commercially available epinephrine auto-injector options are:

KFA provides a helpful chart outlining important differences between the epinephrine auto-injector devices, along with the manufacturers’ websites so we can view the training videos and get the information we need.

Know the Differences So You Can Treat Promptly

Most importantly, KFA tells us to know how to use the epinephrine auto-injectors we have so we can treat severe and life-threatening allergic reactions promptly.

In addition to knowing how your own device works, it’s also important to know the differences between the devices ahead of time in case we need to administer epinephrine to someone else during an emergency.

As KFA says in its post, training is essential because “each device has its own unique set of instructions for use.”

They sure do. After watching the training videos for the different devices, I can see how it could get confusing. Each auto-injector device has a different method for getting it ready to administer the epinephrine.

For example, for the EpiPen Jr, you pull off the blue cap from the top of the device (and the needle will pop out of the orange bottom when you administer it). For the Auvi-Q, you pull the cover off of the bottom of the device. For the Adrenaclick, it looks like you pull caps off of the top and bottom of the auto-injector.

Know How to Use Your EpiPenThese differences surely could lead to confusion for the untrained good Samaritan, especially in the stress of the moment. It puts into perspective the news reports I’ve heard about helpers sticking themselves instead of the person having the reaction.

For my son, we have both the EpiPen Jr and now the Auvi-Q. A few weeks ago, my husband and I were discussing the differences between the two devices. Using the Auvi-Q trainer with voice instructions, we learned that we only need to hold the Auvi-Q auto-injector in the thigh for five seconds, as opposed to the EpiPen Jr, which you are directed to hold in the thigh for about 10 seconds.

Thus, familiarize yourself–and your family members, friends, and teachers–on how they all operate so you all can be ready to help.

Dr. Wood Stresses Importance of Administering Promptly

At the recent Food Allergy Research & Education conference that I attended, Dr. Robert A. Wood, the chief pediatric allergist at Johns Hopkins Children’s Center, stressed the importance of being able to recognize anaphylaxis and treat promptly with epinephrine.

“Failure to treat promptly with epinephrine unifies virtually every death that’s ever happened from a food reaction,” Dr. Wood told the allergy group.

“It’s very hard to find reactions where epinephrine was given promptly where there was a bad outcome,” he said.

His message really resonated with me and drove home the importance of not delaying the administration of epinephrine. In past reports, I’ve written that we shouldn’t be scared, but I realize I will always be scared, no matter how many times I’m told that the risks of giving epinephrine are negligible compared to the risks of not giving epinephrine.

So even though I’m sure the situation will be scary, it doesn’t mean my nerves should affect my actions; I want to be prepared to recognize anaphylaxis and give that epinephrine ASAP!

Further highlighting the importance of being able to administer the epinephrine, Dr. Wood also told the group: “If you have it there and no one’s ready to use it, you’re still in trouble.”

Talk With Your Doctor; Get Right Prescription

KFA advises us to discuss the best option with our doctor, make sure the prescription reflects our choice, and make sure our pharmacist is on board with that choice.

(When thinking about which auto-injector is best for you, remember there also are dosing and weight guidelines. See my related story from the FARE conference.)

Too, KFA in its post reminds us that there is now a generic form of epinephrine available, so pharmacists in many states may be allowed to substitute a prescription with this generic form.

Thus, KFA advises, “If you or your physician prefer to receive a specific brand name of epinephrine auto-injector, your physician must indicate the brand name and ‘DAW’ (dispense as written) or ‘do not substitute’ on the prescription.”

Of course, new options are always a good thing in terms of affordability and usability. As with all new things, we just have to be diligent and learn about these new products now so we are ready if that emergency comes our way.

Kids With Food Allergies Foundation (KFA) provides education and management strategies to families raising children with food allergies and their communities. Please visit the KFA website for more information: http://community.kidswithfoodallergies.org/.

2 Responses to “Daily Nova: The One Thing You Need to Do Now With Four Epinephrine Auto-Injectors On the Market”
  1. gratefulfoodie

    Well written article! I think people pause when it comes to administering epinephrine. I hear story after story of parents saying they waited to see what was going to happen. I’m very happy to shared the importance of NOT delaying epinephrine!

    I wonder if the 4 options will truly bring us confusion or if folks will simply fall back into their patterns of using what they know? What do you think?

    • Alison Johansen

      Thank you! Yes, it is important to continue to get the message out that administering epinephrine promptly is key. I think the confusion will rest not with those who need and carry epinephrine auto-injectors, but potentially with other caregivers (or good Samaritans) who might only be familiar with one device.

      For example, we now have both the EpiPen and the Auvi-Q. Before preschool starts, I will bring in both trainers to make sure the teachers are familiar with them. We probably will carry the Auvi-Q ourselves and leave the EpiPen with the school, simply because they are more familiar with it.

      Too, there is the recent incident where the motorcyclist had an anaphylactic reaction on the road and a bystander (a fireman, I believe) found his EpiPen and administered it. Would the Auvi-Q have confused him? Hopefully not. What do you think?