For people with serious allergies to foods, insect venom, latex, drugs, or other substances that can lead to a dangerous allergic reaction called anaphylaxis, carrying an epinephrine auto-injector—and knowing how to use it properly—could mean the difference between life and death. 

The Growing Risk of Anaphylaxis

Anaphylaxis is a life-threatening allergic reaction; symptoms include difficulty breathing, swelling, weakness, shock, and unconsciousness. "The prevalence of anaphylaxis has been increasing significantly," says Myron Zitt, MD, an allergist and past president of the American College of Allergy, Asthma, and Immunology (ACAAI). "Although previous literature suggested that up to two percent of the population has had an anaphylactic reaction, it's my opinion that the extent of the problem is more widespread."  

What this means is that a large number of people could be at risk of a life-threatening allergic reaction, and may lack the knowledge and tools they need to treat the symptoms while they wait for emergency medical care. "Most deaths from anaphylaxis occur in people who do not administer epinephrine (adrenalin) quickly enough to be effective, or else they don't use it at all," Zitt adds.

Epinephrine Auto-Injectors

The only acceptable way to treat anaphylaxis is with intramuscular epinephrine (epinephrine dispensed directly to the muscles). The easiest and most effective way to deliver epinephrine is with an auto-injector, which the patient or caregiver uses in an emergency to provide a one-dose shot of epinephrine.

For 25 years only one form of emergency anaphylaxis treatment was available, but recently the choices broadened: As of September, 2013, there are four options (three name brands and one generic version) on the market in the U.S. All four contain the same medicine, but each has different packaging, and different directions for use.

Current Treatment Options

The original epinephrine auto-injector is EpiPen® (epinephrine) Auto-Injector, which is shaped like a pen and comes with written instructions for use. It's been joined by Adrenaclick® (epinephrine injection, (USP) United States Pharmacopeia) auto-injector, and a generic version, called Epinephrine injection, USP auto-injector (epinephrine auto-injector). Both Adrenaclick® and Epinephrine injection look and operate in a similar fashion to EpiPen®, but differ slightly in their operation, which can cause confusion for people trained in using the EpiPen®. There's also a new device called Auvi-QTM (epinephrine injection, USP). This has a cell phone-like shape, which some users feel makes it easier to carry in a pocket.

"Auvi-Q also has audio and visual prompts instead of printed instructions, to talk the patient through the injection procedure, making it easier for an understandably anxious patient to appropriately administer life-saving epinephrine," Zitt says. 

The Need for Training

While the new devices (especially the Auvi-QTM and its audio/visual features) may appeal, familiarity with EpiPen® may make the older treatment treatment a better option for some patients: "Since patient and/or caregiver familiarity with a device is likely to improve compliance, those with long experience using one device may be well served by continuing to use it," Zitt says. "This may be particularly true for school nurses and emergency technicians, who are most familiar with EpiPen®, which has been available in this country for 25 years." If a person does want to switch devices, Zitt stresses that appropriate training in proper usage is essential.

What You Can Do

It's also important for patients to be educated about anaphylaxis in general and to take a proactive role in preventing and treating the problem. To this end, Zitt recommends these key steps:

  • With the help of your doctor, create an action plan to identify and avoid your anaphylaxis triggers, and have written guidelines on what to do in an emergency.
  • Learn how to recognize the warning signs of a reaction, and know when to use your epinephrine.
  • Work with your doctor or pharmacist to determine what style auto-injector will best fit your needs.
  • Make sure you are familiar with your specific type of auto-injector, and have been trained in how to use it correctly
  •  Always have your auto-injector easily accessible and carry two doses, since a severe reaction may reoccur.
  • Call 911 after you use your auto-injector(s) and request emergency medical care. 

To learn more about anaphylaxis and using an auto-injector correctly, Zitt also suggests visiting the ACAAI's website at

Myron Zitt, MD, reviewed this article.




Angela Nace, PharmD. "Important News About Epinephrine Auto-Injectors." Kids With Food Allergies Foundation. 6 August 2013. Web. Page accessed Sept. 6, 2013.

Janna Tuck, MD. Generic Epinephrine Injector May Cause Confusion. American College of Allergy, Asthma and Immunology. Web. Page accessed 13 Sept. 2013

Carlos A. Camargo Jr., Adriana Guana, Sheldon Wang, F. Estelle R. Simons. "Auvi-Q Versus EpiPen: Preferences of Adults, Caregivers, and Children." The Journal of Allergy and Clinical Immunology: In Practice 2013: 1(3): 266-272e3.