Dr Andrew Baker Allergy Specialist Immunologist Auckland

Epipen®  and Anapen® patient information                      
EpiPen® and Anapen® Auto-injectors are for emergency use in anaphylaxis (severe allergic reaction) for people with a history of anaphylaxis.

About EpiPen® and Anapen®
These are single use, disposable, spring loaded injections that contain 0.3mg adrenaline which counteracts the effects of a severe allergic reaction and can be life saving. They are designed as emergency supportive therapy only and are not a replacement or substitute for emergency medical or hospital care.

We will show you how to use the Epipen® or Anapen® and give you a practice. They have pictures on them which show:

• the needle end is orange
• the blue safety cap   
• they can be injected into the thigh muscle through clothes if necessary, even jeans, but its best to avoid seams and pockets.

When should I use my Anapen® or EpiPen®?
This information is to be read alongside your Australasian Society of Clinical Immunology and Allergy (ASCIA) action plan for anaphylaxis which is your personal plan and tells you what to do if you are having a reaction and when to use your EpiPen®. A blank action plan can be downloaded from http://www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-action-plan-for-anaphylaxis

How to use an EpiPen® or Anapen®

• Take the EpiPen® out of the plastic holder.    
• Grip the EpiPen® in a tight fist. Do not put your thumb on the end (this is in case it’s the wrong way round and the adrenaline injection goes into the thumb which can cause damage to your thumb or fingers).       
• Hold the middle of the pen in a tight grip. Remove the grey cap.
• You may have been shown one of two ways to do this: you can either position the pen on the outer middle of the thigh, and push hard into the thigh until the unit functions and a click is heard, or you can take off the grey cap and then aim the pen and hit the outer thigh from a  short distance away.
• Hold the pen on the leg and COUNT TO TEN to allow the adrenaline to be injected by the auto-injector pen.
• If your EpiPen® has not clicked push harder into the thigh.
• Massage the area for several seconds to allow the adrenaline to spread out.

 What should I do then?
If you have just given yourself the injection you should:

• phone or ask someone to phone an ambulance on 111 (in New Zealand) and tell the operator you are having anaphylaxis and have given yourself adrenaline
• don’t sit upright if you feel light headed or dizzy as it can be dangerous
• lie down and wait for the ambulance
• record the time the injection was given and take it with you to the emergency room.

Disposal
Dispose of the Anapen® or EpiPen® by putting it back the plastic holder.

Advice on funding and cost

• You don’t need a prescription to get an EpiPen®.
• An EpiPen® costs about $140 and you usually have to pay for the first one, but if you are receiving support from WINZ they may help.
• Prices vary and some pharmacies charge up to $180.
• When I researched this recently I found the cheapest option to order it online at http://www.allergypharmacy.co.nz/.
• If you have to use your EpiPen® it is usually because of an accident (e.g. you accidentally ate peanut when you were peanut allergic, or you got stung by a bee).  In this case the cost of a replacement Epipen® and any ambulance costs may be ACC refunded, so please keep your receipts and approach ACC about this.
• Unfortunately pens that go past their use by date are not refunded.  Also pens      used for reactions of unknown causes are not funded.
• An EpiPen® should last 18 months but some pharmacies will sell you one which lasts less time because it has been waiting on the shelf already so check the expiry date. Shop around and get the cheapest one and make sure you get one that lasts over 12 months.

Epipen Anapen® maintenance and travelling

• Regularly check the EpiPen® expiry date.
• Renew the EpiPen® before the expiry date and record the expiry date on your calendar.
• Always have your EpiPen® with you at all times even if travelling abroad.
• DON’T put it in sunlight, in the glove compartment of your car or anywhere it may get too hot or in the fridge which is too cold. Room temperature is best.
• Pouches are available for men, women tend  to use their handbags.
• You can buy Epipen® trainers off the internet to practise with. Dr Baker will have shown you how to use Epipen® with one of these.
• It is better to use an out of date EpiPen® / EpiPen® junior than nothing at all in the event of a severe allergic reaction.
• Some people have 2 Epipens® – e.g. if they are going to be significantly long way away from any medical help (on a boat/ship or tramping/mountaineering).