How to save a life: understanding anaphylaxis

Anaphylaxis is an extreme allergic reaction experienced by some people with allergies to certain foods (like shellfish and peanuts), insect stings, and latex. Anaphylaxis should be differentiated from a common, non-emergent allergic reaction by the severity and locality of symptoms.

A true anaphylactic reaction will involve multiple systems of the body, comes on within five to thirty minutes of contact with the allergen, and can be life-threatening. One or more of the following symptoms will be present:

  • Rashes with itchy or burning hives
  • Vomiting
  • Diarrhea
  • Difficulty swallowing
  • Difficulty breathing (wheezing or turning blue)
  • Tightness in the chest
  • Losing consciousness
  • Stomach pain

(from the American Academy of Allergy, Asthma & Immunology)


Anaphylaxis is not only caused by eating certain foods, many people can also experience severe allergic reactions from contact with chemicals and latex, injection from bee stings, and inhaling dust, pollen or dander from plants and animals.

If you are experiencing severe allergic reactions, an immunologist will be able to help you identify the specific allergens and provide you with a prescription for a device that auto-injects epinephrine to stop the anaphylactic reaction and save your life.

Expert Advice

There are several epinephrine delivery systems on the market available to individuals with a confirmed diagnosis of anaphylaxis and a prescription. However, not all auto-injectors are created equal.

To be truly effective in an emergency, an auto-injector must deliver 0.3 mg of epinephrine for an adult dose; and 0.3 mg diluted by 50% for a child (0.15 mg epinephrine). The individual must be familiar with correct technique for administering a dose (injecting forcefully and directly into the outer thigh), otherwise precious time is lost. In some cases, it is up to a good Samaritan, or a teacher to administer the dose correctly to someone suffering from anaphylaxis. Furthermore, a good percentage of patients will require two doses of epinephrine within minutes – especially if they are not able to breathe.

Not all auto-injectors are “user-friendly”.

The well-known Epi-Pen® is a large, cigar shaped device that can be clunky to handle, and requires training for proper use. By contrast, the Auvi-Q® auto-injector comes in a short, flat pack and is easier to carry. The Auvi-Q® also has onboard electronics that calmly and clearly talk you through each step of administering a correct dose of injected epinephrine during an anaphylactic episode.


Sanofi voluntary recall of Auvi-Q®

In 2015, Sanofi, the manufacturer of Auvi-Q® auto-injectors, received 26 reports of “suspected device malfunctions in the US and Canada.” While none of the reports were confirmed, and none of the cases reported fatal outcome or serious injury, Sanofi removed its product from general distribution and use for testing and design improvement. (

Fortunately, Sanofi has announced it will release the new and improved Auvi-Q® on February 15th of this year, and is covered by most insurance. While I have not seen the new model personally, I hope that they have modified the outward appearance enough that it is no longer identical to EVZIO®, a naloxone auto-injector specific for opioid related emergencies – with the same shape, design, and size, and is also an “intelligent auto-injection system with voice and visual guidance.” (

You could save someone’s life…maybe even your own

carlpikespeakAs anaphylaxis is a personal interest and specialty, Carl Weil of Wilderness Medicine Outfitters has been following this recall story closely. In an emergency situation, there is simply no time to waste when someone is experiencing a severe allergic reaction that could be life-threatening. If you are in a public place with someone who is anaphylactic, assist that person with his or her auto-injector and direct someone to call 911 immediately.

Voice and visual prompting on auto-injector devices is a brilliant – and life-saving – innovation. Those diagnosed with anaphylaxis will not always be around properly trained personnel, or happen to live with a first responder. This is especially prudent for children with severe allergies, whose caregivers and teachers may not be familiar with how to administer epinephrine with an auto-injector.

final2_medThere is still the issue of accessing that critical second dose. While Auvi-Q® prescription packs come with two devices and one trainer ( , what if the patient only carries one device at a time? Or, what if that one device has been used previously, and a second dose is needed? This is where your training as a Wilderness First Responder is priceless: in my courses you learn how to take apart the most commonly used auto-injectors and reset them for a second dose. This skill takes minutes to perform, and can save a life. Ready to get started? Check out these free public access courses that cover the basics of Emergency Response and First Aid, then go to the Wilderness Medicine Outfitters homepage to find an upcoming training near you!

Golden WFR 3 2017 jpeg


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