Choosing the right auto-injector when considering anaphylactic reactions

Dr. Reza Alizadehfar, MD, FRCPC Allergist

Duration: 5 minutes and 24 seconds

The majority of patients who experience anaphylaxis have a food or a drug allergy or a venom allergy. For this reason it's very important for people to have a treatment on hand at all times.

The trouble with anaphylaxis is that it's very difficult to predict when a severe allergic reaction will occur or how severe the reaction itself will be. It’s also difficult to predict what the severity of the next reaction will be. For this reason it's very important for people to have a medication on hand at all times.

Currently, the recommended treatment for severe allergic reactions is epinephrine which comes in what’s called an auto injector. It's important for patients who are at increased risk to have an epinephrine auto injector with them at all times in the event they come into contact with their allergen.

Unfortunately, a lot of patients don't carry an auto injector with them consistently. As this condition is unpredictable, patients don’t always have the forethought or desire to carry a device on them. Sometimes they might find the auto-injector device inconvenient as it may be too large, or not the right shape to carry. For example, we often see patients leave it at home or in their car. This is definitely a huge problem when these reactions come along unexpectedly.

The size and functionality of an auto-injector device for this reason is really important. The device needs to accommodate people’s lifestyle and needs. For example, there are a significant proportion of patients for whom the format, size and functionality does matter. Women may need to fit the device into a purse and men may need it to go discretely into a pant or jacket pocket.

In Canada, we do have several options and we try to choose the right auto-injector device for each patient. It's important to have a conversation with our patients to try to see which one of devices would be best for them.

Some auto-injector devices have been around for a long time and there are patients that have familiarity with them. Some of the newer devices come in different formats, including smaller sizes such as a ‘pocket size’ format. Having a device that is easier to carry, particularly in small purses or pockets can help ensure the patients carry the device at all times. The smaller size can also be helpful for individuals with hand strength or dexterity issues.

There is also a new product that has a recorded voice in the device that can walk a person through the instructions on how to administer the injection. This can be useful when a friend or family member has to help inject the patient. It can also help when patients, friends or relatives are anxious during the anaphylactic event.

It’s rare for patients not to have some anxiety when using devices that have a needle. Having to either give an injection to yourself or to your child is naturally anxiety provoking. Newer auto-injector devices are designed to never show the needle at all, which definitely represents an advantage to some of our patients.

Having said that, it's important to keep in mind that anaphylaxis itself can be a very dangerous condition. Knowing that the benefits of using the injection to break a severe reaction by far outweighs the risks and fears of getting a needle. This is something that patients should be reminded about. As doctors, we have the role of educating patients and teaching them why it is important to use a needle based device for the treatment of these type of reactions. In summary, accidental exposure to allergens can happen. That's part of life. Epinephrine is a natural hormone that our own body produces. A good example of this is when we go rollercoaster riding and our heart races. This is because our adrenal glands have produced some epinephrine. So having a product that our own body produces, that can break a severe allergic reaction is reassuring. Because of its safety and effectiveness, it is advised that all patients who have an increased risk of anaphylaxis carry an epinephrine auto injector device at all times. Make sure you get one that suits your lifestyle and needs and that you are familiar with how to use it. Most importantly, do not hesitate to use it when it's needed, because the faster it is used following a severe reaction, the quicker you can break that cycle of things getting out of hand.

Presenter: Dr. Reza Alizadehfar, Allergist, Montreal, QC

Local Practitioners: Allergist