Allergy

FOOD ALLERGY OVERVIEW

If you have a food allergy, your immune system overreacts to a particular protein found in that food. Symptoms can occur when coming in contact with just a tiny amount of the food.

Many food allergies are first diagnosed in young children, though they may also appear in older children and adults.

Eight foods are responsible for the majority of allergic reactions:
• Cow’s milk • Eggs • Fish • Peanuts • Shellfish • Soy • Tree nuts • Wheat

Many people who think they are allergic to a food may actually be intolerant to it. Some of the symptoms of food intolerance and food allergy are similar, but the differences between the two are very important. If you are allergic to a food, this allergen triggers a response in the immune system. Food allergy reactions can be life-threatening, so people with this type of allergy must be very careful to avoid their food triggers.

Being allergic to a food may also result in being allergic to a similar protein found in something else. For example, if you are allergic to ragweed, you may also develop reactions to bananas or melons. This is known as cross-reactivity. Cross-reactivity happens when the immune system thinks one protein is closely related to another. When foods are involved it is called oral allergy syndrome (OAS).

Food allergy can strike children and adults alike. While many children outgrow a food allergy, it is also possible for adults to develop allergies to particular foods.

Food Protein-Induced Enterocolitis Syndrome (FPIES), sometimes referred to as a delayed food allergy, is a severe condition causing vomiting and diarrhea. In some cases, symptoms can progress to dehydration and shock brought on by low blood pressure and poor blood circulation.

Much like other food allergies, FPIES allergic reactions are triggered by ingesting a food allergen. Although any food can be a trigger, the most common culprits include milk, soy and grains. FPIES often develops in infancy, usually when a baby is introduced to solid food or formula.

Eosinophilic Esophagitis (EoE) is an allergic condition causing inflammation of the esophagus. The esophagus is the tube that sends food from the throat to the stomach. Most research suggests that the leading cause of EoE is an allergy or a sensitivity to particular proteins found in foods. Many people with EoE have a family history of allergic disorders such as asthma, rhinitis, dermatitis or food allergy.

FOOD ALLERGY SYMPTOMS & DIAGNOSIS

Symptoms
Allergic reactions to food normally occur within minutes of eating the trigger food, though they can sometimes appear a few hours later. Symptoms of a food allergy include:
• Hives or red, itchy skin
• Stuffy or itchy nose, sneezing or itchy, teary eyes
• Vomiting, stomach cramps or diarrhea
• Angioedema or swelling

In some cases, food allergies can cause a severe reaction called anaphylaxis. Signs of this reaction include:
• Hoarseness, throat tightness or a lump in the throat
• Wheezing, chest tightness or trouble breathing
• Tingling in the hands, feet, lips or scalp
If you experience any of these symptoms, call 911 immediately.

Diagnosis
Proper diagnosis of food allergies is extremely important. Studies have shown that many suspected food allergies are actually caused by other conditions such as a food intolerance. Skin tests and blood tests are often ordered. A food challenge under the care of your allergist / immunologist may also be needed to confirm an allergy.

FOOD ALLERGY TREATMENT & MANAGEMENT

Proper diagnosis of food allergy or food intolerance by an allergist / immunologist is the first step to managing your condition.

If you are diagnosed with a food allergy, the treatment plan will be to strictly avoid that food. If you are diagnosed with an intolerance, you may be able to ingest small quantities without having a reaction.

There is currently no cure for food allergies; nor are there medicines to prevent reactions. Yet there are steps you should take to manage your condition. The most important of these is avoiding coming in contact with food proteins that can cause an allergic reaction.

Read food labels to ensure that you don’t eat foods that contain foods to which you are allergic. Always ask about ingredients when eating at restaurants or when you are eating foods prepared by family or friends.

If you have severe allergies to food, be sure to complete an Anaphylaxis Action Plan and carry your autoinjectable epinephrine with you at all times. Use this medication in the event of an anaphylactic reaction.

For milder reactions, antihistamines may help relieve symptoms. Be sure to discuss this approach with your allergist / immunologist.

Food allergies can be confusing and isolating. Contact Food Allergy Research & Education (FARE) for patient support.

DRUG ALLERGY OVERVIEW

Adverse reactions to medications are common, yet everyone responds differently. One person may develop a rash or other reactions when taking a certain medication, while another person on the same drug may have no adverse reaction at all.

Only about 5% to 10% of these reactions are due to an allergy to the medication.

An allergic reaction occurs when the immune system overreacts to a harmless substance, in this case a medication, which triggers an allergic reaction. Sensitivities to drugs may produce similar symptoms, but do not involve the immune system.

Certain medications are more likely to produce allergic reactions than others. The most common are:
• Antibiotics, such as penicillin
• Aspirin and non-steroidal anti-inflammatory medications, such as ibuprofen
• Anticonvulsants
• Monoclonal antibody therapy
• Chemotherapy

The chances of developing an allergy are higher when you take the medication frequently or when it is rubbed on the skin or given by injection, rather than taken by mouth.

DRUG ALLERGY SYMPTOMS & DIAGNOSIS

Symptoms
Adverse reactions to medications range from vomiting and hair loss with cancer chemotherapy to upset stomach from aspirin or diarrhea from antibiotics. If you take ACE (angiotensin converting enzyme) inhibitors for high blood pressure, you may develop a cough or facial and tongue swelling.

In many cases, it can be difficult to determine if the reaction is due to the medication or something else. This is because your symptoms may be similar to other conditions.

The most frequent types of allergic symptoms to medications are:
• Skin rashes, particularly hives
• Itching
• Respiratory problems
• Swelling, such as in the face

Anaphylaxis is a serious allergic response that often involves swelling, hives, lowered blood pressure, and in severe cases, shock. If anaphylactic shock isn't treated immediately, it can be fatal.

A major difference between anaphylaxis and other allergic reactions is that anaphylaxis typically involves more than one system of the body.

Anaphylaxis requires immediate medical attention because the result can be fatal.
If you think you might be allergic to a medication prescribed by your doctor, call your physician before altering or stopping the dosage.

Diagnosis
Your doctor will want to know:
• When symptoms began
• A description of your symptoms
• How long the symptoms lasted
• Any other medications taken during this time, including over-the-counter drugs

If you have a history of reactions to different medications, or if you have a serious reaction to a drug, an allergist / immunologist, often referred to as an allergist, has specialized training and experience to diagnose the problem and help you develop a plan to protect you in the future.

DRUG ALLERGY TREATMENT & MANAGEMENT

If you have side effects that concern you, or you suspect a drug allergy has occurred, call your physician. If your symptoms are severe, seek medical help immediately. A serious anaphylactic reaction requires immediate medical attention because the result can be fatal.

In most cases of adverse reactions, your physician can prescribe an alternative medication. For serious reactions, your doctor may provide antihistamines, corticosteroids or epinephrine.

Standardized allergy testing is available for penicillin and may be followed by an oral challenge in the clinic. Such testing provides a high degree of reassurance that penicillin and like medicines can be tolerated in the future.

When no alternative is available and the medication is essential, a desensitization procedure to the medication may be recommended. This involves gradually introducing the medication in small doses until the therapeutic dose is achieved.
Make sure your physician, dentist and pharmacy are kept current regarding your drug allergies. This will help determine which medications should be avoided.

Allergy Symptoms

The severity and kinds of allergy symptoms depend on a person's genetics, the allergic condition and the type and amount of allergens involved.

There are many different types of allergic conditions.
An allergic condition is the appearance of allergy signs and symptoms in specific organs or areas of the body.
The most common allergy symptoms affect the nose, sinuses, lungs and eyes.
However, in some conditions, organs such as the skin, digestive system and blood vessels can be affected as well.

Not all allergic reactions happen the same way. Some allergy symptoms occur immediately after exposure to an allergen, while others take hours or days to occur.
Scientists think that the biological events leading up to immediate allergic reactions are different from those that result in delayed allergic reactions.

Immediate Allergic Reactions
Immediate allergic reactions typically occur within minutes of exposure to an allergen.
Allergic reaction time will vary depending on a person's genetics and on the site of the body affected.

Delayed or Late-Phase Allergic Reactions
Delayed or late-phase allergic reactions generally occur 2 – 6 hours after exposure (and even longer in some people).
Signs and symptoms of delayed or late-phase allergic reactions are generally the same as those for immediate allergic reactions.

In the case of allergic asthma, a delayed allergic reaction can cause other problems, such as loss of sleep due to nighttime asthma attacks.
There are ways to time allergy and asthma medications to reduce symptoms of the delayed allergic response.

Symptoms of Specific Allergies
Learn about signs and symptoms of different allergens and allergic conditions:
• Anaphylaxis • Animal allergy • Cockroach aller • Dust mite allergy • Eczema (atopic dermatitis) • Food allergy • Insect sting allergy • Latex allergy • Medication allergy • Mold allergy • Pollen allergy

Allergy Causes

Allergies and allergic reactions occur when the immune system misidentifies harmless foreign substances, called allergens, and reacts to them as if they were harmful.
Specifically, allergy symptoms result when the immune system makes IgE antibody that binds to a specific allergen in an effort to protect us from otherwise harmless allergens.
Allergens can include things like pollen, animal dander, latex and foods.

How People Develop Allergies
To become allergic, a person must have a genetic predisposition for allergy, meaning having a personal or family history of allergies, and must be exposed to a sensitizing allergen.
Most allergies begin in early childhood, and early environmental factors play a major role in the development of allergies.


Primary Exposure - Sensitization
An allergen, such as mold spores or pollen, enters the body through the mouth or nose or lands on the skin.
In a person with allergies, lymphocytes (T cells) recognize the allergen as foreign and release chemicals in response.
These chemicals travel through the blood and instruct another kind of lymphocytes (B cells) to produce IgE antibodies.
Some of these IgE antibodies attach to the outside of another special type of white blood cell called a mast cell.
Mast cells are scattered throughout the skin and respiratory tract. Their purpose is to help mediate the inflammatory response of the immune system. IgE antibodies can remain attached to mast cells for many years.


Secondary Exposure - The Cause of Allergy Symptoms
When the same allergen is encountered again, it binds directly to the IgE antibody attached to the outside of mast cells. This causes the mast cells to become activated and release chemicals, such as histamine. Histamine is an example of a chemical mediator — a special "messenger" chemical that immune cells use to talk to each other.

Histamine is one of the best-known mediators — it is responsible for causing many of the symptoms associated with allergies.
Histamine opens small blood vessels, causing them to leak fluid. This results in inflammation: warming and swelling of the skin, itching and watery eyes.
Histamine causes sneezing and the increased mucus production in the nasal cavity and airways that leads to runny nose, postnasal drip and cough.

Why Allergy Is Selective
Some people are allergic to lots of things. Some people are allergic to only one or to very few things. Learn more about why allergy is selective.

Allergic Conditions

Allergic conditions and allergic reactions occur when the immune system misidentifies harmless foreign substances-called allergens-and reacts to them as if they were harmful.
These allergens can cause different types of allergies and related conditions that affect different parts of the body.

Types
Allergic conditions include:
• Rhinitis (Nasal Inflammation) • Allergic Asthma • Hives (Urticaria) • Eczema (Atopic Dermatitis)
• Anaphylaxis

Allergic Rhinitis

In the United States, between 30 and 60 million people suffer from a runny or stuffy nose each year. This is a problem known as rhinitis. There are several types of rhinitis, including allergic rhinitis.

It's important to know about the different types of rhinitis, because often a person has more than one type for a physician to diagnose and treat.
• Allergic rhinitis: Seasonal allergic rhinitis (more commonly known as hay fever) is mainly an allergy caused by outdoor allergens, such as tree, grass and weed pollens, as well as some mold spores. If you sneeze and have a runny or stuffy nose during the spring, summer or fall allergy seasons, you may have hay fever. Hay fever is the most common type of allergy problem, and symptoms include sneezing; itching; runny or stuffy nose; and red, watery eyes.

• Nonallergic rhinitis: This type of rhinitis is not as well understood. Although not triggered by allergy, the symptoms are often the same as seen with allergic rhinitis. Allergy skin test results are negative. Nasal polyps may also be seen with this type of rhinitis.

• Vasomotor rhinitis: Common symptoms of vasomotor rhinitis include nasal congestion and postnasal drip. A person with this type of rhinitis may have symptoms when exposed to temperature and humidity changes. Symptoms may also occur with exposure to smoke, strong odors, including perfumes, and emotional upsets. Vasomotor rhinitis is not caused by allergy. However, it may occur in people who also have allergic rhinitis.

• Infectious rhinitis: This can occur as a cold, which may clear rapidly or continue with symptoms longer than a week. Some people may also develop an acute or chronic bacterial sinus infection. Symptoms include an increased amount of colored (yellow-green) and thickened nasal discharge and nasal congestion.

• Rhinitis medicamentosa: This type of rhinitis is seen with long-term use of decongestant nasal sprays or recreational use of cocaine. Symptoms may include nasal congestion and postnasal drip. Decongestant nasal sprays are intended for short-term use only. Overuse can cause rebound nasal congestion. It is very important for a person with rebound congestion to work closely with a doctor to gradually decrease the nasal spray.

• Mechanical obstruction: This is most often seen with a deviated septum or enlarged adenoids. Symptoms often include nasal obstruction, which may be one-sided.

• Hormonal: This type of rhinitis is often seen with changes in the hormones. This often occurs during pregnancy, puberty, menses or hypothyroidism. A very common cause of rhinitis is pregnancy. Symptoms include significant nasal congestion.

Allergic Rhinitis: Hay Fever Treatment

The goal of treatment for hay fever (seasonal allergic rhinitis) is to reduce symptoms. This often includes identifying, controlling and/or treating things that make your symptoms worse, as well as using and understanding medications.

Anti-inflammatory medicines: These control inflammation in the body. This inflammation causes redness and swelling (congestion).

Nasal steroid sprays: These work well to reduce nasal symptoms of sneezing, itching, runny and stuffy nose. Nasal steroids may also improve eye symptoms. A steroid nasal spray may work after several hours or take several days to work, but the best benefit is usually found after regular extended use. Nasal steroids work best if you take them daily. Nasal steroids are often the most effective medications for nasal allergy symptoms.

Montelukast: This is an anti-allergy medication that blocks certain allergy mediators and reduces swelling, sneezing and runny nose.

Cromolyn and Nedocromil: These are anti-inflammatory medicines that are not steroids. They may help prevent nasal and eye symptoms. Unfortunately, these are often not as effective as some other allergy medications.

Nasal wash with salt water: This may help clean out your nose, and, when done routinely, this can also lessen postnasal drip. If you do a nasal wash, do this before using other nasal medicine.

Antihistamines: These can help decrease allergy symptoms. They may be used daily during allergy season or just when allergy symptoms occur. There are many different antihistamines. If one doesn't work, another can be tried. Some can make you sleepy, and some do not. They may also affect thinking and your reflexes. Because of this, it is best to avoid a sedating antihistamine, especially if you will be driving or using any kind of machine. If possible, it is best to use a non-sedating or less sedating antihistamine.

Decongestants: These help when your nose is stuffy (congestion). They are available as pills, liquids or nasal sprays. Many are available over the counter. Use caution when taking a decongestant nasal spray. Using one longer than four days can have a severe rebound effect. This may cause you to have a lot more nasal congestion.

Allergy shots (also known as immunotherapy): These may be very helpful for specific allergies that aren't controlled with medicine. You should see a board-certified allergist for allergy testing or allergy shots.

Allergen avoidance The best way to prevent allergic rhinitis is to avoid the things to which you are allergic.
• Animal allergy • Dust mite allergy • Insect sting allergy • Food allergy • Latex allergy • Medication allergy • Mold allergy • Pollen allergy

Allergic Asthma

Allergies can make asthma symptoms worse. So it is best to avoid the things to which you are allergic. Knowing if you are allergic, and to what, can help you take appropriate measures in your home to decrease exposure to these allergens. Although many of the measures are important for the entire home, your bedroom is the most important room in the house because that is where you usually spend 1/3 to 1/2 of your time.
Learn how to reduce allergies and asthma, based on your type of allergy.
• Animal allergy • Dust mite allergy • Food allergy (Food allergies rarely make asthma worse.) • Latex allergy • Mold allergy • Pollen allergy

Allergy Shots (Immunotherapy)
If you are allergic, actions to avoid exposure are recommended whenever possible. This can be difficult if you are allergic to pollen, molds and dust mites. Allergy medications, including prescription nasal sprays and antihistamines, can help control symptoms.

If actions to avoid exposure and medications are not effective, your doctor might consider allergy shots. Allergy shots have been shown to reduce symptoms associated with pollen, certain molds, dust mites and cat dander.

Allergy Diagnosis

The diagnosis of allergies, or allergic disease, is based on a combination of the person’s clinical history, family history, physical examination, skin tests and laboratory tests.
These tests serve to confirm the diagnosis of allergic disease and to identify potential allergic triggers, knowledge that is useful to guide allergen avoidance strategies.

Your doctor uses the following information to make a diagnosis of allergy:
• History: The diagnosis of allergy begins with a clinical history. Your doctor will ask questions about your general health and then will focus on allergies and conditions that commonly coexist with allergic disorders, such as asthma and eczema (atopic dermatitis). Your doctor will need to know all the symptoms that are troubling you.
• Family History: Your doctor will ask you whether any of your close relatives have allergic symptoms and whether they have been diagnosed with an allergic disorder such as asthma, hay fever or eczema, or allergic sensitivity to foods or medications.
• Physical Exam: Your doctor will perform a complete physical exam with special emphasis on your eyes, ears, nose, throat, chest and skin.
• Allergy Tests: Allergy tests will likely be performed to determine whether you are allergic and what you are allergic to. Skin tests are carried out by applying drops of allergens to your skin and then scratching or pricking though them. Blood tests may also be performed to evaluate for the presence of sensitizing antibodies.

Reasons to See an Allergy Expert
Many people with allergies see a primary care doctor for allergy care. You may choose to visit a board-certified allergist, which is a doctor who specializes in allergies, for your allergy testing and treatment. Here are a few reasons for seeing an allergy specialist:
• Your regular doctor refers you to an expert for specialized tests.
• Your symptoms interfere with your daily activities.
• Your symptoms are getting worse.
• You are concerned about side effects of medicine.
• You are interested in different types of therapies to treat your symptom

Allergy Tests

The diagnosis of allergies, or allergic disease, is based on the clinical history, family history, physical examination, skin tests and laboratory tests. The tests serve to confirm the diagnosis of allergic disease and to identify potential allergic triggers, knowledge that is useful to guide allergen avoidance strategies.

When you see an allergy specialist, allergy tests will likely be performed to determine whether you are allergic and what you are allergic to.
Skin prick tests are carried out by applying drops of allergens to your skin, usually on your back and occasionally on your arm, and then scratching or pricking though them.
Skin tests are used to test for allergies to environmental allergens, such as pollens, molds, dust mites and animal dander, and also to foods.
If you are allergic to an allergen, you will get a bump and redness where the skin is pricked. After a short time, each skin test reaction is measured for swelling and redness.
A large enough skin reaction is a positive skin test. This means an allergy may exist to the allergen placed at that site.
Your doctor will compare your skin prick test results with your history of symptoms.

Allergy blood tests evaluate for sensitizing IgE antibodies that bind to environmental and/or food allergens and may be performed if skin testing cannot be done, or to gain additional information.

Allergy Treatment

Allergy symptoms can be successfully relieved through a combination of allergen avoidance and allergy treatment options, including allergy medications and immunotherapy.

The primary strategy of treating allergies is the careful identification of what a person is allergic to and staying away from those things.
If that is not possible, medications are used to treat the symptoms of allergy.
Additionally, immunotherapy is used to control symptoms of moderate to severe allergies, if avoidance and medications are not working.

At National Jewish Health, some of the nation's best doctors work with patients in a targeted specific manner to help alleviate and manage allergy symptoms. Learn more about Allergy Programs.

Allergy Medications
Many medications are available to treat the various allergy symptoms.
Allergy medications include antihistamines, leukotriene modifiers, topical and systemic steroids and anti-IgE medications.
Allergy Shots (Immunotherapy)
Currently, allergy immunotherapy is the only proven cure for some allergens. Unfortunately, it does not work for everyone.
Over time, small amounts of what a person is allergic to are introduced, and this helps reduce allergy symptoms in some people who are unable to avoid allergens and who do not respond well to other medications.
Allergy shots may also reduce future sensitization.

Sublingual Allergy Immunotherapy
Sublingual immunotherapy is an alternative treatment method to treat allergies without injections.
Small doses of allergens are introduced under the tongue to reduce allergic symptoms.
Currently, the U.S. Food and Drug Administration (FDA) has approved only three sublingual products.
Two are directed at different kinds of grass pollen, and one is for short ragweed.
The two grass pollen allergy tablets are: Oralair® (Stallergenes), which has five kinds of northern grass pollen, and Grastek® (Merck), which has Timothy Grass pollen.
The short ragweed allergy tablet is called Ragwitek® (Merck).

Allergy Lifestyle Management

In addition to medical treatment, a person living with allergies can improve symptoms by avoiding allergens, which are the proteins that trigger allergies.

Allergen Avoidance
The best way to treat allergy symptoms is to avoid allergens. This is easy to say but can be hard to do, as completely eliminating microscopic allergens, such as pollen or mold spores, may be impossible.
However, even reducing the amount of exposure to allergens in your environment can lead to a significant decrease in symptoms, the need for fewer medicines and a higher quality of life; this is called environmental control.
After identifying what you are allergic to, focus your attention on those places where you spend the most time. These may include your house, place of work or car. The bedroom is especially important, because people usually spend a third to half of their time there.

Learn how to reduce allergen exposure, based on your type of allergy.
• Animal allergy • Dust mite allergy • Insect sting allergy • Food allergy • Latex allergy • Medication allergy • Mold allergy • Pollen allergy

Seasonal Tips
Learn ways to manage your allergies during certain times of the year.
• Spring Allergy Tips • Summer Allergy Tips • Winter Allergy Tips • Holiday Allergy Tips

HEPA Filters
One way to limit exposure to airborne allergens and irritants is the use of a High Efficiency Particulate Air (HEPA) filter. However, neither a freestanding HEPA filter nor a HEPA filter attached to a vacuum cleaner is a substitute for standard medical treatment.

Allergy Medications

Many different medicines are available to help control allergy symptoms when you can't avoid the things to which you are allergic.

Antihistamines
• Antihistamines are medicines that block the allergic reaction, and they are available in tablets, syrups and eye drops.

Drowsiness as a side-effect: Some over-the-counter antihistamines like Benadryl® cause drowsiness. Other over-the-counter antihistamines like Claritin® do not cause drowsiness. Newer prescription antihistamines such as Claritin®, Allegra® and Clarinex®, do not cause drowsiness (Zyrtec® may cause drowsiness in some patients).

Antihistamine and decongestant combinations: Some allergy medicines are available as a combination of an antihistamine and a decongestant. Allegra-D®, Claritin-D® and Zyrtec-D® help to relieve allergy symptoms plus nasal congestion. If you have high blood pressure, ask your doctor before taking any of these.

Eye drops: For eye allergy symptoms that don't respond to an antihistamine, check with your doctor about eye drops. There are a number of eye drops that include an antihistamine, decongestant or other anti-allergy treatments. Make sure you don't worsen eye symptoms by rubbing your eyes and exposing them to more pollen.

Antihistamines and allergy testing: Antihistamines interfere with allergy testing. Consult your doctor about which medicines you must stop taking before your scheduled allergy tests.

Epinephrine
• Epinephrine provide fast, reliable first-aid for an anaphylactic reactions. Anaphylaxis is a systemic (whole body), life-threatening allergic reaction, and is the most severe type of allergic reaction.

Steroids
Steroids work by reducing inflammation and are available only by prescription.
• Nasal sprays: Several different types of medicines are available as nasal sprays to reduce symptoms of sneezing and a runny nose. Nasal steroid sprays require a prescription and are effective in reducing nasal symptoms triggered by allergies and irritants such as perfume and smoke. Although a nasal decongestant spray doesn't require a prescription, use one with caution. It should be used only for a few days because longer use can cause a "rebound" effect that makes symptoms worse. There are also other types of nasal sprays to reduce symptoms.
• Topical steroids: For allergic skin conditions such as atopic dermatitis (eczema) and hives (urticaria), topical steroids are sometimes prescribed. There can be side effects with long-term use of these medicines, and they should only be used under a doctor's supervision.

• Anti-IgE antibody: A relatively new type of allergy medication is called anti-IgE antibody (omalizumab). These drugs work by preventing the release of histamine.

• Leukotriene Modifiers: Leukotriene modifiers are long-term control allergic asthma medications and rhinitis medications. They reduce swelling inside the airways and relax smooth muscles around the airways. Leukotriene modifiers are available as tablets. They are effective at improving asthma and rhinitis symptoms but not to the same extent as inhaled steroids.

Allergy Medication: FAQ

Antihistamines
Is there a major difference between Claritin and Clarinex?
Answer: Claritin is loratadine, which is metabolized in the liver to produce desloratadine, which is Clarinex.

Over-the-counter antihistamines are effective. Benadryl works well but can make you drowsy.
Claritin is a non-sedating antihistamine and is now sold over the counter.
At certain doses, both Claritin and Clarinex can cause sleepiness.
Allegra is an alternative since sleepiness is not a side effect.

Antihistamine/decongestant combinations are also effective. Their effectiveness can be increased by not using a single preparation for longer than a couple of weeks.

Cromolyn is available over the counter with the name Nasalcrom, and it is effective but must be used four times a day or more.

Other Medications for Allergies

How does Singulair help with allergies? Why is it suggested to take in the evening?
Answer: Singulair is a prescription medicine approved to help control asthma in adults and children as young as 12 months and to help relieve the symptoms of seasonal allergies in adults and children as young as 2 years. The reason why it works with both conditions is because the mediators present in asthma are also present in allergic rhinitis. In all of its studies, Singulair has only been tested with a single dose in the evening, so that is how it has been approved for use (it was originally formulated for relief of nighttime asthma symptoms). However, it is a once-a-day medication so its effects should last twenty-four hours. Singulair has no side effects such as drowsiness or dryness, like antihistamines. Singulair is a leukotriene antagonist, different than antihistamines.

I would appreciate some information on the upcoming IgE medication and the effects on spring allergies. How does it relate to allergy? When will it be available? Who would benefit from it? How would it benefit a person who has asthma-like myself? Where can I read more about it?
Answer: A relatively new anti-IgE medication is called Xolair (omalizumab). It is indicated for treatment of moderate to severe allergic asthma and has not been approved for nasal allergy (allergic rhinitis). However, it has been shown in studies that it can relieve hay fever and/or nasal (rhinitis) symptoms, but it must be injected and is far too expensive to justify its use for nasal symptoms only. Most people can treat their hay fever with much cheaper medication that doesn't require injections.

What is the cause and how do I get relief for watery eyes? I am a 70 yr old male with asthma. My eyes water constantly, so much so that tears run down my face. This occurs when I go outside (e.g. grocery shopping, walking, etc).
Answer: Watery, itchy eyes are usually related to allergic conjunctivitis, although other eye conditions can cause these same symptoms. There are a number of eye drops (e.g. Pataday, Zaditor, Alocril) eye drops can relieve the symptoms of itchy, watery eyes that you describe. Check with your doctor about trying this.

I have hay fever really bad in the spring and the fall; how soon before my bad season starts should I take my allergy meds?
Answer: Most medications are effective within a matter of days. Cromolyn takes a full month to be completely effective. Allergy shots may take as long as two years.

What is the best precaution to take knowing that I have severe reactions to insect bites (like swelling, blisters)? Are there certain over-the-counter medications that I should always carry?
Answer: Patients who have had systemic reactions to stings by vespids (honey bee, wasp, hornet, yellow jacket) or ants are at risk for allergic reactions that may be life threatening. Systemic reactions are those that cause low blood pressure, shortness of breath, gastrointestinal symptoms or swelling or rash distant from the site of the sting. Individuals who have experienced such reactions should carry injectable adrenaline that comes in pre-loaded syringes under the names Ana-Kit or Epi-Pen. These preparations are available by prescription only but can be life saving and should be carried by all patients with a history of systemic responses to these insects. It is especially important to carry one of these preparations if one is going to be participating in activities in remote areas. Antihistamines can be helpful but are not adequate for a life-threatening situation.

Allergy Shots (Immunotherapy)

Subcutaneous immunotherapy (commonly called allergy shots) is a form of treatment to reduce an allergic reaction to allergens.
Allergy shots consists of a series of injections (shots) with a solution containing the allergens that cause your symptoms.
There are usually two phases: buildup and maintenance.
Treatment buildup begins with a weak solution given once or twice a week. The strength of the solution is gradually increased with each dose. Once the strongest dosage is reached in few months, the injections are slowly spaced apart until it reaches once a month. At that point, sensitivity to the allergens has been decreased, and a person has reached a maintenance level.

Though not a cure for everyone, allergy shots can significantly reduce allergy symptoms in people who are unable to avoid allergens and who do not respond well to other medications.

Allergy shots should always be given at your health care provider's office since there is a risk of a severe reaction.

Research has shown that allergy shots can reduce symptoms of:
• Allergic rhinitis (hay fever)◦grass, weed and tree pollen allergies
• Allergic asthma
• Dust mites allergy
• Animal dander allergy
• Insect sting allergy

Allergy shots are less effective against molds and are not a useful method for the treatment of food allergy.

When to Consider Immunotherapy?
If you are thinking of allergy shots, ask your health care provider about a referral to a board-certified allergist. A board-certified allergist will follow a number of steps to evaluate if allergy shots are right for you.
1. The allergist will ask you questions about your history, environment and symptoms. This will help determine if skin testing is needed.
Prick skin testing may be done. This will help identify the specific allergens that are causing your symptoms.
Skin testing should only be done under the supervision of a board-certified allergist.

2. Once an allergy has been identified, the next step is to decrease or eliminate exposure to the allergen. This is called avoidance of allergen exposure or environmental control.
Evidence shows that allergy and asthma symptoms may improve over time if the recommended environmental control changes are made. For example, removing furry or feathered pets or following control measures for house dust mites and cockroaches may decrease symptoms. Preventing your contact with grasses, weeds and tree pollen may be more difficult. Closing outside doors and windows and using air conditioning decreases exposure in the home.
3. Next, your allergist may recommend medication. Antihistamines and nasal medications may be recommended.
Allergy shots may be recommended for people with severe hay fever. They may also be recommended for people with allergic asthma when the allergen cannot be avoided. Allergy shots and sublingual tablets should be prescribed only by a board-certified allergist.

Length of Time
Six months to a year of allergy shots may be required before you notice any improvement in symptoms.
If your symptoms do not improve after this time, ask you allergist to review your overall treatment program.
In general, allergy shots should be stopped if they are not effective within 2 – 3 years.
If the treatment is effective, the shots often continue 3 – 5 years, until the person is symptom-free or until symptoms can be controlled with mild medications for one year.
After stopping, some individuals may have return of symptoms. You should discuss this with your allergist to design an individual treatment program that optimizes your goals.

"Rush Immunotherapy"
"Rush immunotherapy" is a series of allergy shots. They are given over 2 – 3 days in a row.
This "rushes" the initial buildup phase of the treatment. Increasing doses of allergen extract are given every 30 minutes to hourly instead of every few days or weeks.
There is an increased risk of a reaction with this procedure. Therefore, rush immunotherapy should only be done in a hospital or high-risk procedure area under very close supervision.

Alternatives
There are a number of alternative treatments that claim to "cure" allergies. These methods are not supported by scientific studies, and they are not approved by the American Academy of Allergy and Immunology.
Unapproved alternative treatments include:
• high-dose vitamin and mineral therapy
• urine ingestion or injections
• bacterial vaccines
• exotic diets
• liquid sublingual therapy.

It can be easy to feel overwhelmed or confused by the many different methods of allergy testing and treatment. Some treatment strategies are undergoing vigorous scientific evaluation in clinical trials here at National Jewish Health and around the world, but they are not yet proven in safety and efficacy.
It is best to work with a board-certified allergist to evaluate and determine what is appropriate for you.

Allergy Treatment: FAQ

If you have allergies to oak, grass, weeds, mold, etc. would you recommend taking Claritin® all year?
Answer: There are various brands of antihistamines that are available, including non-sedating ones that are available over the counter. Some more effective nasal medications also provided relief.
The use of medications may be required for both year-round and seasonal nasal symptoms.
Allergy shots (immunotherapy) are an alternative to antihistamine therapy in people with multiple allergies and nasal symptoms (rhinitis).
A discussion with your care provider will help to put together a comprehensive treatment strategy personalized for your lifestyle.

I am extremely allergic to grass, tree, weed pollen, mold, dust mites, dogs and cats. I avoid the latter animals, but this season is so intense with pollen that nothing I take lasts for more than 4 or 5 hours. I can't even go outside of my house without a mask, which doesn't help much, and within minutes my eyes, nose and asthma kick in. I've tried taking lots of different antihistamines in high doses, but they tend to make me very drowsy. Also, I don't like having to take so much medicine all of the time. Any ideas?
Answer: Allergy shots (immunotherapy) may be the treatment option for you to help with such numerous and severe allergies. This therapy may help you avoid some of the side effects that you describe from the medicines.

I am 30 years old and have been suffering from allergies for 10 years. All the medicines I have tried over the years have failed to control it. Are there any alternatives?
Answer: An important key step is to be evaluated by a trained allergist to identify what may be causing your allergic reactions to see if those can be avoided.
Besides medication, hay fever and nasal symptoms can also be effectively treated with allergy shots (allergy immunotherapy).
This kind of treatment is very often effective and it initially requires weekly shots slowly spaced out to monthly.
However, this mode of treatment is the only one available that could cure allergies.

I am considering allergy shots for my daughter and was wondering if this will lead to her taking less medicine (Advair®, Clarinex®, Flonase®, Singulair®).
If the allergy immunotherapy is used properly, use of less asthma medicines should result.
This works especially well in children and young adults.
Allergy shots have been shown to reduce the future sensitizations.
There are important considerations to think about and discuss during an in-depth conversation with her and your allergist.

Are allergy shots (immunotherapy) relatively safe? This is one of the reasons I have held off giving them to my daughter, who is 14. Her doctor has recommended them, but the anaphylactic risk scares me.
Answer: There is some risk to allergy shots when done with proper dosing of allergens. These risks are minimized by proper observation after injections (in the doctor's office).
This type of treatment is indicated and usually well tolerated for an otherwise healthy 14-year-old adolescent, and they usually respond well.
If she is only sensitized to specific grass or ragweed, she may benefit from sublingual therapy that avoids shots.
Targeted precise tailored therapy is critical to optimizing her chances for a staying on therapy and a good outcome.

ANAPHYLAXIS: OVERVIEW

Anaphylaxis is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, medications.

If you are allergic to a substance, your immune system overreacts to this allergen by releasing chemicals that cause allergy symptoms. Typically, these bothersome symptoms occur in one location of the body. However, some people are susceptible to a much more serious anaphylactic reaction. This reaction typically affects more than one part of the body at the same time.

Anaphylaxis requires immediate medical treatment, including a prompt injection of epinephrine and a trip to a hospital emergency room. If it isn’t treated properly, anaphylaxis can be fatal.

Certain people are more at risk of anaphylaxis. If you have allergies or asthma and have a family history of anaphylaxis, your risk is higher. And, if you’ve experienced anaphylaxis your risk of having another anaphylactic reaction is increased.

Accurate diagnosis and successful management of allergies is essential. An allergist / immunologist, often referred to as an allergist, has specialized training and experience to diagnose the problem and help you develop a plan to protect you in the future.

ANAPHYLAXIS SYMPTOMS & DIAGNOSIS

Symptoms
Symptoms of anaphylaxis typically start within 5 to 30 minutes of coming into contact with the allergen to which you are allergic. In some cases it may take more than an hour for you to notice anaphylactic symptoms.
Warning signs typically affect more than one part of the body and may include:
• Red rash, with hives/welts, that is usually itchy (It is possible to have a severe allergic reaction without skin symptoms.)
• Swollen throat or swollen areas of the body (It is possible to have a severe allergic reaction without skin symptoms.)
• Wheezing
• Passing out
• Chest tightness
• Trouble breathing, cough
• Hoarse voice
• Trouble swallowing
• Vomiting
• Diarrhea
• Stomach cramping
• Pale or red color to the face and body
• Feeling of impending doom

Diagnosis
To diagnose your risk of anaphylaxis or to determine whether previous symptoms were anaphylaxis-related, your allergist / immunologist will conduct a thorough investigation of all potential causes. Your allergist will ask for specific details regarding all past allergic reactions.

ANAPHYLAXIS TREATMENT & MANAGEMENT

The best ways to manage your condition are:
• Avoid allergens that trigger your allergic reactions
• Be prepared for an emergency

If you are at risk of anaphylaxis, carry epinephrine autoinjectors (adrenaline). They contain a prescribed single dose of medication that is injected into the thigh during an anaphylactic emergency.

Be sure to talk to your healthcare provider about how to use the epinephrine autoinjector. It is important for you, family members and others in close contact with you or your child to know how to use the epinephrine autoinjector.

Complete an Anaphylaxis Action Plan and keep on file at work, school, camp or other places where others may need to recognize your symptoms and provide treatment.

Important Reminder
If you think you are having an anaphylactic reaction, use your epinephrine autoinjector and call 911 immediately so you can be transported to the nearest emergency department for evaluation, monitoring and any further treatement by healthcare professionals. Your life depends on this. Don’t take an antihistamine or wait to see if symptoms get better.

ANAPHYLAXIS: SUMMARY

Anaphylaxis is a serious allergic reaction that typically comes on quickly and may cause death. This medical emergency requires immediate treatment and then follow-up care by an allergist / immunologist, often referred to as an allergist.

Many people may not realize they have an allergy until they experience anaphylaxis. An allergist can examine you and make a proper diagnosis. If warranted, your doctor will prescribe injectable epinephrine to use in an emergency.

Anaphylaxis is triggered when the immune system overreacts to a usually harmless substance (an allergen such as peanut or penicillin) causing mild to severe symptoms that affect various parts of the body. Symptoms usually appear within minutes to a few hours after eating a food, swallowing medication or being stung by an insect.

Anaphylaxis requires immediate medical treatment, including an injection of epinephrine and a trip to a hospital emergency room. If it isn’t treated properly, anaphylaxis can be fatal. Sometimes symptoms go away, and then return a few hours later, so it is important to take these steps as soon as an anaphylactic reaction begins and to remain under medical observation for as long as the reaction and symptoms continue.

Symptoms of Anaphylaxis
Symptoms of anaphylaxis may include:
• Breathing: wheezing, shortness of breath, throat tightness, cough, hoarse voice, chest pain/tightness, trouble swallowing, itchy mouth/throat, nasal stuffiness/congestion
• Circulation: pale/blue color, low pulse, dizziness, lightheadedness/passing out, low blood pressure, shock, loss of consciousness
• Skin: hives, swelling, itch, warmth, redness, rash
• Stomach: nausea, pain/cramps, vomiting, diarrhea
• Other: anxiety, feeling of impending doom, itchy/red/watery eyes, headache, cramping of the uterus

The most dangerous symptoms are low blood pressure, breathing difficulty and loss of consciousness, all of which can be fatal. If you have any of these symptoms, particularly after eating, taking medication or being stung by an insect, seek medical care immediately (call 911). Don't wait to see if symptoms go away or get better on their own.

Common Causes
Foods: Any food can cause an allergic reaction, but foods that cause the majority of anaphylaxis are peanuts, tree nuts (such as walnut, cashew, Brazil nut), shellfish, fish, milk, eggs and preservatives.

Stinging insects: Insect sting venom from yellow jackets, honeybees, paper wasps, hornets and fire ants can cause severe and even deadly reactions in some people.

Medications: Almost any medication can cause an allergic reaction. Common medications that cause anaphylaxis are antibiotics and anti-seizure medicines. Certain post-surgery fluids, vaccines, blood and blood products, radiocontrast dyes, pain medications and other drugs may also cause severe reactions.

Latex: Some products made from natural latex contain allergens that can cause reactions in sensitive individuals. The greatest danger of severe reactions occurs when latex comes into contact with moist areas of the body or internal surfaces during surgery.

Exercise: Although rare, exercise can cause anaphylaxis. Oddly enough, it does not occur after every exercise session and in some cases, only occurs after eating certain foods before exercise.

Treatment and Prevention
If you (or anyone you are with) begin to have an allergic reaction, use your autoinjectable epinephrine and get to the closest emergency room. The sooner the reaction is treated, the less severe it is likely to become. If you have taken medications and are feeling better, go to the hospital anyway to be sure your reaction is under control.

Once you've had an anaphylactic reaction, visit an allergist to get a proper diagnosis. The allergist will take your medical history and conduct other tests, if needed, to determine the exact cause of your reaction. Your allergist can provide information about avoiding the allergen as well as a treatment plan. Avoiding the allergen(s) is the main way to remain safe, but requires a great deal of education. Specific advice may include:
• Food: how to interpret ingredient labels, manage restaurant dining, avoid hidden food allergens
• Insects: not wearing perfumes, avoiding bright colored clothing and high risk activities; wearing long sleeves/pants when outdoors
• Medications: which drugs/treatments to avoid, a list of alternative medications

In some cases, your allergist may suggest specific treatments, such as immunotherapy (allergy shots) to virtually eliminate the risk of anaphylaxis from insect stings, or procedures that make it possible to be treated with certain medications to which you are allergic.

Your allergist may also prescribe autoinjectable epinephrine. If so, be sure you understand how and when to use it. Always refill the prescription upon expiration. This medication should be carried with you at all times.

Your allergist may also want you to wear special jewelry that identifies you as having a severe allergy. This ID can provide physicians and others with important information about your medical condition.

If you have had an anaphylactic reaction, inform family, healthcare workers, employers and school staff about your allergy.

Healthy Tips
• Anaphylaxis is a serious allergic reaction that comes on quickly, causing at times severe symptoms that affect various parts of the body.
• The most dangerous symptoms are low blood pressure, breathing difficulty and loss of consciousness, all of which can be fatal.
• The most common causes of anaphylaxis are foods, medications and insect stings.
• If you (or anyone you are with) begin to have an allergic reaction, call for medical help to get to the closest emergency room.
• See an allergist for follow-up care and developing a treatment plan.

Feel Better. Live Better.
An allergist / immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of problems such as allergies, asthma, autoimmune diseases and the evaluation and treatment of patients with recurrent infections, such as immunodeficiency diseases.

The right care can make the difference between suffering with an allergic disease and feeling better. By visiting an allergist, you can expect an accurate diagnosis, a treatment plan that works and educational information to help you manage your disease.

Anaphylaxis

Anaphylaxis is a systemic (whole body), life-threatening allergic reaction, and is the most severe type of allergic reaction.
Fortunately, it is very rare and many people with allergies will not experience anaphylaxis.
Anaphylaxis can be caused by allergies to many environmental agents. The common ones are:
• Medicines • Insect stings • Foods • Latex

In addition to allergens, physical exertion can cause anaphylaxis. This is known as exercise-induced anaphylaxis.
Some forms of anaphylaxis are called idiopathic (unknown cause). Doctors diagnose this condition when they rule out the contribution from environmental factors.

Symptoms
Symptoms of anaphylaxis often appear quickly. They often appear within minutes of exposure to an allergen (a substance which causes an allergic reaction).
In a few cases, reactions have been delayed as much as 12 to 24 hours. Symptoms of anaphylaxis include:
• Breathing difficulties, coughing, chest tightness or wheezing
• Dizziness, fainting, rapid or weak heartbeat
• Swelling in the mouth and throat or trouble swallowing
• Flushing, itching, hives or a feeling of warmth
• Vomiting, diarrhea or stomach cramping along with some of the symptoms mentioned above

Anaphylaxis-Like Reactions

When exposed to a foreign substance, some people suffer reactions identical to anaphylaxis, but no allergy (IgE antibody) is involved. These reactions are called anaphylactoid (meaning anaphylaxis-like) reactions.
While the immune system must be "primed" by previous exposure to cause anaphylaxis, anaphylactoid reactions can occur with no previous exposure at all.
An example of something that can bring on this kind of reaction is radiographic contrast material. This is the dye injected into arteries and veins to make them show up on an X-ray.
Although the mechanism of an anaphylactoid reaction is different, the treatment is the same as for anaphylaxis.

Anaphylaxis: Triggers

An anaphylactic reaction is often triggered by an allergen exposure. An exposure may occur through injection, swallowing, inhaling or skin contact.

• Injected Allergens: Include bee, hornet, wasp and yellow jacket stings, and allergen extracts used for diagnosis and treatment of allergic conditions. Antibiotics such as penicillin can trigger a reaction by injection or ingestion (swallowing).

• Ingested Allergens: A severe reaction caused by a food allergy occurs after eating that particular food, even a small bite. Foods that most commonly cause anaphylaxis are peanuts, seafood, nuts and, in children, eggs and cow's milk. Skin contact with the food rarely causes anaphylaxis.

• Inhaled Allergens: An anaphylactic reaction from an inhaled allergen is rare. An example is a latex-allergic person who inhales particles from rubber gloves or other latex products.

• Multiple Factors: For some people, two or more factors may be needed to cause anaphylaxis. It has been recognized that an anaphylactic reaction can occur if a person eats a certain food and then exercises. Neither the food alone nor exercise alone causes any problem, but the two together do.

Anaphylaxis: Prevention

There are a few ways to help prevent anaphylaxis.
• Allergen Avoidance: To prevent anaphylaxis, it is important to avoid the allergen that causes the reaction.
That may not be easy since stinging insects can find their way indoors and allergenic foods can be concealed in a wide variety of food products.
If certain exercises trigger anaphylaxis, you may have to avoid those forms of exercise and/or modify them in consultation with your allergist-immunologist. Learn how to avoid certain allergens.

• Allergy Shots (Immunotherapy): For many people, allergy shots can help lower the risk of anaphylaxis and decrease the severity of reactions.
For example, allergy shots for bee, wasp, hornet and yellow jacket stings give effective protection 98 percent of the time.
There is some risk when an individual with past episodes of anaphylaxis is injected with an allergen, and the doctor's office should be ready to treat any anaphylaxis reaction.

• Medication Testing and Changes: If allergy shots are not practical or available for a particular allergen, the doctor has other options.
For example, if someone has experienced an anaphylactic reaction to penicillin, the physician might order skin tests before giving certain other types of antibiotics. In most cases, different classes of antibiotics are available.
People with a history of severe reactions to medicines should take a new medication orally (by mouth) whenever possible because the risk of anaphylaxis is higher with an injection.
Rarely, someone may get an infection that requires treatment with an antibiotic known to cause anaphylaxis in that individual. In this case, your allergist/immunologist may perform a procedure called desensitization. This involves administration of rapidly increasing oral (by mouth) doses of the antibiotic under carefully controlled conditions.

Anaphylaxis: Preparation & Treatment

These preparations can help a person at risk for severe allergic reactions to avoid and respond to an anaphylactic reaction:
• Wear a Medic Alert tag at all times.
• Be in the care of a board-certified allergist.
• Always carry an emergency kit with an antihistamine (chewable pill or syrup) and injectable epinephrine that you can give to yourself. Make sure you replace the injectable epinephrine after you use it or when it passes the expiration date.
• Know the symptoms of a life-threatening reaction and have an up-to-date Anaphylaxis Action Plan.

Treatment
How and When to Give Epinephrine
Learn why and watch our videos to eliminate the fear surrounding self-administered injections.

Epinephrine is the most important medicine for the treatment of anaphylaxis.
It is injected into the lateral thigh. A special syringe that is easy to give (to yourself or someone else) is available.
If prescribed, your doctor or nurse will teach you the proper way to use it.
The effects of epinephrine can wear off quickly, and it is possible a second dose of epinephrine or other medications may be required to treat the allergic reaction. Therefore, it is important to get emergency medical attention right away after giving the shot.
Common brands of epinephrine are:
• EpiPen® Auto-Injector
• EpiPen® Jr. Auto-Injector
• Adrenaclick® Auto-Injector
• Auvi-Q™ Auto-Injector (epinephrine injection, USP) 0.3 mg, 0.15 mg

Epinephrine is a life-saving medication for the emergency treatment of anaphylaxis. Therefore, it must be carried at all times by the person at risk for severe allergic reactions.

The Auvi-Q is the newest form of epinephrine available. It is a compact device that fits inside a pocket. It has voice instructions to guide the user through the injection process step by step.

Anaphylaxis Medications

Anaphylaxis is a systemic (whole body), life-threatening allergic reaction, and is the most severe type of allergic reaction. Fortunately, it is very rare and many people with allergies will not experience anaphylaxis.
Medicines, insect stings, foods and latex can cause anaphylaxis.
Epinephrine is a medicine used to treat an anaphylactic reaction. Epinephrine provides fast, reliable first-aid for an anaphylactic reactions.
A special syringe that is easy to give (to yourself or someone else) is available. If prescribed, your doctor or nurse will teach you the proper way to use it.
The effects of epinephrine wear off quickly. It is still important to get emergency medical attention right away after giving the shot.

Types of epinephrine include:
• Epi-Pen® • Adrenaclick® • Auvi-Q®

Epinephrine Injector: Using An Epi-Pen®

The EpiPen® Auto-Injector is an easy and convenient way to give epinephrine.
Epinephrine is a medicine used to treat an anaphylactic reaction.
The EpiPen is designed to provide fast, reliable first-aid for an anaphylactic reactions. It works quickly to help reverse symptoms which may follow exposure to insect bites and stings, food or drug reactions and exercise-induced anaphylaxis.

The EpiPen Auto-Injector is compact and easily carried in your pocket, purse or fanny-pack. The EpiPen is pre-assembled, filled and ready to use right away.
A tiny, concealed, spring-activated needle penetrates the skin once the syringe is activated.
The EpiPen is available in two strengths:
EpiPen (yellow label) and EpiPen Jr® (green label). Your health care provider will prescribe the EpiPen that you should use. You should be taught how to use the EpiPen by a health care professional.

How To Use An Epipen or Epipen Jr. Auto-Injector
■ Remove the Epipen from the carrier tube
• Flip open the yellow cap of the EpiPen or the green cap from the Epipen Jr Auto-Injector carrier tube.
• Remove the EpiPen or Epipen Jr. Auto-Injector by tipping and sliding it out of the carrier tube.
■ Give the Epipen injection
• Grasp the unit with the orange tip pointing downward. Never put your hands, fingers or thumb over the orange tip.
• Form a fist around the unit (orange tip down).
• With your other hand, pull off the blue safety cap.
• Hold the orange tip near the outer thigh.
• Hold the leg firmly when giving the EpiPen injection. This means holding a young child’s leg firmly in place and limit movement.
• Swing and firmly push against the outer thigh until it clicks so that the unit is perpendicular (at 90º angle) to the thigh. Do not inject into the buttocks.
• Hold firmly against the thigh for 3 seconds to deliver the medicine.
• Remove the unit from the thigh (the orange needle cover will extend to cover the needle) and massage the injection area for 10 seconds.
• Call 911 and seek medical attention right away. The effects from this medicine may wear off in 10-20 minutes.
• Take the used auto-injector with you to the hospital emergency room.

Video: Learn How to Use an EpiPen -- It Could Save a Life

Special Tips About Using an Epipen Auto-Injector
• Remember, if you use the EpiPen you should call 911 and seek medical attention right away. The effects from this medication may wear off in 10-20 minutes.
• After using the EpiPen, most people experience a rapid heartbeat and "nervousness." Ask your health care provider for a complete list of side effects.
• Watch for signs or symptoms of infection, such as persistent redness, warmth, swelling, or tenderness, at the EpiPen injection site. See the health care provider if this occurs.
• Keep your EpiPen at room temperature. Do not expose it to extreme cold, heat or direct sunlight. Refrigeration can cause the Auto-Injector to malfunction. Light and heat can cause the medicine to go bad, turning brown. Look through the viewing window of the unit regularly, to make sure the solution is clear and colorless.
• Check the expiration date on your EpiPen. Be sure to replace your EpiPen before the expiration date. You can dispose of an expired Epipen at the Doctors office or hospital.

Epinephrine Injector: Using An Adrenaclick®

The Adrenaclick is available in two strengths.
How to use an Adrenaclick
■ Giving the injection
• Remove the Adrenaclick® from the carrier tube.
• Pull off both grey (may be blue) end caps. You will now see a red tip.
• Grasp the unit with the red tip pointing downward. Never put your hands, fingers or thumb over the red tip.
• Hold the red tip near the outer thigh.
• Hold the leg firmly when giving the Adrenaclick injection to someone else. This means holding a young child’s leg firmly in place and limiting movement.
• Put the red tip against the middle of the outer thigh until it clicks so that the unit is perpendicular (at 90º angle) to the thigh. Do not inject into the buttocks.
• Hold firmly against the thigh for about 10 seconds to deliver the medicine.
• Remove the unit from the thigh and massage the injection area for 10 seconds.
• Call 911 and seek medical attention right away. The effects from this medicine may wear off in 10-20 minutes.
■ Caring for the used Adrenaclick
• Place the black portion of the carrying case on a firm surface. Slide the Adrenaclick into the case, needle with red end first. Place the other end of the carrying case over the Adrenaclick and close the case.
• Take the used Adrenaclick with you to the hospital emergency room.

Epinephrine Injector: Using An Auvi-Q®

The Auvi-Q® is an auto-Injector with voice instructions. It is an easy and convenient way to give epinephrine.
The Auvi-Q is available in two strengths, 0.3 mg. and 0.15 mg.

How To Use An Auvi-Q Auto-Injector
■ Remove the Auvi-Q from the outer case.
• Do not proceed until you are ready to use Auvi-Q. If you are not ready to use, the Auvi-Q replace the outer case.
• Once you remove the Auvi-Q from the outer case you will hear voice instructions.
■ Give the Auvi-Q injection
• Pull off the red safety guard. Pull firmly to remove. The safety guard is meant to be tight.
• Never put your hands, fingers or thumb over the black base, to avoid accidental injection.
• Place the black end against the middle of the outer thigh. Only inject into the middle of the outer thigh (upper leg). Do not inject into another location.
• If you are administering Auvi-Q to a young child, hold the leg firmly in place while administering an injection.
• Press firmly and hold in place for 5 seconds to deliver the medicine. Auvi-Q makes a click and hiss sound when activated. This is normal. Do not pull Auvi-Q away from the leg when you hear to click and hiss sound.
• The voice instruction system will confirm Auvi-Q has been used. The Auvi-Q will beep and the lights will blink red.
• Remove the unit from the thigh.
• The needle automatically retracts after the injection is complete, so the needle will not be visible after the injection.
■ After Using Auvi-Q
• Call 911 and seek medical attention right away. The effects from this medicine may wear off in 10-20 minutes.
• Take the used auto-injector with you to the hospital emergency room.
■ After Auvi-Q is given:
• The black base will lock into place.
• The red safety guard cannot be replaced.
• The viewing window will no longer be clear.
• Some medicine will remain in Auvi-Q. The injection is complete.
• After using the Auvi-Q most people experience a rapid heartbeat and "nervousness." Ask your health care provider for a complete list of side effects.
• Check the expiration date on your Auvi-Q. Be sure to replace your Auvi-Q before the expiration date. You can dispose of an expired Auvi-Q at the Doctors office or hospital.
• Remember, if you use the Auvi-Q, call 911 and seek medical attention right away. The effects from this medication may wear off in 10-20 minutes.