Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you’re allergic to, such as peanuts or bee stings. Anaphylaxis causes your immune system to release a flood of chemicals that can cause you to go into shock — your blood pressure drops suddenly and your airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting.
If anaphylaxis isn’t treated right away, it can be fatal. An EpiPen is an auto injector that contains epinephrine (also called adrenaline), a medication that narrows blood vessels and opens airways in the lungs. When administered during an anaphylactic reaction, epinephrine can reverse the signs and symptoms and prevent death. EpiPens are very effective at treating anaphylaxis and saving lives. However, in some cases, it may be possible to survive anaphylactic shock without an EpiPen if you receive appropriate emergency medical treatment quickly.
What happens during anaphylactic shock?
Anaphylactic shock occurs when anaphylaxis causes your blood pressure to suddenly drop to dangerously low levels. This is called distributive shock. Your body goes into shock when blood doesn’t circulate properly, depriving vital organs, such as your brain, kidneys and heart, of oxygen. If untreated, anaphylactic shock is extremely dangerous and can be fatal within minutes.
During anaphylactic shock, immune system chemicals like histamine lead to blood vessel dilation and increased permeability (leakiness). As a result:
- Blood pools in peripheral blood vessels, leading to low blood return to the heart and decreased cardiac output.
- Plasma leaks from blood vessels into the tissues, causing edema and loss of intravascular volume.
- Blood pressure falls rapidly, depriving the brain and other vital organs of oxygen.
In addition, swelling of the airways causes narrowing or obstruction, also reducing oxygen levels. Respiratory failure and cardiac arrest can occur within a few minutes if shock isn’t treated.
Can you survive without an EpiPen?
Surviving anaphylactic shock without an EpiPen is possible but very difficult. The key is getting emergency medical treatment immediately. The longer shock persists, the higher the risk of death and permanent organ damage.
If you’re having a reaction and don’t have access to an EpiPen, it’s vital to call 911 or emergency services right away. While waiting for help to arrive:
- Lie flat on your back with your legs elevated to improve blood return to your heart.
- Loosen any tight clothing to reduce breathing difficulties.
- Take an antihistamine like Benadryl if available.
- Have someone administer CPR if you lose consciousness or stop breathing.
Once emergency responders arrive, they can provide interventions to reverse shock and improve your chances of survival, including:
- Epinephrine: Giving epinephrine through an IV rapidly reverses the signs and symptoms of anaphylaxis. Several doses may be needed.
- IV fluids: Administering large volumes of IV fluids helps improve blood pressure and circulation.
- Airway management: Respiratory support, such as oxygen, intubation, and mechanical ventilation, helps ensure adequate oxygen levels.
- Medications: Other drugs like steroids and antihistamines can provide additional relief.
- Monitoring: Continuous monitoring of vital signs, oxygenation, and cardiac rhythms is important.
With aggressive and timely treatment in an emergency department, it’s possible to stabilize someone in anaphylactic shock. However, the longer the shock persists, the greater the risk of lasting complications or death. Studies show fatality rates over 3% even with appropriate emergency care.
Why is epinephrine critical for treating anaphylaxis?
Epinephrine is the first-line treatment for anaphylaxis because it acts quickly to reverse the life-threatening symptoms of anaphylactic shock:
- Constricts blood vessels to improve blood pressure
- Relaxes airway muscles to improve breathing
- Reduces swelling and histamine release
- Strengthens heartbeat
When given at the first sign of a reaction, epinephrine can prevent shock from developing in the first place. It provides vital time until emergency medical services arrive.
While sedatives like antihistamines relieve itching and hives, they don’t affect the dangerous drop in blood pressure or improve breathing. This makes epinephrine uniquely suited for anaphylaxis.
Benefits of epinephrine auto-injectors like EpiPen
EpiPens and similar auto-injectors provide an easy, fast way to administer epinephrine outside of medical settings. Benefits include:
- Easy to use – designed for self-administration or administration by laypersons
- Convenient, portable size
- Fast-acting – epinephrine is quickly injected into the muscle
- Fixed, premeasured dose removes guesswork
- Built-in safety features help prevent accidental injection
This makes epinephrine auto-injectors ideal for use by people with severe allergies, their caregivers, and first responders with little medical training.
Who is at risk of anaphylaxis?
Anyone with a severe allergy can experience anaphylaxis after exposure to an allergen, though some people are at greater risk:
- People with food allergies, especially to peanuts, tree nuts, fish and shellfish
- People with insect sting allergies
- People with medication allergies, such as to penicillin or NSAIDs
- People with asthma or other respiratory conditions
- People with mast cell disorder or elevated baseline tryptase levels
- People who have had anaphylaxis previously
Around 1-2% of the U.S. population has experienced anaphylaxis. Contact dermatitis and gastrointestinal symptoms are also common manifestations.
Because it’s impossible to predict the severity of an allergic reaction, people at risk for anaphylaxis should always have immediate access to emergency epinephrine and seek prompt medical care after use.
Prevention tips for people at risk of anaphylaxis
The best way to prevent life-threatening anaphylaxis is to avoid contact with known allergens. Recommendations include:
- Wear a medical alert bracelet describing your allergy.
- Check ingredient labels carefully and avoid foods that may contain hidden allergens like peanuts.
- Have injectable epinephrine available at all times.
- Tell friends, family and coworkers about your allergy and how to administer epinephrine if needed.
- Follow safety precautions specific to your allergy, such as carrying an epinephrine auto-injector when flying if you have an insect sting allergy.
Despite precautions, accidental exposure still occurs. Always have emergency epinephrine on hand whenever you encounter a potential allergen.
Conclusion
Anaphylactic shock is a life-threatening complication of severe allergic reactions. Surviving without an EpiPen or epinephrine is very difficult but possible with prompt emergency care to maintain blood pressure, breathing and oxygenation. Epinephrine is the most critical medication for anaphylaxis due to its rapid reversal of shock symptoms. People at risk should take precautions to avoid allergen exposure and always have access to injectable epinephrine.