Frequently asked questions

Q. What is anaphylaxis?

Anaphylaxis (a-na-fi-LAX-is) is a life-threatening allergic reaction that is rapid in onset and may cause death,1 either through swelling that shuts off airways or through a significant drop in blood pressure.2

Q. What are the common signs and symptoms of anaphylaxis?

Involvement of body organ systems in anaphylaxis varies among patients, and even in the same patient from one allergic reaction to another. However, there are general patterns regarding organ system involvement and respective signs and symptoms associated with anaphylaxis.2

Most often, allergic reactions involve the:2,3

  • Skin (80-90% of episodes): hives (urticaria), itching (pruritus), flushing, itching and swelling of lips, tongue, uvula/palate
  • Respiratory tract (up to 70% of episodes): shortness of breath, chest tightness, wheezing, itchy throat, hoarseness (dysphonia)

Less often, allergic reactions involve the:2,3

  • GI tract (30-45% of episodes): nausea, cramping, abdominal pain, vomiting, diarrhoea
  • Cardiovascular system (10-45% of episodes): hypotension, chest pain, fast heart rate (tachycardia), weak pulse, dizziness, fainting
  • Central nervous system (10-15% of episodes): feelings of uneasiness, throbbing headache, dizziness, confusion, tunnel vision

Q. How quickly do symptoms appear?

The signs and symptoms of anaphylaxis usually occur within the first 20 minutes to 2 hours after exposure. Rapid onset and development of potentially life-threatening symptoms are characteristic markers of anaphylaxis. Allergic symptoms may initially appear mild or moderate but can progress rapidly. The most severe reactions involved the respiratory system (breathing) and/or cardiovascular system (heart and blood pressure).5

Q. How do people know if they may be at-risk for anaphylaxis?

Anyone can develop a life-threatening (severe) allergy at any time in life, but certain factors may increase the potential to experience anaphylaxis. These include:2

  • History of life-threatening allergic reactions (anaphylaxis)
  • Certain age groups associated with high-risk behaviour (adolescents and young adults)
  • Diagnosed food allergies along with:
    - Eczema
    - Asthma
    - Severe allergic rhinitis (symptoms include sneezing, itching, watery nose and/or eyes)
  • History of lung problems
  • Allergy/anaphylaxis causing medications (immunologic) such as, anticonvulsants, insulin (especially those produced from animals), iodine (iodinated), x-ray contrast dyes, penicillin (related antibiotics) and sulfa drugs
  • Immunotherapy (allergy shots)

Q. What are the most common food allergens associated with anaphylaxis?

Milk, eggs, peanuts, tree nuts, sesame, fish, shellfish, wheat and soy are the most common food triggers, which cause 90% of allergic reactions, however, any food can trigger anaphylaxis. It is important to understand that even small amounts of food can cause a life-threatening reaction.4

Q. How are people treated for anaphylaxis?

According to food allergy guidelines by the National Institute of Allergy and Infectious Diseases (NIAID), adrenaline is the only first-line treatment in all cases of anaphylaxis (including from food allergies) and should be available at all times to people at-risk for anaphylaxis.3

Avoidance of allergic triggers is the critical first step to prevent a serious health emergency; however, accidental exposure may still happen.5 According to NIAID, if experiencing anaphylaxis, use an adrenaline auto injector and seek immediate emergency medical attention.3 Carrying an adrenaline auto-injector does not prevent patients from having an anaphylactic reaction; hence, patients must avoid their allergens at all times.3,5

Q. When should adrenaline be administered?

Adrenaline is the only first-line treatment in all cases of anaphylaxis (including from food allergies).3 If experiencing anaphylaxis, use an adrenaline auto-injector and seek immediate emergency medical attention.3 Anaphylaxis occurs when an allergic reaction involves one body system, either respiratory or cardiovascular alone; it may also occur in multiple body systems, such as the skin, gastrointestinal, and/or central nervous system.1 It is important to remember that the benefits of adrenaline treatment outweigh the risks of delayed or no administration. Delays in adrenaline administration have been associated with negative health consequences, even possibly death.6

Q. Why should I carry two EpiPen®'s?

Studies have shown that up to 1 in 5 anaphylactic reactions require additional doses of adrenaline due to biphasic or continuing symptoms. For this reason, it is important to have doses of adrenaline available. 

Q. Antihistamines vs adrenaline?

The use of antihistamines to treat anaphylaxis is the most common reason reported for not using adrenaline. This may place a person at significantly increased risk. Adrenaline is the only first-line treatment for anaphylaxis. 

Q. At what age should a child change from EpiPen® Junior to EpiPen®

The point of change is NOT determined by age. It is based on the weight of the child. In New Zealand the Medsafe approved guidelines are that EpiPen® Junior is suitable for children 15-30kg. Once the child is over 30kg in weight, they should be changed over to EpiPen® Adult.

The Australian Society of Clinical Immunology and Allergy (ASCIA) have slightly different guidelines and there are some healthcare professionals in New Zealand who choose to work with the ASCIA guidelines. The ASCIA guidelines state that EpiPen® Junior is suitable for children weighing 10-20kg and once the child is over 20kg in weight, an adult EpiPen® should be used.

Your doctor or allergy specialist will determine which EpiPen® is right for your child. If you are in doubt please contact your healthcare professional.

Q. Do I need a prescription to purchase EpiPen®?

No, you do not require a prescription to purchase EpiPen®. EpiPen® is a Pharmacist Only Medicine. What this means is it can only be sold to you by a Pharmacist or other medically trained healthcare professional after an appropriate consultation.

Q. How can I find out what the current dating is of EpiPen® stock in New Zealand

Current dating information is available on

1. Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391-397.
2. Simons FER. Anaphylaxis. J Allergy Clin Immunol. 2010;125(suppl2):S161-S181.
3. Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6):S1-S58.
4. ASCIA. Food Allergy 2016. Available at Accessed May 2017.
5. Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 Update. J Allergy Clin Immunol. 2010;126(3):477-480.e1-e42.