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How to Administer Epinephrine for Anaphylaxis: A Step-by-Step Guide

If you or someone you love has an allergy that results in anaphylaxis, you know how important it is to administer epinephrine at the first sign of a reaction. Epinephrine is the frontline treatment that can stop anaphylaxis before it becomes life threatening.

“Epinephrine is adrenaline,” says William Reisacher, MD, an otolaryngologist at Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York City. “It helps reverse symptoms and gives you precious time to get to a medical facility.”

Epinephrine is usually given with an auto-injector — a quick shot in the thigh — or a nasal spray. These devices are designed to be easy to use, even in a high-stress moment. Still, using epinephrine can feel overwhelming, which is why it’s so important to prepare.

“You don’t want to be opening the packet for the first time during an emergency or searching, ‘What do I do when I have a severe allergic reaction?’” says Dr. Reisacher. “You want to just go ahead and say, ‘Okay, epi time. Here we go.’ And then call 911.”

Knowing what to do ahead of time can help you stay calm and act fast in an emergency.

The steps below apply to several common auto-injectors. Always follow the instructions for the specific device you have. Most brands offer free practice devices or online video tutorials to help you prepare.

Step 1: Know When to Use Epinephrine

Use epinephrine at the first signs of anaphylaxis, especially if symptoms affect more than one part of your body. Symptoms may include:

  • Breathing trouble or wheezing
  • Dizziness or confusion
  • Hives or swelling
  • Nausea or vomiting
  • Rapid heartbeat or low blood pressure

Don’t second-guess your decision to use it. “If you’re thinking about using it, go ahead and use it,” says Reisacher, noting that even if the reaction turns out not to be anaphylaxis, epinephrine is generally safe. “The worst thing that’s going to happen is you’ll feel like you’ve had a few cups of coffee.”

Delays — even brief ones — can lead to serious outcomes, including a higher risk of more severe symptoms, needing multiple doses of epinephrine, or extended hospitalization.

Step 2: Inject the Epinephrine

Each EAI has slightly different instructions, but here are the general steps for using it on yourself:

  • Remove the auto-injector from its container. You may need to flip open the cap or pull it out of a case.
  • Hold it firmly in your fist with the needle end pointing down.
  • Press it into your outer thigh (even through clothing).
  • Push firmly until it clicks.
  • Hold it in place (usually 2–10 seconds, depending on the device’s instructions).
  • Rub the area for 10 seconds to help with absorption.

“One of the biggest misconceptions that I’ve seen about [auto-injectors] particularly is that it involves a lot of strength,” says Reisacher. “You just need some pressure until you hear the click.”

If you’re using an epinephrine auto-injector on someone else, you may feel nervous. But staying calm can make a big difference. Speak gently and let them know what you’re doing:

  • If they feel faint, help them lie flat with their legs raised.
  • If breathing is difficult, roll them onto their side.
  • Hold their thigh steady, press the injector into the middle of the outer thigh until you hear a click, and count — usually 2 to 10 seconds, depending on the device’s instructions.

Step 3: Note the Time and Call 911

Remember the time of the injection, so you can tell the medical team. If you’re helping someone else, reassure them that help is on the way and you’re staying by their side.

Even if symptoms improve, you (or the person you’re assisting) still need medical attention. Epinephrine works quickly, but it wears off in 15 to 20 minutes. “It’s broken apart very quickly in the liver, so it buys you a short amount of time to get to an emergency room after you’ve delivered epinephrine,” says Reisacher.

If symptoms return and you have a second auto-injector, use it 15 minutes after the first.

Nasal spray is a newer, needle-free way to administer epinephrine.

To use it on yourself:

  • Hold the device with your thumb on the plunger and fingers on either side of the nozzle.
  • Insert it into one nostril until your fingers touch your nose.
  • Push the plunger up until it clicks. That’s the full dose.
  • Don’t sniff or deeply inhale during or after using it.
  • Call 911 and note the time.
  • Monitor symptoms. If they don’t improve in five minutes, use a second spray in the same nostril.

If you’re helping someone else, the person can be in any position — lying down, reclined, sitting, or standing. To administer the spray:

  • Gently tilt their head back, insert the spray into one nostril, and press until you hear the click.
  • Call 911 and note the time of the dose.
  • Stay by their side and speak gently.
  • Never reuse the spray, even if it looks full. It’s designed for onetime use only.

After receiving emergency care for an episode of anaphylaxis, it’s a good idea to follow up with your allergist. They can help you better understand (and avoid) triggers and create a personalized allergy action plan.

When talking to your doctor, bring up which type of epinephrine auto-injector you’d feel most comfortable carrying. “We have more choices than ever before,” says Reisacher. Think about what feels easiest and most natural to keep on hand.

Consistency matters. Bring your epinephrine device with you wherever you go — school, work, parties, vacation. “Carrying it means you’re ready if an emergency happens,” he says.

Once you have your device, here’s what you need to know to store it safely and use it confidently:

  • Always carry two doses. You may need a second dose, because anaphylaxis symptoms can return after the first injection.
  • Keep it at room temperature. Don’t store it in your car, the fridge, or direct sunlight.
  • Look at the liquid, if your device has a window. It should be clear, not cloudy or discolored.
  • Check the expiration date. Expired epinephrine may not work as well. Consider asking your allergist to set up automatic refills or bringing the epinephrine to your annual checkup to make sure it’s up to date and ready to use. That said ...
  • Use it even if it’s expired. In an emergency, an expired device is better than none at all.
  • Epinephrine should be used immediately, at the first sign of anaphylaxis. Delaying treatment — even by minutes — can lead to life-threatening consequences.
  • Read or watch instructions on how to use the epinephrine autoinjector or nasal spray, and practice with a trainer device, so you feel confident and prepared to act quickly in an emergency.
  • Always carry your epinephrine auto-injector with you, and make sure those around you know where it is and how to use it. After using epinephrine, call 911 or seek emergency medical help right away, even if symptoms start to improve.

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