Mastocytosis/ Mast Cell Activation Disorders > FAQs > Anaphylaxis FAQ
Frequently Asked Questions about Anaphylaxis
Can an EpiPen cause a more severe shocking attack?
What does it mean if I have an attack each day at the same time?
Question: Although I have never had to use one, I carry two EpiPens with me at all times because in the past I have gone into anaphylactic shock. I usually try to take meds when I am starting an attack because I would rather avoid the EpiPen injection if I can. The main reason is that I am nervous about using an EpiPen, even in emergency. Could the EpiPen cause a more severe shocking attack? I tend to react to all sorts of medications, and so I get very apprehensive about trying anything new.
Answer: Epinephrine, or adrenalin, is different from other medications because it is a hormone that our own body naturally produces. So, you are being exposed to at least small amounts of it already on a daily basis.
In her 2007 article, “Anaphylaxis: Evidence-Based Long-Term Risk Reduction in the Community,” F. Estelle R. Simons (Immunol Allergy Clin N Am 27 (2007) pp. 231–248) writes [on page 240]:
“Occasionally, epinephrine is not injected because of fear of adverse effects. Individuals at risk for anaphylaxis, or their caregivers, should be advised that the transient anxiety, pallor, tremor, and palpitations that commonly occur after epinephrine injection correlate with the beneficial pharmacologic effects of epinephrine and should not be a cause for concern.... Serious adverse effects, such as myocardial ischemia, arrhythmias, and pulmonary edema, are seldom attributable to use of epinephrine auto-injectors by individuals in the community. More commonly they are attributable to overdose of epinephrine in health care settings, such as intravenous administration of inappropriately high concentrations or an overly rapid rate of infusion. Moreover, there is increasing awareness that the heart, like the skin, airways, gastrointestinal tract, and vasculature, can be a target organ in anaphylaxis and that coronary artery spasm, myocardial injury, and cardiac arrhythmias can occur in individuals who have anaphylaxis episodes before they receive any epinephrine treatment....”
Epinephrine is the only treatment that can really stop the process of anaphylaxis. Medications like Benadryl or H1 and H2 antihistamines just clean up the effects of the anaphylaxis. Epinephrine stops it.
Question: Does it seem to anyone else that the attacks fall at the same time in the day? I used to have the attacks late at night. Then, all of a sudden I had one at lunch and now after lunch seems to be the worst time for me.
Answer: Usually, if you’re having attacks at the same time each day, it’s a clue as to what might be setting you off.
For example, on the weekends, are you having after-lunch-time attacks? Probably not, if the trigger is something that’s in the lunches you eat at work.
Here are some problems that cause time-of-day-related attacks in some people:
- Our bodies have the naturally highest levels of histamine in the wee hours of the morning, which is why some of us will have an attack first thing in the morning (unless we take adequate long-acting meds at bed time to carry us through — a 12-hour time-released Chlor-Trimeton works well for this, as does two Zyrtec and/or two Ketotifen at bedtime).
- Many mold spores are released in the late afternoon or early evening, which creates another problematic time for some of us.
- Some people are very sensitive to the material produced by dust mites or house pets, which means that they’re most likely to have an attack after they go to bed for the night (if that happens, you need to get dust-mite-proof encasings for your pillows, mattress, and box spring and use bed linens and blankets that can be washed regularly in hot, soapy water — and if the problem is pet-related, you made need to banish pets from your bed or bedroom).