Allergy Emergency Kit: Using an Adrenaline Pen Correctly

A wasp sting, a peanut in a cake, a new antibiotic — and within minutes an allergy turns into a life-threatening emergency. In anaphylaxis, adrenaline is the only medicine that works in time. Antihistamines and cortisone take too long. This guide shows you step by step how to use the auto-injector, what else belongs in the kit — and why every use is always followed by a call to 112.

1. First things first: only adrenaline works fast enough

Anaphylaxis is an excessive reaction of the immune system that affects the whole body. Blood vessels widen and become leaky, blood pressure falls, the airways swell and narrow. This can happen within minutes — and that is exactly why time is decisive.^¹

Adrenaline works precisely against these mechanisms: it narrows the blood vessels, stabilises blood pressure, widens the airways and slows the further release of messenger substances. Injected into the thigh muscle, it takes effect within a few minutes.

The two other medicines in the kit still make sense — but they are supporting medicines, not emergency medicines:

• Antihistamine (e.g. cetirizine or loratadine as a liquid or orodispersible tablet): works well against itching, weals and skin reactions, but usually takes half an hour or longer — and has no effect on the circulation or airways.
• Glucocorticoid (e.g. prednisolone): takes effect even later, often only after one to two hours. Its main purpose is to dampen a delayed second wave of reaction.

2. Recognising anaphylaxis: the warning signs

Anaphylaxis usually starts on the skin and then spreads. What matters for assessing it is not how severe a single symptom is, but how many organ systems are affected and how quickly it progresses.

The simple rule of thumb for an emergency: skin plus airways, or skin plus circulation, means adrenaline. And with a known trigger and rapidly progressing symptoms, you do not wait for a second organ system. Hives that spread over the whole body within minutes are also an alarm signal.

3. Typical triggers

Three groups of triggers stand out — and they differ markedly by age.

Insect venom

Bee and wasp stings are a very common trigger of severe reactions in adults. The course is often particularly rapid because the venom enters the tissue directly. Anyone who has ever had more than a local swelling should have an allergy assessment.

Foods

In children and teenagers, foods dominate: peanut, tree nuts, cow's milk, hen's egg, fish, shellfish, sesame, soya and wheat. Hidden ingredients in ready-made products and situations in which other people do the cooking are treacherous — the school canteen, restaurants, birthday parties. Exertion or alcohol shortly after eating can make a reaction more likely.

Medicines

Antibiotics, painkillers and X-ray contrast media are among the most common drug-related triggers. After a confirmed drug allergy, the triggering active substance must be entered in an Allergiepass (the German allergy passport) — with the name of the active substance and the type of reaction. Why this document is worth so much in an emergency is described in the guide Medical emergency card: the document that speaks for you.

In some people, no trigger can be found. That changes nothing about the consequence: anyone who has had a severe reaction needs an emergency kit — even without a known trigger.

4. What belongs in an allergy emergency kit

A prescribed emergency kit usually consists of three to four components. Exactly what you receive is decided individually by the treating practice.^²

• Adrenaline auto-injector: the central element. The dose strength depends on body weight — children are given a lower strength. Important: not all models are operated in the same way.
• Antihistamine: as a liquid, drops or orodispersible tablet, because in an emergency these can be swallowed more quickly than a tablet with water.
• Cortisone preparation: as a liquid, suppository or tablet, depending on age and situation.
• For asthma, also the reliever inhaler: a short-acting beta-2 agonist such as salbutamol. People with asthma have an increased risk of severe reactions — well-controlled asthma is therefore itself part of preventing anaphylaxis.
• A written emergency plan: a laminated card with the trigger, the warning signs, the order of the medicines and emergency numbers — for you and for everyone who is meant to help you.

5. The adrenaline auto-injector: step by step

Operation differs in the details from model to model — the prescribing practice or the pharmacy will show you your product on a trainer pen. The basic sequence, however, is the same for all of them:

1. Get someone to call for help. If someone is with you: have them call 112 straight away while you get the pen ready. If you are alone, inject first and call immediately afterwards.
2. Take the pen out of its case and pull off the safety cap. Only immediately before use. Grip the pen in your fist — your thumb never goes over either end.
3. Into the outer side of the thigh. The muscle on the side of the thigh between hip and knee is the right place. It may be injected through clothing — there is no time to undress. Not into the buttocks, not into the arm, not into the abdomen.
4. Press firmly, trigger and hold. Press the pen firmly against the thigh until it triggers, and then hold it in position for as long as the instructions for your product specify (a few seconds, depending on the model). Then pull it straight out.
5. Briefly massage the injection site — for about ten seconds, so that the drug spreads. Note the time if possible.
6. Position correctly. Afterwards, lie flat with the legs raised. Exception: with shortness of breath, sit upright; if unconscious but still breathing, place in the recovery position. Anyone who has collapsed must not be stood up or asked to get up.
7. Give the supporting medicines — antihistamine and cortisone, provided swallowing is safely possible. With asthma, the reliever inhaler as well.
8. Do not leave the person alone, and keep watching. If the symptoms do not improve after about five to fifteen minutes, or get worse, a second dose may be needed according to the guideline — preferably into the other thigh. That is why a second auto-injector makes sense.^¹

6. After use: what happens in hospital

The length of monitoring is decided individually by the treatment team — depending on how severe the reaction was, how quickly it began and whether asthma is present. Circulation, breathing and signs of a second wave of reaction are monitored.^³

Take whatever you have with you: the used auto-injector, the packaging of the suspected trigger, your Allergiepass and your medication list — in the acute moment for the treatment, later for finding the cause.

• Get a replacement straight away. A used pen must be replaced on the same or the next day — without a kit, you are unprotected.
• Document the incident. What did you eat, where were you stung, which medicine was new, how long did it take until the first signs appeared? These notes are often decisive for the allergy assessment.
• Report a suspected medicine. Suspected side effects can also be reported by patients themselves to the BfArM (German Federal Institute for Drugs and Medical Devices) — this improves the data for everyone.^⁴

7. The most common mistakes

A sixth, silent mistake: never having practised. If you have only heard the procedure once, you will rarely be able to act under stress. Most manufacturers offer free trainer pens without a needle — ask for one at the pharmacy and practise the grip two or three times a year, together with the people around you.

8. Shelf life, storage, availability — the underestimated part

This is where most emergency kits fail in everyday life. Not because of the technology, but because the pen has expired, has overheated or simply is not to hand.

Actively manage the expiry date

Adrenaline auto-injectors have a short shelf life, often one to one and a half years. Put the date in your calendar — with an advance warning four weeks beforehand, so that there is time for a prescription and to get a new pen. Also check the viewing window: if the solution is discoloured, cloudy or contains flakes, the pen needs replacing.

Storing it correctly

• Not above 25 °C — heat destroys the drug.
• Not in the fridge, and never frozen. Cold is just as harmful; a pen that has been frozen is unusable.
• Protected from light in its original case.^⁵
• Do not leave it in the car. In summer, the inside of a car easily reaches well over 50 °C — even in the shade. The basics are in the guide Storing medications correctly.
• At the beach and during sport, put it in an insulated bag, but without direct contact with ice packs.

Two kits in two places

A single kit is a single point of failure. A tried-and-tested approach: one in the bag that goes with you every day, and a second at the other place where you spend your time — school, nursery, workplace. Two auto-injectors also make sense because a second dose may be needed if there is no improvement.

9. Training and the people around you: briefing those who are meant to help

In a severe reaction, you are often no longer able to use the pen yourself. That is why briefing the people around you is not an extra but part of the treatment.

• Family and close friends — they should know where the kit is kept and have practised the grip once on a trainer pen.
• Nursery and school — a separate kit, a written emergency plan with a photo and the names of the people who have been briefed belong there. Put in writing who is allowed to act in an emergency. What else to bear in mind with children is covered under Medications for children.
• Colleagues — it is enough if two or three people on the team are in the picture and know where the kit is kept.
• Anaphylaxis training — structured training courses for those affected and their relatives are offered by medical societies and patient organisations and are recommended by the guideline.

With teenagers, there is an added factor: the kit often stays at home out of embarrassment. Finding an inconspicuous way of carrying it helps more than turning the subject into a question of discipline.

10. Beta blockers: when adrenaline works less well

A little-known but important point: beta blockers such as metoprolol or bisoprolol occupy exactly the receptors through which adrenaline acts. In anaphylaxis, the effect of adrenaline can therefore be weakened and the reaction can be more severe. Something similar is being discussed for certain blood pressure medicines from the ACE inhibitor group. Beta blockers in eye drops for glaucoma also act on the whole body and count here too.^¹

If you have an adrenaline pen, this information belongs in every treatment conversation — especially before desensitisation or an operation. Why combinations like this otherwise get lost is shown in the guide Drug interactions.

11. Afterwards: assessment and desensitisation

A severe allergic reaction is followed by an allergy assessment — usually with a detailed medical history, skin tests and blood tests, sometimes supplemented by controlled challenge tests in specialist centres. An interval of a few weeks after the reaction usually makes sense, because tests carried out straight afterwards can come back falsely negative.^²

For insect venom allergies, specific immunotherapy (desensitisation) offers a treatment that tackles the cause and can markedly lower the risk of severe reactions; it usually takes several years. For some foods, oral immunotherapy is available in specialist centres. What is suitable for you is decided by the treating practice — the auto-injector usually remains a must in the meantime.

The assessment also includes the question of whether accompanying allergic rhinitis or asthma should be better controlled. Both lower the risk of severe reactions — according to current evidence, one of the most effective levers that you can help to influence yourself.

12. How brite helps you with your emergency kit

Your emergency kit, always ready for use — with brite

Shelf life tracked, medicines documented, interactions checked. Free of charge.

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