Anaphylaxis (also called anaphylactic shock) seems to be more common than ever. It’s a topic covered in all courses of 1 day or longer and everyone gets to see and practice with the training Epipen &/or TwinJect devices so that you have some idea what to do if it’s ever needed. So, let’s start with what it is….

Epipen Logo Twinject Logo
Parts of this post were created with information from Epipen & Twinject websites

Anaphylaxis is a severe allergic reaction (or ‘hypersensitivity’). It may happen to some people when their body (over) reacts to certain, specific ‘triggers’. Anaphylaxis is usually life threatening and happens very quickly (within seconds to minutes). In rare instances, there can be a delayed reaction type anaphylaxis as well. It affects the whole body, as you’ll see when we get to signs & symptoms.

What triggers Anaphylaxis?

(Please add your own, or your children’s in the comments section. The more people are aware, the better it is for everyone!)
Common ‘triggers’ (also called allergens) include:

  • Nuts, especially peanuts
  • Fish, especially shellfish
  • Bees, wasps & other stinging bugs
  • Latex (check the gloves in your first aid kit!)
  • Medications – almost any, but penicillins & NSAIDs (like Advil) are common

A much less common trigger is exercise, and at times the trigger is never found. The producers of EpiPen have a pdf document they call their allergy risk test. It lists common triggers and common symptoms and may be a useful starting point. If you think you have allergies, especially severe ones, talk to your doctor!

What Signs and Symptoms might we see?

The symptoms of anaphylaxis can occur in several body systems including:

  • Mouth: Swollen lips, swollen tongue, airway can swell shut (you may have to do CPR)
  • Skin: Hives, redness, swelling, itchiness. Skin may be warm and red at first, eventually becoming paler
  • Stomach and intestines: Nausea, vomiting & stomach/abdominal cramps
  • Heart and blood vessels: Increased heart rate, eventually may have abnormal heart rhythm
  • Lungs: Wheezing, coughing, prolonged, sneezing, may eventually become unable to breathe
  • Throat: Swells and eventually closes.

Canadian Red Cross Training PartnerSo what can we do?

Call Emergency Medical Services fast!
As soon as anaphylaxis is recognized, the person needs epinephrine (adrenaline) by injection. If the person has one, assist them with their Epipen or TwinJect. More information on the devices can be found below, and also on their respective websites. Alternatively they may have a TwinJect. If possible, find out which they have before hand. Remember that the treatment will only buy them time (about 10 min) and is not a cure! There are times when one dose is enough, but don’t expect this to be the case. Also:

  • Keep them comfortable. From a text-book point of view, lying flat with legs raised will help with the breathing & circulation issues, but may not be practical or comfortable.
  • Keep them at rest (to reduce heart rate).
  • Ensure adequate air-flow (open windows/doors if appropriate & needed).

 Injection Devices

There are two common devices on the market here in BC: the Epipen (and Epipen Jr) and TwinJect. They work in a similar fashion and you can find out more information on the respective websites. The TwinJect has the advantage of having a second, back-up, dose contained within the same device.
Both deliver the same dose of the same drug, both come as adult and junior size. If you’re treating a child and don’t have the Junior device, use the adult one anyway – it will still work (the same isn’t true for giving an adult the child dose, although it would be better than nothing).
Both have approx 1 yr expiry. If the product has recently expired and you really need it in an emergency, use it anyway (it just won’t be guaranteed sterile any more) – if it’s many years out of date, your on your own with that decision!
Join a course to practice using one!

Prevention is better than cure

Make sure you know what your/your child’s triggers are and avoid them as far as possible. Share this information with care workers, friends, teachers, sports coaches, etc.
There are steps you can take for each allergen or trigger, for example reading labels on foods; telling you health care providers if you have a latex allergy; not wearing floral perfumes if bees are an issue, etc. Take a look here for more suggestions.
Here are some recipes for people with allergies (courtesy of Epipen)


Remember you will probably never be able to avoid or eliminate all allergens & all risks. Make sure you and your friends, family & others around you have appropriate training on what to do. Showing them the ‘how to use a TwinJect’ video is a good start, but it would be better all round if they had at least some basic CPR training too