Anaphylaxis is a sudden, potentially severe allergic reaction

What Is Anaphylaxis?

Anaphylaxis is an acute, potentially life-threatening allergic reaction that is rapid in onset, and may result in respiratory compromise, cardiovascular collapse, and death.^1,2,3 Reactions are most commonly caused by allergies to food such as peanuts and seafood, drugs like penicillin and aspirin, and insect stings from bees or wasps.^1,4

Common Causes of Anaphylaxis

Food allergies (caused by peanuts, tree nuts, fish, shellfish, milk, eggs)¹

Food allergies account for 35% to 55% of all cases of anaphylaxis

Insect stings (often associated with bees, wasps, hornets)⁴

At least 40 people die each year in the United States as a result of insect stings
Estimated that potentially life-threatening systemic reactions to insect stings occur in 0.4% to 0.8% of children and 3% of adults

Drug allergies (caused by penicillin, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs])¹

Penicillin is the most common cause of drug-induced anaphylaxis

Latex allergies (caused by gloves, catheters, adhesives, tourniquets, and anesthesia equipment)¹

Higher risk groups include health care workers, children with spina bifida and genitourinary abnormalities, and workers with occupational exposure to latex

Exercise (associated factors include aspirin, NSAIDs, food ingestion before or after exercise)¹

Patients with exercise-induced anaphylaxis should carry epinephrine and MedicAlert^® identification of their condition

Symptoms of Anaphylaxis

The signs and symptoms of anaphylaxis may begin within seconds to minutes of exposure to or contact with an offending stimulus, but in certain situations symptoms may develop more than 30 minutes after exposure.^1,5

Patterns of Anaphylactic Reactions

An isolated anaphylactic reaction is referred to as a uniphasic reaction.⁵ Biphasic reactions often occur 8 to 12 hours after the immediate reaction. Biphasic reactions can occur up to 72 hours after resolution of initial reactions; a need for a second dose cannot be predicted.² Some protracted reactions can last up to 32 hours, despite aggressive treatment.¹

Symptoms of anaphylaxis may include any of the following¹:

Swelling in the mouth and throat
A rash anywhere on the body and appearance of flushed skin
Difficulty swallowing or speaking
Difficulty breathing
Abdominal cramps
Nausea, vomiting, diarrhea
Feeling of “impending doom”
Lightheadedness
Headache
Menstrual cramps
Collapse and unconsciousness

Emergency Treatments for Anaphylaxis

Epinephrine and oxygen are the most important therapeutic agents to be administered during an anaphylactic reaction.¹ Immediate recognition of the signs and symptoms of anaphylaxis is crucial.

Twinject Auto-Injector (Epinephrine)

Epinephrine is the treatment of choice and the appropriate dose should be given promptly at the onset of apparent anaphylaxis.¹ If a patient has previously had an anaphylactic reaction, he or she may already be carrying an auto-injector.² Twinject auto-injectors contain 2 doses of epinephrine. One dose is for a uniphasic (occurring immediately) reaction. The next step is to call 911 to ensure emergency services are on the way. The second dose is to be administered for an acute reaction in which a single dose is not enough to reverse symptoms, or to be used in the event of a biphasic or protracted reaction.

Twinject auto-injectors also are available in 2 dosing strengths. The Twinject 0.15 mg is for those weighing between 33 and 66 pounds (approximately 15 to 30 kilograms) and the Twinject 0.3 mg is for those who weigh 66 pounds (approximately 30 kilograms) or more.

Twinject also may be prescribed as a Two-Pack, which includes 2 Twinject auto-injectors and a demonstrator. Storing Twinject auto-injectors in multiple locations helps ensure that protection is always within reach—at school, at home, and on the go.

Click here for Twinject administration instructions.

Once emergency treatment has been administered, it is important to seek immediate medical attention.

INDICATION:

Twinject (epinephrine injection, USP 1:1000) is indicated in the emergency treatment of severe allergic reactions (Type I) including anaphylaxis to stinging insects (e.g. order Hymenoptera, which includes bees, wasps, hornets, yellow jackets and fire ants), and biting insects (e.g. triatoma, mosquitoes), allergen immunotherapy, foods, drugs, diagnostic testing substances (e.g. radiocontrast media), and other allergens, as well as anaphylaxis to unknown substancess (idiopathic anaphylaxis) or exercise-induced anaphylaxis.

IMPORTANT SAFETY INFORMATION ABOUT TWINJECT:

Twinject should only be injected into the anterolateral aspect of the thigh. Accidental injection into the hands or feet may result in loss of blood flow to the affected area and should be avoided. DO NOT INJECT INTO BUTTOCK. DO NOT INJECT INTRAVENOUSLY.

Epinephrine should be administered with caution to patients with cardiac arrhythmias, coronary artery or organic heart disease, or hypertension. In patients with coronary insufficiency or ischemic heart disease, epinephrine may precipitate or aggravate angina pectoris as well as produce ventricular arrhythmias. It should be recognized that the presence of these conditions is not a contraindication to epinephrine administration in an acute life-threatening situation.

Adverse reactions to epinephrine may include flushing; apprehension; syncope; tachycardia; thready pulse with a fall in blood pressure; convulsions; respiratory difficulties; vomiting, diarrhea or cramps; pruritus; or angioderma. Twinject is designed as an emergency supportive therapy only and is not a replacement or substitute for immediate medical care.

Since the doses of epinephrine delivered from Twinject are fixed, the physician should consider other forms of injectable epinephrine if doses lower than those available from Twinject are felt to be necessary (e.g., patients who weigh less than 15 kilograms approximately 33 pounds). IN ALL CASES, THE PHYSICIAN SHOULD INSTRUCT THE PATIENT AND/OR ANY OTHER PERSON WHO MIGHT BE IN A POSITION TO ADMINISTER THE EPINEPHRINE, IN THE PROPER USE OF TWINJECT.

Please see complete prescribing information for more details.

Your doctor can give you more information about Twinject or call 1-888-TWIN-JCT (894-6528). Ask your doctor if Twinject may be right for you.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.

MedicAlert^® is a Federally Registered Trademark and Service Mark.
MedicAlert and Kid Smart are registered trademarks and service marks of their respective owners.

Twinject is a registered trademark of Shionogi Inc.
© 2011 Shionogi Inc., Florham Park, NJ. All rights reserved. TWI.04.09.031.01

This web site and its contents are intended for use only by residents of the United States. Products discussed may have different labeling, regulatory requirements, and/or medical practices in other countries that may require reference to different or additional information.

References:

1. Lieberman P, Kemp SF, Oppenheimer J, et al. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. 2005;115(3):S483-S523. 2. Järvinen KM, Sicherer SH, Sampson HA, Nowak Wegrzyn A. Use of multiple doses of epinephrine in food-induced anaphylaxis in children. J Allergy Clin Immunol. 2008;122(1):133-138. 3. Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391-397. 4. Moffitt JE, Golden DB, Reisman RE, et al. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol. 2004;114(4):869-886. 5. Ellis AK, Day JH. Incidence and characteristics of biphasic anaphylaxis: a prospective evaluation of 103 patients. Ann Allergy Asthma Immunol. 2007;98(1):64-69.

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