Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Epinephrine for Allergic Reactions

A reader posed a question in response to my post about killer bees in New Orleans:

"I have a question regarding the proper use of epinephrine in wilderness medicine situations. In my recent wilderness first responder (WFR) recertification, we were told that if epinephrine is required, the protocol is to administer one dose, then give an oral antihistamine. Before the oral medication has time to work, another does of epinephrine will (might) be required. The point was that TWO doses (minimally) of epinephrine should be packed for each individual with severe allergies on a wilderness trip. This is NOT what I was taught in my initial certification - there, we were taught that one dose is enough. I believe in always being on the safe side in packing meds, but is a second dose of epinephrine always necessary?"

The answer is that most of the time, one dose of epinephrine injected subcutaneously or into muscle tissue (intramuscularly) will be sufficient to handle an allergic reaction. However, it is unpredictable. So, sometimes a second dose of epinephrine is necessary. My recommendation is to carry two doses, because there is absolutely no harm in being prepared.

The premise of the Twinject product is that it provides for two doses of epinephrine in a single unit package, as opposed to the EpiPen, which only provides for a single dose. Both products can be lifesavers.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.