It’s important to go to the ER after using epinephrine for an allergic reaction, even if your symptoms have cleared up. Talk with your doctor about the best steps to take after you have a reaction.

If you have severe allergies, you probably carry epinephrine, a medication you can use to treat a type of severe allergic reaction called anaphylaxis.

The symptoms of anaphylaxis include:

  • low blood pressure
  • wheezing or difficulty breathing
  • dizziness or fainting
  • a weak or rapid pulse
  • hives, itchiness, and flushed or pale skin
  • throat or tongue swelling
  • voice changes
  • vomiting

Until recently, epinephrine was available only as an auto-injector, often known by the brand name EpiPen. But as of August 2024, it’s also available as a nasal spray. Epinephrine reduces swelling, opens up your airways, and increases your blood pressure — all of which can save your life.

After you’ve experienced an anaphylactic reaction and used epinephrine to treat it, it’s important that you go to the ER to follow up. Even if your symptoms have gone away, they could come back.

Read on to learn more about epinephrine and what to do after using it.

Yes, you should go to the ER after you’ve used epinephrine to treat an allergic reaction.

Epinephrine can start to work in less than 5 minutes, and your symptoms might go away after you use it. About 98% of allergic reactions improve after one or two epinephrine doses. But the effects of epinephrine can wear off.

That means your symptoms might return, and you might need further treatment.

If you’re close to a hospital and can get there quickly, you might not need to call an ambulance. But if you can’t get to the hospital on your own and no one else can take you there, you might need to call one. It is important that you get to the hospital one way or the other.

While epinephrine was traditionally available only as an injectable, the Food and Drug Administration (FDA) approved a new emergency epinephrine nasal spray under the brand name neffy in August 2024.

The nasal spray is FDA approved to treat anaphylaxis in adults and children who weigh at least 66 pounds. It comes as a single dose that you spray into one nostril. If symptoms worsen or don’t improve in 5 minutes, you can give a second dose in the same nostril.

If you have a history of nasal surgery or nasal polyps, you may want to use an injectable instead, as these factors might affect the absorption of inhaled epinephrine.

The FDA approved neffy based on four studies involving adults who did not have anaphylaxis. The results showed that the nasal spray and the injectable form produced similar epinephrine concentration levels in the blood and increased blood pressure and heart rate similarly.

If you want to try neffy, your doctor might suggest that you carry both the nasal spray and an auto-injector in case the nasal spray doesn’t work for you.

You should go to the ER any time you experience a severe allergic reaction, even if you’ve used epinephrine and your symptoms have cleared up.

It’s especially important to seek emergency care for an allergic reaction in any of the following situations:

  • if you don’t have any epinephrine on hand
  • if you’re not comfortable using epinephrine or don’t know how
  • if you’re alone or with someone who cannot help you take a dose of epinephrine
  • if you have a history of severe or near-fatal anaphylaxis that required more than two epinephrine doses and hospitalization to treat

The American Academy of Family Physicians recommends that people who have used epinephrine for anaphylaxis be monitored for 4 to 6 hours in case of another reaction. But if you have a history of severe reactions, the observation period may last 8 to 12 hours or even overnight.

Your specific guidelines may differ depending on the severity of your allergic reactions. Be sure to talk with your doctor to find out what they recommend for you.

It’s important to go to the ER for follow-up care after you use epinephrine for anaphylaxis. Even if your symptoms stop after you’ve used a dose of epinephrine, they could come back hours later.

In August 2024, the FDA approved a new emergency epinephrine nasal spray. If your doctor thinks the nasal spray may be a good option for you, you can use it instead of an epinephrine auto-injector.