Epipens and Epilogues

20180516_091744.jpgEpilogue: a section or speech at the end of a book or play that serves as a comment on or a conclusion to what has happened.

If it wasn’t for epinephrine, my story would have stopped a while ago. There would have been a little eulogy, with maybe some information on the dangers of food allergies and possibly how a restaurant, doctor’s office, or coffee shop revised their policy towards allergens — and that would have been it.

Instead, a nurse barked that she was going for epi, there was a lot of shouting and running, and some hazy while later, a doctor said “hi.” And I was back. I’d experienced my first bout of anaphylaxis, luckily enough in the actual health clinic. I survived thanks to epinephrine, medical staff, my friend (who recognized what was going on), and God’s mercy. Epilogue, not eulogy.

Now I have a list of allergens that’s 8 1/2  by 11 inches and growing. And — I’ll be honest — I try to remember to carry epipens, plural, with me everywhere I go. The fact that my life might depend on my remembering epipens means I put a little bit more effort into remembering this particular accessory than, say, my apartment keys. My track record for remembering my apartment keys is positively dismal, so the bar is set pretty low. But I have a routine established, and generally I have managed not to lock important, life-saving medications in places where I can’t get to them.

Unfortunately, if I have to use the epinephrine I have, I might find myself in a bit of a bind. Right now, the USA has a shortage of epipens. So, for that matter, does Canada and the UK. This is particularly bad as summer starts, which means more BBQs and birthday parties, potlucks and play dates, swimming and soccer camps… basically, a lot more activities that might deviate from the norm and lead to more opportunities to accidentally be exposed to an allergen. Mylan and Pfizer’s Meridian, the two companies involved in the shortage, were already under investigation for faulty injectors and are now facing more scrutiny for the delay in informing people of the epipen shortage. Although there have been reassurances that other manufacters’ epipens are available if the Mylan EpiPen is not, the reports cropping up with disturbing frequency across social media, FARE’s pages, and in interviews say otherwise. Many of my fellow allergy sufferers are writing that they haven’t had good success using other brands of epinephrine injectors in the past and would rather just stick with Mylan’s brands — or that they haven’t been able to get a hold of any epinephrine at all.*

Alternatives include self-injecting using a syringe (either filling when a reaction is taking place or keeping a syringe pre-filled). Lisa Klimas did an excellent study of why this is not a good idea here. I know that I would not be able to draw up and inject a reliable dose of epinephrine while experiencing a severe attack. Epinephrine is also not entirely stable: it needs to be kept in a certain temperature range, protected from oxygen and light, and if in a syringe, kept intact. It’s not always easy not to bend the delicate needles! The bulky autoinjectors do a great job at protecting the mechanism and the drug … and therefore at protecting me from everything from avocados to walnuts.

Basically, the alternatives aren’t great, and Mylan still hasn’t responded with an estimate of when the shortage will be resolved. Most news reports are using words like “short term” or “a few months.” Yeah. My mom used to use words like that for when dinner would be done … when we were pestering her about it in the middle of the afternoon and she still had no idea what she was fixing.

Whatever the timetable is for a resolution, most recommendations are to check your epipens and see if they will be out-of-date in the next couple of months. If so, doctors recommend trying to start filling early, in case there is a shortage in your area. If you don’t need to refill your epipens for several months, then don’t. And in the meantime, do everything like you normally would … meaning please stay safe out there during the fun upcoming summer months!


*It may seem strange to prefer one type of device over another, but everyone’s needs and reactions are different. Also, each different brand uses a slightly different delivery mechanism. In an intense situation, not everyone who was trained on one type of device will be able to use a different device absolutely correctly. This means the person experiencing anaphylaxis might not get the whole dose of epinephrine. When dealing with summer camps, where most leaders might only have received the briefest instruction in how to use The Epipen, insisting on having the reliable, recognizable brand-name Epipen doesn’t seem as unreasonable. Other injectors have also occasionally struggled with trouble with delivery mechanisms (failing to deliver the complete dose or failing to fire at all).  


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