As the spring is here, I have been getting my usual requests for a refill for an Epipen. These are autoinjectors for epinephrine, which are available as various brands, but have commonly come to known by the brand Epipen although that is certainly not the only available. Epinephrine is used in the treatment and prevention of anaphylaxis from beestings or other such close encounter with nature for someone who is known to be at risk for such a reaction.
What amazes me however, is how confused my patients get, when I ask them where they live, or about their travel or other plans. Such as going hiking up in the mountains etc. Before you all get all upset at the nosy physician, take a read here. It may save your life.
Epinephrine is a hormone and a neurotransmitter. Although very potent, it is rapidly metabolized, and made ineffective within a half hour. Anyone who has had severe anaphylaxis can attest to its potent lifesaving properties, but the short duration of action is seldom apparent to the consumer. Usually, soon after one has to use it, they will be in the back of an ambulance or in an emergency department within 10 or 20 minutes, where they get ongoing care for the severe reaction. But what happens if you are up in the Adirondack mountains, hiking. Will you be able to get to help? Probably not.
The WHO recommends that 1 Epipen be carried for every 10-20 minutes that one might be from the nearest rescue center. So if you are going to be in a remote location and are about an hour from the closest firehouse, you probably need about 4 pens. Yes, you read that correctly, that would be a pair of 2-Paks.
So next time you decide to go commune with nature, be it a hike up a mountain, or a stroll in a local nature preserve, and there is the of chance you might come across your buzzing nemesis, or whatever might trigger anaphylaxis for you – take time to assess how far will you be from help. I usually recommend to my patients to also be aware of cell phone service where they will be traveling. If out of service, they may avoid making the fatal mistake of thinking they may call for help, and make absolutely sure to carry enough epinephrine to get them to safety.
The other area where I find myself advising my patients frequently, is about storage and expiration. Be mindful of expiration dates. Epipens should be renewed annually, or at the expiration date – whichever comes first. They are best stored in room temperature, so unlike your aunts insulin, this does not belong in the refrigerator, and they are certainly not to be frozen. Also avoid hot places. like the glove box of the car, or near a bright window. Although your Epipen needs to be replaced regularly, in the case of a reaction, it is better to use an expired pen, then avoiding its use altogether.
As always – talk to your doctor. Anaphylaxis is serious stuff – it kills people. Make sure you and your doctor have a thorough understanding of what you are allergic to, and have in place strategies to prevent inadvertent exposure, and an emergency treatment plan. Needless to say, the opinions expressed above, are not specific patient advice. Every person is different, and make sure you and your physician are in agreement with your treatment plan as the above advice may not be appropriate for you.