EpiPen advice: Doctors say when in doubt, use it to nip allergic reactions in the bud – Seacoastonline.com

Posted: February 6, 2021 at 4:50 am

By Karen Dandurant| news@seacoastonline.com

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PORTSMOUTH -- Most people have heard of an EpiPen, and know, at least marginally, that they are used to help quickly counteract symptoms of severe allergic reactions that can quickly result in anaphylactic shock, which is life threatening and can be fatal.

There are many reasons for EpiPen use. Allergic reactions can come from bee stings, from food or medication allergies and even environmental allergies.

But health care experts say parents are often hesitant to use the device on their children, sometimes delaying until it is too late to stop the dangerous cascade of allergic reactions.

Eric Jaeger, a paramedic, and the EMS educator at Exeter Hospital said he sees hesitation and reluctance to use EpiPen all the time.

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Parents sent home with an EpiPen are cautious, said Jaeger. There was a death several years ago of a college student who didnt use the EpiPen in time. It prompted me to realize there is still a significant issue, where people are not sure when to use it, or who wait longer than they should. Often people wait for a severe reaction and by that time, within 5-10 minutes, the cascade of symptoms has started, and a person can die.

EpiPens are a type of epinephrine auto-injector. They work by automatically injecting a dose of the hormone epinephrine (also called adrenaline) into a person's body.

Dr. Anupriya Grover, is a primary care physician at Appledore Family Practice in Portsmouth and is the Associate program director at the family medical residency program at Portsmouth Regional Hospital, in association with Tufts School of Medicine.

EpiPens are basically adrenaline and it is used to counteract symptoms that can constrict the airway, said Grover. That is an adverse event. The throat can swell; blood pressure can be lowered, and it can be a very serious condition. Bees and peanuts are commonly known allergies. Adults and children can be allergic to many medications, Tylenol, antibiotics, or opioids. There are airborne allergies that can be severe.

Grover said an EpiPen should be used in any situation where there is an allergy exposure resulting in difficulty breathing or tightening in the chest.

I have come into a home and as a paramedic, the signs of anaphylaxis are clearly there, said Jaeger. The parent is standing there holding an EpiPen. Once the dam has broken, an EpiPen might not pull the child back from the brink. Using it, even if unsure, makes so much more sense.

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I tell my patients if you are feeling like maybe you should use the pen, use it, said Dr. Nicholas Armellino, an emergency department physician at Exeter Hospital. The only time an EpiPen will not work, is if you do not use it. A lot of people are hesitant for whatever reason but my thought is if you do not feel well, use it. There are no detrimental effects for doing so, no contraindications.

Using an EpiPen is simple but Grover said taking the time to practice, using a fake EpiPen is a good idea.

I teach patients the swing and push method, said Grover. You hold your hands straight out and push into your thigh. The needle is so fine it will go through clothing. Then you hold for 10 seconds. People can practice this with a writing pen. The twin packs often come with their own practice pen.

No one would ever advocate using a medication past its expiration date, except with the use of an EpiPen in an extreme medical emergency.

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Parents should inspect the device, said Grover. There should be no floating particles in it, and the liquid should not be cloudy. However, if you only have access to an expired pen; it is still preferable to not using it at all. Some residual benefits will still be there.

Armellino said the medication might not be fully active if past the expiration date. But he said the chance there is some active medication is definitely worth it in an emergency.

Ashley Child, PharmD at Wentworth-Douglass Hospital, said she tries to answer questions when parents come in to get an EpiPen for their child.

I agree there is some hesitation to use them, said Child. I tell them the rule of thumb is when in doubt, use it. EpiPens are not considered a dangerous medication when used properly. You cant buy it at a store, so if a family has one, it is a needed device, given by prescription. I think there is a small stigma attached to it. Some parents feel if they use it someone will judge them for it, will judge if they needed to. Thats not enough reason not to use it for your child when you feel it is needed. Most allergists will tell you the same thing, thatit's better to use than not to use. And in the case of anaphylaxis, the sooner you use it, the better. Delaying care can be harmful.

Child said using expired medication is never a decision to make without talking to your doctor.

However, studies have shown that after an EpiPen has been expired for six months, it still contains about 60% of its active ingredients, said Child. So, the benefit outweighs the risk.

Grover said EpiPens should be stored at room temperature, and never stored in a car where temperatures can fluctuate.

Cost may be a factor in peoples reluctance to use devices unnecessarily. A twin pack of EpiPens averages about $350, very pricey if a person has no insurance and has to pay out-of-pocket.

They are expensive, said Armellino. Its not actually the medicine that is expensive. Its the delivery system itself. I think there should be some entrepreneurial type who can create a less expensive way to deliver this medicine.

Jaeger said EMTs used to carry EpiPens, but the cost is prohibitive so many are now not being routinely equipped with them.

Child said all pharmacists should explain the pen and its use.

If you have questions ask, said Child. The more education you get, the better and more confident you will feel about using an EpiPen.

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EpiPen advice: Doctors say when in doubt, use it to nip allergic reactions in the bud - Seacoastonline.com

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