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What Is an EpiPen and Who Needs It?

Monday, May 13, 2019

Atlanta Allergy & Asthma Blog

Cost and access to EpiPens was big news a year ago, however, we are still facing shortages today. It’s Food Allergy Awareness Week so we asked Atlanta Allergy & Asthma physician Dr. Lily Hwang to talk about who needs this drug and how to make sure you have access if it is medically necessary.

What Is an EpiPen and What Is It Used For?

EpiPen is the brand name of an auto-injectable device that delivers the drug epinephrine. It is a life-saving medication used when someone is experiencing a severe allergic reaction, known as anaphylaxis.

EpiPen is just one of the brand names of devices known generically as injectable epinephrine. This medication acts on the whole body to shut down the allergic response. It constricts the blood vessels, leading to increased blood pressure, and decreased swelling. This allows the muscles around the airways to relax, causing the lungs to open. Epinephrine also prevents the release of more allergic chemicals, which stops the progression of the allergic response.

Epinephrine is the only medication that works on the entire body, multi-system, multi-organ, for anaphylaxis, which is why it is the only drug recommended.

How Do You Know If You Need Injectable Epinephrine?

First and foremost, if you suspect you have had an allergic reaction to a food or insect sting, you should see a board-certified allergist to evaluate your reaction/symptoms. The allergist will obtain pertinent medical history, perform a physical exam, and recommend diagnostic testing if indicated.

If you already have a diagnosis of food allergy, it is important to see your allergist regularly for possible re-testing and an oral challenge to determine if you have outgrown some of your allergic triggers. In some cases, a prescription for injectable epinephrine may no longer be medically necessary.

Can You Give Us Some Examples of When Injectable Epinephrine Is Not Needed?

Insect stings commonly cause large local reactions in the general population and bring concern to some; however, this is not an indication for injectable epinephrine because the risk of a life-threatening reaction is very low.

Also, a child who was diagnosed with an allergy to egg should have regular evaluations by an allergist. Most children will outgrow their egg allergy. Your allergist will determine the need for re-testing and recommend a skin test, blood test, and/or oral food challenge. An oral challenge is always done in a medical office where personnel trained to deal with any reactions are present.

Throughout our practice, every week we have children that are able to add egg back into their diet. If you are being properly managed by an allergy expert, filling prescriptions that are no longer medically indicated should not happen.

Once There Is a Confirmed Diagnosis That Includes the Risk of Anaphylaxis, Besides the Prescription for Injectable Epinephrine, What Else Does the Patient Need to Do?

Knowing when and how to use your injectable epinephrine is very important. Your allergist and their staff will help you put a plan in place so you can recognize the signs of anaphylaxis and feel comfortable acting in the event of an emergency. Most deaths from anaphylaxis are caused by a delay in the administration of epinephrine. We tell our patients: when in doubt, administer. Using epinephrine if not medically necessary will not hurt you – however – not using can have dire consequences.

It is important that you are trained on the proper technique for using your specific device.

Studies show that those who did not administer said they were not sure when or how to use correctly.

A patient that has a confirmed food allergy diagnosis should also have a Food Allergy Action Plan in place. This document serves as an excellent way of communicating your medical needs to schools, daycare, and camps, in the event others need to make life-saving decisions for you. And as stated earlier, regular follow-up visits to determine your ongoing risk of anaphylaxis.

If Cost or Availability Is an Obstacle to Getting Your Epinephrine Auto-Injector, What Are the Options?

We continue to experience shortages with some products, so it is important for patients to know that there are options in injectable epinephrine including EpiPen, Auvi-Q, and several generic choices. If you are switching devices, again, make sure you know the differences in the administration technique of each product. Speak with your allergist and make sure you are comfortable using your device of choice. There is a link with training videos at the end of this blog.

See which devices have manufacturing delays.

Because of the shortages with some of the injectable epinephrine devices, the FDA has extended the expiration dates on some lots.

Mylan (manufacturer of EpiPen and the authorized generic) and Kaléo (Auvi-Q) offer assistance programs to help patients gain access to injectable epinephrine when cost is an issue.

You also might consider writing a letter to your insurance company for a tier exception to help lower patient cost.

Anything Else You’d like People to Know?

If you have any questions or concerns, speak with your allergist to discuss your options for epinephrine coverage. Having generic options have helped a lot of people who previously had cost concerns. Regardless of your choice of epinephrine device, work together with your board-certified allergist to devise an anaphylaxis plan that you are able to follow in the event of an emergency.

See a list of epinephrine options as well as training videos.