Written by Dao Le
Mothers of children with deadly allergies know the feeling. They’ll be having normal days when their worst nightmares become realities; once the allergic reactions begin, it’s a race against time. These mothers need to get their children to healthcare providers before it is too late. One potentially life-saving device that most allergy mothers depend on is the EpiPen. These devices can buy them precious minutes, minutes that can save a life.
An EpiPen is an injection of the hormone epinephrine, better known as adrenaline. The rush of fear or excitement can be attributed to epinephrine being released into the bloodstream. Epinephrine is useful for alleviating severe allergic reactions because it narrows blood vessels and opens airways. Narrower blood vessels delay potentially fatal inflammatory responses by the immune system to allergenic substance. Opening the airways ensures that the patient continues taking in oxygen [1]. The brain is almost completely reliant on oxygen for fuel; if it fails to properly send signals to other parts of the body due to a lack of oxygen, the result is the death of an individual [2].
In 2016, Mylan, the company with a monopoly on the EpiPen, hiked its price. In 2009, the listing price for an EpiPen was $103.50. By 2016, this price had gone up to about $608. The costly nature of the EpiPen is completely attributed to the device’s design, since the chemical epinephrine only costs a few dollars [3]. Even with such an expensive design, however, the number of EpiPen failure reports has increased from just four in 2012 to 228 so far in 2017 [4]. This makes one wonder: how expensive should a design that has been failing more frequently actually be?
According to Dr. Scott Sicherer, pediatric allergy expert at Mt. Sinai Hospital, some of these failure reports are caused by people not knowing how to use their EpiPens properly [4]. In a study performed by the National Poison Center, 6,806 reports of unintentional contact with an EpiPen were made to poison centers in the United States in 2013 and 2014 [5]. To properly administer this device, one should hold the EpiPen so that the side containing the needle is pointing down. Then, the safety cap should be removed and the needle should be pushed firmly into the patient’s thigh until one hears a click. Most auto-injector devices allow the needle to reenter the device after use. To learn how to correctly use an EpiPen, one should thoroughly read the instruction manual and visit the provider’s website for more information. It is also imperative to call 911 after administration. An EpiPen is a time buyer, not a treatment or cure. If further allergic reactions occur while waiting for help, a second EpiPen can be safely administered [6].
With all these price hikes, it may be difficult for those who need it to obtain an EpiPen. Those who qualify can sign up for Mylan rewards cards that can save them up to $300 on the device [7]. This reduces some burden when it comes to medical costs. For those who absolutely cannot afford an EpiPen, one can prepare a syringe filled with epinephrine and store it in an eyeglass or pencil case. Though having an EpiPen is preferable, an epinephrine-filled syringe is still a safe option for low-income families [8].
References:
1. Churchwell, Megan. “Epinephrine effects.” Peanut Allergy. http://www.peanutallergy.com/articles/peanut-allergy/epinephrine-effects. Accessed 18 November 2017.
2. Villines, Zawn. “What Happens After a Lack of Oxygen to the Brain?” Spinal Cord Injury Journal. https://www.spinalcord.com/blog/what-happens-after-a-lack-of-oxygen-to-the-brain. Accessed 25 November 2017.
3. “Mylan CEO on EpiPen drug price controversy: ‘I get the outrage.’” CBS News. https://www.cbsnews.com/news/epipen-price-hike-controversy-mylan-ceo-heather-bresch-speaks-out/. Accessed 18 November 2017.
4. “Complaints of reported EpiPen failures has Mylan on defensive again.” CBS News. https://www.cbsnews.com/news/epipen-complaints-that-device-is-not-working/. Accessed 25 November 2017.
5. Anshien, M., Rose, S.R., Wills, B.K. 2016. Unintentional Epinephrine Auto-injector Injuries: A National Poison Center Observational Study. Am J Ther.
6. “Blue to the sky. Orange to the thigh.” EpiPen. http://www.epipen.ca/en/about-epipen/how-to-use. Accessed 18 November 2017.
7. “Access and Savings Programs.” EpiPen. https://www.epipen.com/paying-for-epipen-and-generic. Accessed 18 November 2017.
8. Pepper, A.N., Westermann-Clark, E., Lockey, R.F. 2017. The High Cost of Epinephrine Autoinjectors and Possible Alternatives. J Allergy Clin Immunol Pract. 5(3): 665-668.