EpiPen

Similar rules in Australia

Unfortunately, used incorrectly, it’s extremely dangerous. It’s adrenaline, which is an inotrope, chromotrope, and vasopressor. It will raise your heart rate and blood pressure… useful things in anaphylaxis but can rapidly cause (catastrophic) things like a hemorrhagic stroke in someone who doesn’t require it.

-hence, to reduce this risk it makes sense to only prescribe the Epipens to those who actually have a documented allergy that could require it. The overall public health risk is probably worse for letting random people everywhere have Epipens, vs the chance of an undiagnosed allergy causing a fatality from anaphylaxis. Many allergies develop over time and become worse, and riskier, after the first exposure.

If you are leading others outdoors, I would simply make pains to check for anaphylactic allergies in their medical history and make sure they carry an Epipen before you go, including encouraging them getting a second one to take. Make sure you know where they both are in their pack.

Very good info.

Thank you.

I would simply make it a point to identify the need to carry critical medications on your trips. Force a signed waiver upon the parents/guardians of you need to.

Rescue inhalers, migraine medication, epi-pens, prescriptions, would all fall into that description.

Very good points.

Thanks

On a related note, has anyone sized up the new epinephrine nasal spray (neffy) on the market or the sublingual film (Anaphylm) under development? I haven’t seriously looked into either, but it’s on my to-do list. Of particular interest for backpacking, both have promising published studies related to stability above and below room temperature (neffy study, Anaphylm study). Both studies do appear to have been conducted by the companies manufacturing the drugs.

I was diagnosed with a severe bee venom allergy a few years ago, and now always carry an epipen.  Two, in fact, because I hike in the backcountry.  The pharmacist originally resisted the second one until I explained how and where I hike.

But since then I have undergone desensitivity treatments, and they seemed to have worked.  My allergist still suggests I carry an epipen, and when hiking in a group, I always announce this to everyone.

But please make sure you know how to use whichever epipen you have.  They are different, and there are numerous examples of people injecting themselves in the hand instead of the patient in need of the epipen…they held it wrong way around.

I also carry both sudafed Benadryl and Zytek. [edited MK]  My doc instructed me take both of those immediately if I am stung.  The Sudafed can kick in about tweny minutes after ingestion, and the Zyrtek is longer acting.  Both will at least help, and may avoid the need for the epipen.

This stuff is no joke. If you think you may be in a situation where an epipen is medically indicated, learn about them well in advance.  This is one area where FAFO definitely doesn’t work.

Labeling an epipen as extremely dangerous is a bit dramatic.  Here is a good summary. The noted complications are VERY rare.  I hope the link works.  https://www.openevidence.com/ask/885c02ab-229e-46f1-9734-1e99c51ba5bb

The link worked.

Thanks.

It says “the risk of untreated anaphylaxis almost always outweighs the risk of the drug.”

Some people have talked about legal issues and just leaving the responsibility with each individual, but I would surlily hate to find myself in a position where a person’s airway closed and watch them expire.

Back in 2012 I was backpacking in a NC wilderness and set up camp on the fringe of the wilderness when I saw three ATV come up the mountain.  They had to rescue a yellow jacket stung woman about 2 miles away on rugged trails.  She told me later she was supposed to carry an Epi pen but decided not to on that trip.  Oops.

My youngest, who is 14, has severe food allergies. Literally, he will die-level. When we travel, we carry FOUR of his pens (we use Avi-Q, they talk to you). He has self-carried since he was 4 years old.

If the pens are stored correctly (not in your car!!!!), they are good for years after they expire. And cough cough for $35 or 45 you can go on Amazon Pharmacy and tell them you are allergic to peanuts, and it will be prescribed. I will admit I did that – we couldn’t see a Dr immediately when we moved, the school required new ones. They won’t do that for children, but adults they do. Now then, none, not one brand, is actually affordable. Expect to pay $200 to 400 for 2 pens. Unless your insurance is ungodly good.

Would I offer up a pen to someone in ana shock? If I had 4 I would without blinking. Some people require 2 of them. And they only last so long as well – you must get immediate medical care.

The other part is that many with severe allergies like this also have asthma. Not having an inhaler can kill even faster.

When our son had his last ana – how we found out about cashews – we got very, very lucky. We wouldn’t find out about the asthma till he was 4 and the coughing started in a school setting.

He has had reactions (how we found out sunflowers and soy are bad. He reacts, but not ana level). He gets 2 hits from his inhaler IMMEDIATELY. Then Benadryl (because he isn’t turning bright red, full body hives, eyes shut, etc). Then we rinse his mouth out, give him water and watch him very carefully.

He takes his inhaler for topical reactions (he walked off a plane and his arms were covered in hives; we believe they touched material on a seat that someone had touched with allergens), and the same protocol.

He wears long clothing since that day. Doesn’t matter if it is 110* out. He never eats anything without me looking at it.

But on the expiration, this came from the CEO of Mylan – back before Covid I sat in on a lecture he gave, and that subject came up. You rarely can harm someone with a shot of it – if you don’t need it, it just acts like minor speed.

That’s why they come in 2 packs. You don’t want to know how many parents stab themselves on accident, because they are so scared. The first time I had to do it – my son was just over a year old, I got it in … for 3 seconds (the 10 seconds is so you have a focus) and it was enough. I was shaking so hard doing it.

Btw, if you want to learn safety on use:

If you have an actual Epi-Pen, it is “blue to the sky, orange to the ground”.

Practice on oranges. It’s the same as doing it on a human, thru jeans. That is why a practice one comes with many brands. Or use a severely expired one.

Tips came from the CEO of the company.

Excellent points, Sarah!

I read there are generics cheaper

One thing is, the manufacturer patented some minor changes in the mechanism to extend the patent period.  Then, it’s hard to get a generic approved by the FDA unless the generic has the exact same mechanism.  So they have jacked up the price.

But I read there are generics with a different mechanism much cheaper.

Everything about health care costs is screwed up.  And food regulations,…  But the manufacturers like it.  Getting the value out of their political “donations”.

I carry ampules of adrenalin- and syringe and needle. So, about 6 ‘doses’.

I haven’t had an anaphylactic reaction, but my responses to bee stings are increasing and there are these lovely ants (Jack Jumpers) around here. And I have asthma, as did my kids.

A outdoorsy doctor encouraged me to do this years ago. I practiced on other people in a Wilderness First Aid course- my practice partner groaned dramatically to try and put me off (didn’t work 🙂).

I wonder if the post up thread meant Benadryl but said Sudafed? I don’t think Sudafed would do crap for an allergic reaction to a bee sting.  Am I wrong there? I’ve never heard of using that.

Even if you aren’t going to carry a “just in case” epipen for a group, and simply require individuals to carry their own as needed, it is really helpful to learn to use one, because the person involved may be incapacitated quickly. There are “tester” dry, needle-free pens. My son, like Sarah’s, has deathly reactions to certain foods. I was always scared to use the epi, even when I should have in one case where we ended up in the ER. I finally learned to do it using the tester. Nothing like rehearsal for better opening night performance.

My son was in NYC once with his college friends, and although he’s very careful to ask questions in restaurants, he ended up getting some contamination in a bagel shop. They never did figure out the cause. It can happen anywhere. It’s a fast reaction for him- within a few minutes he’s getting hives, he gets weak as blood pressure drops, and vomiting starts. He had his epi but even he was scared to use it. Fortunately a savvy friend took his epi and gave it to him correctly, then called 911. He got two more epi shots from the ambulance crew on the way to the hospital, which had the end result of him no longer being afraid of the shots. Didn’t have his insurance card so they refused to take him to the closest hospital, but took him to the poor person one across town! for a potentially life-threatening situation. But that’s another topic.

He has had numerous exposures since but now knows exactly what to do and what to tell others to do. He is careful in town at restaurants or when sharing food, and when camping or in remote locations, only eats his own food that he has brought – no sharing when so far from help. Managing something like this without 911 access nearby would be a nightmare. Folks definitely need to know how to use the pens, and as a group leader I’d want to confirm they have them, and that they’re going to be careful to avoid other people’s food (for that type of allergy). People forget what ingredients they use (guilty), cross contaminate, or just don’t think it’s that important. If acceptable to the allergic person, it would be good to share the allergy info with the group.

Even with bees or wasps, I’d not put that allergic person in the front going down trail; let someone not allergic encounter a nest first!

Prevention first. Epi, benadryl and steroids if needed.

I wonder if the post up thread meant Benadryl but said Sudafed?

I had the same thought, but Sudafed is as close as we can get to an over-the-counter epinephrine-like stimulant that is widely available, so it makes sense.

Since I ws the person who wrote sudafed, I can confirm that I meant Benadryl! Sorry for the brain fart.

sudafed used to be pseudo ephedrine.  But people used it to make meth so they now have it behind the counter only, limited amount you can buy.

There is something called sudafed on the shelf.  It’s not pseudo ephedrine.  It’s not effective.

Not a doctor, but I’ve had severe seasonal allergies for nearly 30 years now, and have experienced every prescription & OTC antihistamine known to man it seems…

Benadryl is effective, but it should never be a substitute for Epi. I would hesitate to give Benadryl on-trail as well, due to the drowsiness. Non-life threatening reaction, and you can afford to rest? Sure…

My daughter had a severe reaction to Cashews (tree nuts) as a toddler, and has carried Epi since. As mentioned, they’re still useful after expiry, and due to the cost, I wouldn’t hesitate to hang onto them for several years later.

Bringing this back to the idea of leading trips – I would just reiterate the importance for everyone coming on the trip to have their required medications, including Epi, etc… Require signature by the parent/guardian of notice. Perhaps a quick inspection by the group-leader day-of, to make sure they have actually packed what they’ve said they need.

While being conscious of HIPPA, personally, I wouldn’t hesitate meet with the Hiker & parents individually, and do a quick “Show me where you put your Epi in your pack…” You’re not auditing their meds, or questioning their condition(s). Simply covering essential awareness & preparedness. Perhaps a 2nd form on trip-day, with the parent’s signatures, stating that they actually packed the essential med’s, and verified with the trip-leader.

Thanks for all the response!

I do carry children’s chewable Benadryl as well as the regular.

It was suggested by an EMT friend that also backpacks.

He said they carry liquid Benadryl on the ambulance but chewables are easier for backpacking.

Also, I have an allergic reaction to cashews. It’s been on my chart forever.

I can remember every time that I accidently ate some. Most of the time I threw up and just felt like crap for a while and got over it, but one time, for some reason, I did not throw up. I swelled up so much that I was told that if Ithey didn’t know it was me, they wouldn’t recognize me.

I sat in the ER for about three hours until the swelling began to go away and I began to feel better.

Then they called my name. I told them to never mind. I had sat there until I got better.

But there was another time when we hiked up a mountain from the bottom to the top, about 8 hours.

I’m pretty careful about reading labels but the freeze-dried meal I brought had an ingredient list a mile long and I missed that it had cashews in it.

I tried to gag myself but wasn’t able to get anything out. It was a rough night. I felt like there was some swelling in the throat as well as the face, but I got through the night.

I had forgotten about that since all worked out but maybe I should talk to my doctor about that as well.

Many people who are severely allergic require a 2nd injection. Also, many people who’ve never had an allergic reaction can develop anaphylactic shock after a bee sting. If you feel more comfortable carrying a 2nd EPI-pen as a group leader, get a refill when due and keep the one that just expired as your backup should a 2nd injection be needed. Also carry lots of diphenhydramine(Benadryl). Another person mentioned Sudafed, but that could dangerously complicate the elevated heart rate and BP if EpiPen is used. Sudafed is more appropriate for nasal/sinus symptoms.

Thanks Maxine.

“Another person mentioned Sudafed, but that could dangerously complicate the elevated heart rate and BP if EpiPen is used. Sudafed is more appropriate for nasal/sinus symptoms.”

That wasn’t another person, that was me!  And I did post a correction that I meant Benadryl, not Sudafed. I wish that there were a way to edit our posts on this site…