Epinephrine Injector... Is it Enough?

You are attending a birthday party for a wonderful friend. It is time for her to cut the cake and for everyone to indulge in the delicious cake that her mother made. However, when you begin to take your first bite you quickly realize that you forgot to ask if there were any peanuts used… but it’s too late. Your body begins to defend itself against the invader and overreacts by producing antibodies. You begin to feel extremely flushed, a tingling sensation that is unusual, tightness in your throat, and shortness of breath. What do you do?

It is known that those who experience a severe or life-threatening allergic reaction (anaphylaxis) quickly inject themselves with epinephrine. Epinephrine, also known as adrenaline, is used as the first-line treatment medication in battling anaphylaxis before the reaction turns deadly (1). When an individual experiences an allergic reaction and administers an injection of epinephrine promptly, it’s shown to be extremely effective in reversing the symptoms. Epinephrine helps release obstruction and opens the airway, strengthens the heart so that it beats quicker and stronger, raises blood pressure and can reverse anaphylactic shock.

However, on CNN it was reported in August 2^nd, 2013 a little girl sadly passed away after taking a bite and spitting out a desert that did not seem right (2). She had a severe allergic reaction to peanut butter.  She was injected with epinephrine three times. However, little is known about the length of time that had elapsed before administering the first injection of epinephrine. If it was not administered promptly, the effectiveness of the epinephrine injected is diminished. This article helped me to further research the effectiveness epinephrine has on anaphylaxis.

The article Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community written by Sheikh, Simons, Barbour and Worth assessed the effectiveness of epinephrine injectors in helping to relieve respiratory, cardiovascular, and other symptoms that occur during anaphylaxis by looking for reviewed and relevant evidence (3). They looked at the effects of a variety of epinephrine auto-injectors (EpiPen, Anapen etc.) compared to no treatment (found to be unethical to try), a placebo (found to be unethical to try), alternative pharmacological agent, or gaining adrenaline using an alternative route (3). However, no new discoveries were found to support other effective treatments other than the epinephrine injectors we currently have (3). It is found that given the right dosage of epinephrine promptly (.01mg/kg to 0.5 mg/kg (for adults)) is necessary to help prevent anaphylaxis from worsening (4). Once it is initially given the individual must be monitored for a certain amount of hours to ensure that the anaphylaxis has passed and the body is returning back to homeostasis (4).

Although epinephrine injectors are currently the best first-line treatment of anaphylaxis, I often wonder if there is or will be another form of medication that could potentially become more effective in the future. The best we can do is to continue educating others about how anaphylaxis is not a rare disease. Regardless of the severity of an allergic reaction, prompt response with the proper medication could mean the difference between life and death.

Works Cited

FARE. "Epinephrine Auto-Injectors." FARE- Food Allergy Research and Education. FARE, n.d. Web. 27 Nov. 2013. <https://www.foodallergy.org/treating-an-allergic-reaction/epinephrine>.

How Stuff Works. "What Does Epinephrine Do For Anaphylaxis." Discovery Fit and Health. N.p., n.d Web. 27 Nov. 2013. <http://health.howstuffworks.com/diseases-conditions/allergies/allergy-treatments/what-does-epinephrine-do-for-anaphylaxis.htm>. [1]

Landau, Elizabeth. "Despite Shots, Peanut Allergy Kills Teen." CNN. Cable News Network, 01 Jan. 1970. Web. 27 Nov. 2013. http://www.cnn.com/2013/07/31/health/california-peanut-allergy-death/ . [2]

Sheikh, Aziz, F., et. al. "Adrenaline Auto-injectors for the Treatment of Anaphylaxis with and without Cardiovascular Collapse in the Community." The Cochrane Library (2012): n. pag. 15 Aug. 2012. Web. 27 Nov. 2013. http://onlinelibrary.wiley.com.dml.regis.edu/doi/10.1002/14651858.CD008935.pub2/full  [3]

Simons, F. Estelle R., M.D., et al.  "World Allergy Organization Anaphylaxis Guidelines: Summary." Journal of Allergy and Clinical Immunology 127.3 (2011): 587-93. Science Direct. Elsevier, Mar. 2011. Web. 27 Nov. 2013. http://www.sciencedirect.com.dml.regis.edu/science/article/pii/S009167491100128X . [4]

WebMD. "Anaphylaxis Treatment: Epinephrine Injections." WebMD. WebMD, 23 Mar. 2013. Web. 27 Mar. 2013. <http://www.webmd.com/allergies/understanding-anaphylaxis-treatment>.