Do ‘EpiPens’ save lives?

A new study on EpiPens by Dr Richard Pumphrey of the Central Manchester Hospitals, UK, looks at the reasons that even though over 100,000 adrenaline auto-injectors have been issued over the last 20 years, the death rate from severe allergic reactions has remained the same.

Looking at each of the 110 deaths from food allergy that have occurred since its introduction, two out of three had not been issued with an EpiPen because their previous reactions were so mild. Of those who were issued pens, half used the pens too late or were not carrying them at the time. The other half used the pens correctly but still died.

At the European Academy of Allergy and Clinical Immunology (EAACI) congress 2011 in Istanbul, Dr Pumphrey said it was this latter group that were most perplexing, and were the focus of his research. The auto-injector shoots a needle through the skin, followed by an adrenaline injection – if the needle goes into muscle the adrenaline is most effective. In overweight people the needle may not reach the muscle, so nor does the adrenaline. Because the needle tracks are rarely dissected at post mortem, this failure to reach muscle has only been confirmed in one case.

Manufacturers claim that the force of the injection means that adrenaline will reach muscle even if the needle doesn’t, however recent research from the UK and US shows that this is not the case. One solution may be to make longer needles. Another may be to instruct users where the fat is thinnest on the thigh for optimum injection. Regarding those who do not carry their pens at all times, Dr Pumphrey says the highest risk group are 18-24 year olds, who have varying views on risk itself, and need to have advice tailored specifically for them. Auto-injectors need to be combined with avoidance of trigger foods and management of other health conditions that may increase the severity of reactions.

Source: European Academy of Allergy and Clinical Immunology

First published in June 2011


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