Extra Epinephrine

by Kerry Schiller

On a beautiful afternoon in early June, my cousin Maggie picked me up from school. She had just gotten her license, and we were thrilled to drive around and enjoy the beginning of summer on Long Island. As we cruised along with the windows down, singing our favorite songs at the top of our lungs, Maggie took a bite of a granola bar. Suddenly, she pulled the car over. 

      “We’re just going to stop here a second because my tongue feels very itchy,” she said, almost laughing, though I could hear the nervousness in her voice. She reached for the package of the granola bar and skimmed the ingredients. I peered over her shoulder, my eyes catching on the bold print at the bottom of the package: CONTAINS CASHEWS.

      “Sh*t!” Maggie yelled, her voice shaking. She is severely allergic to nuts and seeds, and was about to go into anaphylaxis, a life-threatening allergic reaction.

     “Do you have your EpiPen?” I asked, trying to stay level headed.

      “No,” she squeaked out, her voice cracking. All the color had drained from her face, leaving her ghost-white. Her eyes bulged out of her head.

“Okay Mags. Call your mom, and I’ll call an ambulance. It’ll be okay.” Honestly, I wasn’t so sure.

9-1-1. I took out my phone and dialed the number I was taught was only for an emergency. It felt so weird, like I was doing something I wasn’t supposed to, but this was definitely an emergency. 

I sat with Maggie, waiting and praying Hail Marys, as her tongue swelled, her throat closed, and she started gasping for air. After an excruciating ten minutes, the ambulance finally arrived, and the EMTs were able to give her a life-saving dose of epinephrine before bringing her to the hospital.

Stories like Maggie’s happen all the time, and unfortunately, they don’t always have a happy ending. A few months ago, a Florida teen died after eating a cookie she didn’t realize contained Reese’s peanut butter cups (Smith). Severe allergy diagnoses are on the rise in the United States. In fact, reported cases of anaphylaxis increased “377 percent from 2007 to 2016” (Gelburd). For people with severe allergies, the availability of epinephrine can be the difference between life and death. Epinephrine is a drug that temporarily halts the body’s allergic autoimmune response. After the onset of anaphylaxis, “epinephrine is the only effective treatment” (“Facts and Statistics”). It stops anaphylaxis from progressing long enough for a person to seek medical attention. 

Patients diagnosed with severe allergies are routinely prescribed epinephrine auto-injectors (EAIs), such as the EpiPen or the Auvi-Q, to carry with them in case of emergencies. However, as in Maggie’s case, people often forget them on their way out the door. Additionally, people may not be aware of their severe allergies until it is too late. For example, when I was eight, my mom, who had eaten shellfish her entire life, ate shrimp and went into anaphylaxis. Luckily, my aunt dug an EpiPen out of her purse. Without that EpiPen, my mom likely wouldn’t have survived. So, how can we decrease the number of allergy-related deaths in the United States? It might be solved by increasing the presence of EAIs in public areas. 

When Maggie went into anaphylaxis, we were in my high school’s parking lot. After calling the ambulance, Maggie and I flagged down some faculty members, hoping they could get an EpiPen from the nurse’s office. I was shocked to learn that they couldn’t give her an EpiPen because all were prescribed to specific students, and the nurse had gone home for the day. While the faculty members were very helpful and kept us calm, it bothered me that Maggie could have died because of a lack of available epinephrine.

Currently, most public places, including restaurants, schools, and businesses, have some sort of first aid kit, which typically contain Band-Aids, antiseptic, an ice pack, and pain relieving pills. These kits also increasingly carry defibrillators  to save people who are having heart attacks. Why are so many common medical emergencies accounted for in first aid kits while allergies seem to be forgotten? First aid kits should include some form of EAI, particularly in places where food is served, such as restaurants and school cafeterias. People can go into anaphylaxis without warning and die in a matter of minutes. It is important to make epinephrine more readily available and widely distributed.

Requiring public locations to carry EAIs is comparable to implementing common fire safety measures. Businesses and schools, for example, are mandated to carry fire extinguishers and smoke alarms. These locations carefully maintain their fire precautions in order to ensure the safety of their patrons in the event of a fire. Similarly, they should be required to carry epinephrine to protect people in case of an allergy emergency. Managers of these spaces might argue that this requirement would be a liability. Businesses and schools could be sued for intervening when the medication was unnecessary. To remedy this issue, public areas should be obligated by law to carry the drug and should not be responsible for its administration. Employees should be prepared to supply epinephrine to a person who appears to be experiencing anaphylaxis and allow him or her to inject it. Staff members should then ensure that an ambulance is promptly called. 

Moreover, it would be expensive for public places to maintain supplies of epinephrine, as it is a relatively expensive drug that expires roughly every 18 months. To offset expenses for the business, I would suggest that a person who utilizes this epinephrine be asked to pay for the crucial medicine. Another idea is to provide public locations with funds for the drug via tax money. Additionally, police officers should be given EpiPens and trained in giving them to people undergoing anaphylaxis. Police officers are typically the first responders to an emergency, arriving minutes before an ambulance. Consequently, if the officers were given the drug and taught how to use it, they could intervene earlier and prevent more serious consequences in the case of severe allergic reactions. Officers are commonly trained in how to administer Narcan to those who overdose on opioids, so it seems logical that they should carry the drug that can save the lives of those who suffer from allergies. 

With the prices of EAIs on the rise, many people struggle to afford the vital medication. The availability of epinephrine in public locations would be a stress reliever for people with allergies of lower socioeconomic statuses. The presence of EAIs would allow them access to the drug they need if they accidentally consume their allergen.

As I write, I’m texting Maggie. She’s currently in the emergency room with her younger sister, Bridget, who went into anaphylaxis at school today. The doctors aren’t even sure what caused Bridget’s reaction. Thankfully, she had an EpiPen with her, but I can’t help but wonder what would have happened if she didn’t. Would she have been left to die in the middle of her high school, waiting for an ambulance?

Works Cited

“Facts and Statistics.” Food Allergy Research and Education. n.d. Web. 10 November 2018. <https://www.foodallergy.org/life-with-food-allergies/food-allergy-101/facts-and-statistics>

Gelburd, Robin. “Food Allergies: New Data on a Growing Health Issue.” FAIR Health. n.d. Web. 6 December 2018. <https://s3.amazonaws.com/media2.fairhealth.org/research/asset/FH%20Published%20Research%20-%20Food%20Allergies%20-%20New%20Data%20on%20a%20Growing%20Health%20Issue.pdf?mod=article_inline>

Smith, Nicole. “Florida Teen Dies Following Severe Allergic Reaction to Peanut.” Allergic Living. 29 June 2018. Web. 6 December 2018. <https://www.allergicliving.com/2018/06/29/florida-teen-dies-following-severe-allergic-reaction-to-peanut/>