{"id":19248,"date":"2021-09-21T15:37:00","date_gmt":"2021-09-21T20:37:00","guid":{"rendered":"https:\/\/thepapergown.zocdoc.com\/?p=19248"},"modified":"2023-03-06T11:55:03","modified_gmt":"2023-03-06T16:55:03","slug":"with-an-epipen-the-first-time-is-the-worst-time","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/patient-stories\/with-an-epipen-the-first-time-is-the-worst-time\/","title":{"rendered":"With an EpiPen, the First Time Is the Worst Time"},"content":{"rendered":"

They say you never forget your first. I know I won\u2019t.<\/span><\/p>\n

I was 19 and nervous \u2014 and a little embarrassed about being so nervous. As I stood there, shaking and sweating, the questions piled up: <\/span>Would it hurt? Is it safe? How quickly do I pull it out?<\/em><\/span> But I wasn’t going to let mislabeled peanut butter cookies be my downfall, so I<\/span> held my breath, hoped for the best and went for it.<\/p>\n

I\u2019ve been extremely allergic to peanuts since birth. If I ingest anything laced with the legume, my lips swell up and my throat constricts almost instantly. As a result, I keep an EpiPen within arms reach at all times. EpiPens are the best-known brand of epinephrine auto-injectors,<\/span>\u00a0prescription-only medical devices that deliver concentrated shots of adrenaline into the bloodstream to counteract severe allergic reactions, most often to food. Other brands <\/span>include Auvi-Q, Adrenaclick and Impax, and they all basically work the same way.\u00a0<\/span><\/p>\n

Allergies \u2014 especially to food \u2014 are becoming more common because of environmental changes<\/a>, new genetic variations and potentially even insufficient exposure to germs (the “hygiene hypothesis”)<\/a>. That means more and more EpiPens will be used to save lives in the future. That is, if they\u2019re used correctly. While they\u2019re becoming easier to use (some even talk you through the procedure<\/a>), the prospect of willingly stabbing yourself in the leg is daunting. It’s also necessary.<\/p>\n

My first injection was both harrowing and comical: I was asphyxiating in my college apartment, acutely aware of what I needed to do (jam an inch-long, spring-loaded needle into my thigh with gusto, ASAP), but unsure if I could actually do it. I felt like a Civil War soldier mustering the courage to amputate his own arm. Finally, with Blink-182 blasting in the background, I did it. The needle pierced my thigh. I yelped. My best friend, a witness to the madness, and I waited briefly to see what would happen. Then we called my mom.<\/span><\/p>\n

\u201cGet to the hospital,\u201d she commanded. \u201cRight now.\u201d\u00a0<\/span><\/p>\n

On the way, I started feeling better \u2014 my throat loosened up and I began breathing normally again. The EpiPen had saved my life, and I was grateful to have it. But I didn\u2019t know anything about how it worked or how often I’d need to reach for it. And I had to wonder: Why couldn\u2019t Big Pharma come up with a less terrifying way to halt allergic reactions, like an Epi-pill or Epi-inhaler?<\/span><\/p>\n

Nineteen years later, I’m a lot more informed about EpiPens and a lot less nervous when the situation demands whipping one out.<\/p>\n

\n

The allergen diaries<\/h3>\n

My complicated relationship with allergies started long before I got an EpiPen. I\u2019m allergic to numerous things, but my peanut allergy<\/a> <\/span>is the most severe. Eight major food allergens are thought to account for 90% percent of food allergies: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybeans. These are called the “Big 8”<\/a> in the allergy community; the FDA requires food manufacturers to list them as ingredients on product labels. The list isn’t necessarily fixed, though \u2014 there’s federal legislation pending<\/a>\u00a0to make sesame No. 9.\u00a0<\/span><\/p>\n

Growing up, I was the only one of my friends with a Big 8 allergy. Now, it seems like every kid’s a member of the club. Indeed, data indicates food allergies are more prevalent than they used to be. For example, according to the National Center for Health Statistics, the percentage of children under 17 with a food allergy increased from 7.4% to 12.5% between 1997 and 2011. This isn’t because our bodies have gone soft. Instead, greater allergy awareness and advanced diagnostic tools have led to earlier, more widespread allergy testing in kids, according to Dr. John Panuto, an allergist and immunologist.<\/p>\n

Allergies aren\u2019t necessarily with you for life. The list of things I\u2019m allergic to is a lot shorter than it used to be. I overcame allergies to dogs, cats, pollen, dust and mold with help from weekly allergy shots, which I received until I was 18. I also overcame allergies to certain foods, including shellfish and eggs, by avoiding them entirely.\u00a0<\/span><\/p>\n

\u201cIf you [successfully avoid the foods that harm you] long enough, you can down-regulate the memory cells to the point where they actually disappear,” Panuto says. “It doesn\u2019t work for everyone, but when it does, it\u2019s basically the body forgetting that you\u2019re allergic to something.\u201d<\/span><\/p>\n

While my peanut allergy has stuck with me, I’m grateful that nothing else has emerged, since food allergies can also develop during adulthood. Research suggests<\/a> this is the case for about half of food-allergic adults.<\/p>\n

War against the reaction<\/h3>\n

A chemical called histamine is responsible for many allergy symptoms. Histamine lives in mast cells, a type of white blood cell found in connective tissue. Coming into contact with an allergen activates mast cells and releases histamine. If the roof of your mouth itches after eating pineapple, or you sneeze when a cat\u2019s nearby, that\u2019s histamine in action.<\/p>\n

\u201cCompromised mast cells near the surface of the skin can cause hives and irritation, while histamine released in the lungs or throat can cause bronchoconstriction, narrow airways, wheezing, and respiratory compromise,\u201d says <\/span>Dr. Schuman Tam<\/span><\/a>, an allergy, asthma and immunology specialist in San Francisco.<\/span><\/p>\n

Originally, Tam explains, our bodies released histamine to ward off dangerous parasitic infections like malaria. But in our industrialized world, our bodies now primarily use it to flag allergens. Antihistamines are the class of drugs that block the effects of histamine; they include Benadryl (diphenhydramine), Claritin (loratadine) and Zyrtec (cetirizine).\u00a0<\/span><\/p>\n

While antihistamines are a good tool against minor or moderate allergy symptoms, they aren\u2019t strong enough to combat anaphylaxis, an extreme and potentially life-threatening allergic reaction that causes blood pressure to plummet and affects multiple areas of the body at the same time. Symptoms include wheezing, hives and swelling, and trouble breathing and swallowing. Food allergies are the most common cause of anaphylaxis, but other possible triggers include allergies to insect venom and certain medications.\u00a0<\/span><\/p>\n

Enter: EpiPens.<\/span><\/p>\n

A standard EpiPen delivers 0.3mg of the hormone epinephrine, also known as adrenaline. (The adorably named \u201cEpiPen Jr.\u201d halves that dose for users under 66 lbs.) An epinephrine injection reverses anaphylaxis by blocking the release of additional histamine, increasing heart rate and blood pressure, and relaxing muscles in the airway and around the lungs. Experts recommend injecting the pen into the back-side of your thigh, specifically, because it offers a large, muscular surface area that’s ideal for drug absorption.<\/span><\/p>\n

Unfortunately, there\u2019s no way to eliminate needles from the equation. A pill can\u2019t be absorbed quickly enough to stop a massive allergic reaction, says Tam. \u201cThe drug would be broken down too substantially, and food in your stomach would prevent it from being absorbed rapidly,\u201d he says. \u201cIn order for epinephrine to potentially save your life, it must be absorbed into your bloodstream almost immediately. That\u2019s why the thigh makes the best injection site \u2014 it\u2019s full of blood supply.\u201d<\/span><\/p>\n

Sealing the deal<\/h3>\n

EpiPens are recommended for generally healthy adults and children with truly severe allergies who don’t have underlying heart disease. Older adults and people with minor or moderate allergies aren’t good candidates, Panuto says. <\/span><\/p>\n

\u201cIf a patient says, \u2018Hey, can I have an EpiPen? When I get stung by a yellow jacket I get a little swelling in my hand,’ that\u2019s not a valid reason,”‘ Panuto says. “Or if you\u2019re an 85-year-old with cardiovascular disease and hypertension, an EpiPen isn\u2019t the best idea. But if you\u2019re relatively healthy, you\u2019re better off being aggressive in an emergency situation.\u201d<\/span><\/p>\n

Still, it’s possible that more adults should be carrying around EpiPens. Research suggests<\/a> they’re prescribed to as little as one-quarter of adults with food allergies.<\/span><\/p>\n

While there\u2019s no official rule, most allergists say kids with diagnosed food, insect or medication allergies <\/span>should \u201cself-carry\u201d auto-injectors \u2014 and be prepared to use them in an emergency \u2014 starting at <\/span>12 to 14 years old<\/span><\/a>. <\/span>I got my first EpiPen in middle school; I just never had to use it until college. <\/span>Since my inaugural shot, I\u2019ve stabbed myself seven times. Who knows what my lifetime total will be. There will always be the chance of unknowingly scarfing down pecan-laced strawberry pie at a family gathering (stab No. 3). Or confusing the red-colored granola bar wrapper (chocolate) and the orange-colored one (peanut butter) during a chaotic morning (stab No. 7).<\/span><\/p>\n

EpiPen pro tips<\/h3>\n

Over the years, I\u2019ve gotten a lot better at wielding an EpiPen. Based on my own experiences, here are some tips to help you get the hang of it:\u00a0<\/span><\/p>\n