Note: The following is a letter to the editor of the South Florida Sun-Sentinel. It is signed by Allergy & Asthma Network, Asthma and Allergy Foundation of America, Food Allergy & Anaphylaxis Connection Team, Allergy Bright Communities and American Latex Allergy Association.
On behalf of the approximately 15 million people with food allergies, and as patient advocacy and clinical organizations, we write to express our concerns about the recent opinion column “EpiPens are oversold and overused” (published Dec. 1, 2016 in Viewpoints on Sun-Sentinel.com), written by Adriane Fugh-Berman. The piece is misleading and irresponsible – and could lead to dangerous consequences for people at risk for a life-threatening allergic reaction, or anaphylaxis.
The writer’s column fails on multiple levels, particularly when it suggests antihistamines are appropriate to treat an allergic reaction. This may be true of mild reactions, but certainly not severe or life-threatening ones. And when allergic reactions occur, there’s no way of knowing whether it will progress from mild to severe.
Clinical practice guidelines (such as the Guidelines for Clinicians and Patients for Diagnosis and Management of Food Allergy in the United States) and ongoing medical research and scientific evidence support epinephrine – not antihistamines – as the first line of defense to treat anaphylaxis and the only medication that can reverse life-threatening symptoms. Epinephrine auto-injectors, no matter the brand, are the most efficient and safest way to deliver the medication.
The writer’s suggestion that epinephrine auto-injectors are overprescribed and overused by people with food allergies is unfounded. Further, her statements that antihistamines work equally as well contradicts available data and will likely result in unnecessary confusion, particularly among the newly diagnosed.
Life-threatening food-allergic reactions are hardly rare. Approximately 15 million Americans have a food allergy, including 6 million children; while many food allergy symptoms are mild, there are more than 300,000 ambulatory-care visits per year by children under the age of 18 experiencing a food-allergic reaction, according to the Centers for Disease Control and Prevention (CDC). Food allergy is the leading cause of anaphylaxis, outside of hospitals where medication allergy is most prevalent. Another critical statistic: 40 percent of children with food allergies have experienced at least one severe reaction, according to a study in Pediatrics, the medical journal of the American Academy of Pediatrics.
Instead of the author’s suggestion to use antihistamines, we urge your readers to listen to the advice of leading food allergy experts such as Dana Wallace, MD, based in Fort Lauderdale, Florida: “Use epinephrine for any serious allergic reaction as epinephrine administered intramuscularly in an appropriate dose, such as with an auto-injector, has never caused a fatality – but delay or withholding epinephrine has resulted in many deaths.”
Allergists urge people at risk for anaphylaxis to take epinephrine at the first sign of symptoms, which can include itchy rashes or hives, swelling of the lips, tongue and throat, shortness of breath, chest tightness, nausea, vomiting, dizziness and loss of consciousness. Taking Benadryl will treat the rash and hives, but not life-threatening symptoms.
When anaphylaxis starts, sometimes within seconds of exposure to allergens such as a peanut or insect venom, immediate treatment is critical because symptoms progress quickly. When injected, epinephrine takes effect right away. Any delay in treatment of anaphylaxis greatly increases the chances of respiratory or cardiac arrest and hospitalization. Fatal reactions are often associated with either delaying the use of epinephrine or not using it at all.
The author mentions using vials of epinephrine and a syringe as a less expensive alternative to epinephrine auto-injectors. As anyone who has experienced anaphylaxis knows, this is an impractical method of delivering the medication, especially during an emergency. Imagine that your throat is swelling and you’re disoriented and dizzy – and then trying to draw epinephrine from a vial into a syringe and correctly inject it into the upper thigh. Or you’re a parent panicked your child is losing precious seconds as you must take the time to carefully draw medication from a vial. Simply put, using an epinephrine auto-injector is quicker and safer, especially in an emergency.
The implication that taking a prescribed dosage of epinephrine can kill based on one anecdotal incident – the tragic suicide of a 34-year-old woman – is fear-mongering at its worst. Allergists stress there’s no contraindication in the setting of anaphylaxis for epinephrine, meaning there is no medical condition that serves as a reason to withhold it.
While the cost of prescription drugs such as epinephrine auto-injectors is a concern, epinephrine needs to be immediately available to treat anaphylaxis – and for most patients and families there’s no dollar value that can be placed on ensuring the availability of epinephrine auto-injectors. Furthermore, there are ways to keep costs from becoming a burden, such as changing health insurance plans to include lower copays and deductibles and asking your doctor about coupons and discounts.
We urge patients and parents of children at risk for anaphylaxis to have an open conversation with their primary care doctor, allergist or pediatrician about the severity of their allergy. Certainly there may be people who only experience mild allergic reactions to food, insect venom, medication and latex. But you cannot predict the severity of a future allergic reaction based on past experience. The next allergic reaction could be life-threatening.
Epinephrine saves lives from anaphylaxis. We respectfully ask that you print a retraction and abstain from printing such irresponsible journalism in the future.
President & CEO, Allergy & Asthma Network
Concerned mother of Karson, an 11-year-old with peanut allergy
Chief Operating Officer, Asthma & Allergy Foundation of America
Concerned mother of a 26-year-old with severe allergies
President & CEO, Food Allergy & Anaphylaxis Connection Team
Concerned mother of Thomas, a 13-year-old with peanut, tree nut and sesame allergies
Allergy Bright Communities
President & CEO, mother of a 3-year-old peanut-allergic daughter
Executive Director and Co-Founder
American Latex Allergy Association