Indications for Autoinjectors of Epinephrine

I had a brief chat with the Dey folks at the FAAN conference a few Saturdays ago. Did you notice that the indications for when to use your Epi-pen have changed? What’s the difference and why should you care?

For a more formal answer I turned to colleague board certified allergist Dr. Matthew Greenhawt whose bio is here. Here's what Dr. G had to say:

Dey Pharmaceuticals (Napa, CA) recently modified the prescribing indications for EpiPen® and EpiPen Jr.®. Formerly, the prescribing indications were limited to those with a history of having an anaphylactic reaction, overlooking the potential of those with milder reactions to have more severe reactions upon their next encounter. The indications now recommend use “in patients, who are determined to be at increased risk for anaphylaxis, including individuals with a history of anaphylactic reactions.”

The distinction is an important one, allowing the physician a liberal interpretation of who needs the device to include anyone who they feel may be at increased risk of anaphylaxis. Most allergists were likely following these “new” indications all along, as the medical literature has long supported this practice. However, this wording change may provide incentive to primary care and emergency room physicians to prescribe more devices, which will ultimately protect more at risk individuals.

A person “at increased risk” for anaphylaxis should be interpreted broadly, and include persons with milder food induced or insect sting induced symptoms, in addition to those with a history of recurrent angioedema or anaphylaxis without a known provoking cause, to name a few examples of how this could apply.

As an allergist, my rule of thumb has always been to consider anyone who has shown even mild evidence of the potential to react to food or a sting as someone at future risk of anaphylaxis, because no individual can accurately predict the severity of one’s next allergic reaction.

Current data has clearly shown the association between fatality (at all ages) and the lack of having an available epinephrine auto-injector.

*As always, if you are concerned that you may be at risk for anaphylaxis and are interested in exploring if you need an epinephrine auto-injector, discuss your concerns with your allergist as soon as possible.*

Not everyone who feels they are at risk may actually need the device, as one must actually have evidence of a condition that would place them at risk. If you do not have an allergist, discuss with your primary care physician if a referral to an allergist is necessary. And, most importantly, once you are prescribed a device, it should be carried with you AT ALL TIMES. Having the device at home while you are having a reaction outside of the home is akin to not having the device at all.

Well said Dr. Greenhawt, thank you!

Additional resources from Dey Pharmaceuticals :
--a video on how to use your epi.
--a slide presentation about allergic reactions.