RumiDude
Trail Wise!
Marmota olympus
Posts: 2,361 
|
Post by RumiDude on Apr 25, 2016 17:42:39 GMT -8
If a person has anaphylaxis, then that person heeds an epipen. If not, then the person does not need one. If a person has anaphylaxis, they will know it. Severe local swelling after being stung is simply a localized reaction to the sting. Anaphylaxis is systemic. If you get stung on the leg and your chest and back breakout in hives, your face flushes, and your eyelids burn and start to swell, you feel like someone is choking you or start wheezing, then you are having a systemic reaction and need to carry an epipen.
Various reasons doctors over-prescribe epipens are: the doctor thinks it will help the patient feel more confident, the doctor is doing a little CYOA, it feels better than telling the patient to take an antihistamine and wait out the swelling, patient asks for one, the patient's mother asks for one, the patient's father asks for one, the patient's grandparents ...
Epipens are expensive, rather bulky and weighty, and inconvenient to carry. If out in the backcountry, a person needs to carry at least two because it may take more than one dose to get results. Bottom line is if you need it, carry it. If not it is a waste.
Rumi
PS: My older brother developed a severe reaction to shellfish late in his life. He carried epipens because he had anaphylaxis reactions. My youngest son had anaphylaxis to eggs, peanuts, and several other things when he was young. He could not even eat cake because of the eggs. Thankfully he outgrew them and enjoys a good padthai when he gets a chance.
|
|
daveg
Trail Wise!
Michigan
Posts: 565
|
Post by daveg on Apr 25, 2016 20:44:06 GMT -8
When I was in college I got stung in the face by a bee while riding my motorcycle. I'd been stung many times before in my life -- some swelling but no serious reaction -- but because the sting was close to my eye I decided to play it safe and go to the university health center. I checked in at the reception area, explained why I was there, was handed over to a nurse -- and that was the last thing I remembered until I regained consciousness in a hospital room two days later. A doctor came to check me out and the first thing he said was "We didn't know if you were going to make it."
Back then (late 1960s) there were no epipens. Instead, I was prescribed a "bee sting kit," which was a plastic box containing a vial of epinephrine, a syringe, and several Benadryl tablets.
I was also referred to an allergist who started me on a program of allergy shots for bee stings. I continued getting the shots for over 20 years. Back then, I was told immunotherapy had about a 50% success rate. (Today, I hear the success rate is much higher.)
I've been stung quite a few times since my college experience. Been to a hospital on several occasions but, fortunately, have not had a reaction as severe as the one I had in college. I assume the immunotherapy worked. But I still keep Benadryl and two epipens handy.
One of the problems when hiking with epipens is that they are supposed to be stored at (ideally) 77*F. "Excursions" where the temperature ranges between 59*F and 86*F are acceptable. The trouble is that I'm often out for weeks when temps (at least part of the day, sometimes all day) are outside that range. I do what I can to protect the epipens from the "extreme" temperatures, but I don't always succeed. From what I gather, extreme temperatures can cause the epinephrine to degrade and affect the auto-injector. I keep an eye on the color of the solution. Pinkish or brownish is supposed to be bad. But I don't know whether it can be clear and still be degraded.
I usually wear long pants when hiking. I tell myself it's to help guard me against bee stings. Ironically, the one time I was stung while hiking was when I stepped on a nest of bees and one flew up inside my pant leg and stung me in the thigh. I was solo and about 10 miles from the nearest road. So after a quick striptease I just sat down, took my Benadryl, and waited with epipen in hand, ready to use if I reacted. After two hours without a reaction, I continued hiking.
|
|
|
|
Post by Lonewolf on Apr 26, 2016 2:21:54 GMT -8
|
|
mk
Trail Wise!
North Texas
Posts: 1,217 
|
Post by mk on Apr 26, 2016 7:36:40 GMT -8
My older brother developed a severe reaction to shellfish late in his life. This has happened to my husband, too. For some reason, he can still eat shrimp, but not lobster or crab. He doesn't have an epipen, and it tries my nerves to watch him eat shrimp. You never know when you might go from no reaction to life-threatening reaction. Thanks for the informative post, rumidude. *OTOH, how much is your life worth? Good point! |
|
Ed
Trail Wise!
Philmont Advisor and FOM (Fat Old Man)
Posts: 125
|
Post by Ed on Apr 26, 2016 7:42:08 GMT -8
sarbar - Yep, epi first, then other stuff. Also, immediate evacuation is called for if epi is used. Epi is NOT a long-term solution, just give the shot, follow with antihistamine and get medical help. Antihistamines commonly used: Benedryl (diphenhydramine) "histamine-1 receptor anagonist”. Drowsiness could be a problem. Zantac (ranitidine) is commonly used for heartburn. “histamine-2 receptor antagonist”. Zyrtec (cetirizine) “can treat hay fever and allergy symptoms, hives, and itching”. “2nd generation histamine-1 antagonist”. Claritin (loratidine) “2nd generation histamine-1 antagonist”. Zantac, Zyrtec, and Claritin do not have the drowsiness problem.
|
|
sarbar
Trail Wise!
After being here since 2001...I couldn't say goodbye yet!
Posts: 980
|
Post by sarbar on Apr 26, 2016 10:15:22 GMT -8
As for cost....well, I'll be honest I pay the co-pay, which depends on the year: Some years it is $25 a box, other years $50. I have to buy 3 boxes per year (1 home, 1 in my purse, 1 for school).
The reason why 2 pens are given is sometimes a second dose is needed, for severe allergies. With children especially now, the allergist doctors are recommending no antihistamines till they are seen in the ER. We only give Benadryl for things we know make him uncomfortable not Anaphylaxis. (Such as exposure to cheap wheat where his eczema pops out) For cashews and peanuts, it is Epi only.
As for the "trainers" that come with them, an expired one is much better to practice with - as it has the "weight".
And yes, never store an epipen in your vehicle. The heat is not good for them. You can see online how to check the fluid for if it is cloudy.
If anyone has children or they have severe allergies, there is a GREAT conference held for Food Allergy Bloggers, in Denver this year. It is fantastic, even for those who don't blog.
|
|
|
|
Post by Lonewolf on Apr 26, 2016 16:11:15 GMT -8
|
|
RumiDude
Trail Wise!
Marmota olympus
Posts: 2,361
|
Post by RumiDude on Apr 26, 2016 19:33:45 GMT -8
My whole point concerning the expense of an epipen applies IF YOU DON'T REALLY NEED IT. As I mentioned a couple times in this thread, doctors often over-prescribe epipens. I know several people who carry them in case of insect stings and bites who have never suffered an anaphylactic reaction or even been skin tested for reaction. Almost all of them asked their doctor for a prescription because they feared they might someday have an anaphylactic reaction to bee/wasp stings. Their doctors complied with their request, just like doctors comply with requests for antibiotics for colds. Some doctors feel pressured to prescribe something and so they do even when it is not indicated or totally worthless to help the condition.
Anaphylaxis has specific symptoms and if you have ever had it you would know it. Swelling, even severe localized swelling is not an anaphylactic reaction. Immunologists/allergists can conduct many tests to help determine if a person needs to carry an epipen.
Soooooooo, if you really need an epipen, then by all means carry two of them. But if you really don't need one, then carrying then is a wasted of energy and expense. And worse case scenario, if you used an epipen when you didn't need to, it could actually do you great harm, including kill you.
Rumi
|
|
sarbar
Trail Wise!
After being here since 2001...I couldn't say goodbye yet!
Posts: 980
|
Post by sarbar on Apr 27, 2016 7:12:20 GMT -8
Not all places honor it FYI nor does it apply with all insurances. So while great, it isn't always an option. |
|
sarbar
Trail Wise!
After being here since 2001...I couldn't say goodbye yet!
Posts: 980
|
Post by sarbar on Apr 27, 2016 7:22:32 GMT -8
On the subjet of dosing yourself with an Epi....for the most part it is safe - you will just have a lot of energy. Obvisouly, there are people it'd be bad for - but it is rare. This came from experts in a talk on food allergies I attended (who were doctors).
|
|
|
|
Post by immadman on Apr 27, 2016 18:28:15 GMT -8
Anaphylaxis is a true, life threatening emergency. I have had two patients over the 22 years I have worked as a medic that presented with anaphylaxis. One was a man in his fifties allergic to wasp stings (known allergies) and the other was an infant with peanut allergies (new onset). Fortunately, both survived.
My treatment protocols and for which I have standing orders vary a bit based on degree of allergic reaction, but anything from moderate reaction to anaphylaxis include Epi first, followed by benadryl (diphenhydramine), followed by a steroid (we carry dexamethasone), along with a breathing treatment (albuterol) if they are conscious and can breathe on their on. Of course along the way they get IVs, placed on a monitor, etc, etc. But that is in an ambulance and not out in the wild.
I do carry injectable epi, benadryl, and dexamethasone in my FAK when I get out. Only weighs a few grams and can make the difference.
That being said, and as stated earlier in this thread, allergic reactions need to be taken to the nearest medical facility in the safest, fastest way possible.
|
|
daveg
Trail Wise!
Michigan
Posts: 565
|
Post by daveg on Apr 27, 2016 20:21:47 GMT -8
When I was working, my co-pay for a two-pack of epipens was $20. Now that I'm retired and on Medicare, the co-pay is a LOT more. I can afford it, but I've wondered what people who can't afford it do.
I followed Lonewolf's link thinking it might be the answer to my question. From the website:
The offer is "[n]ot valid for uninsured patients (except for commercially insured patients without coverage for EpiPen® Auto-Injector) and patients who are covered by any state or federally funded healthcare program, including but not limited to any state pharmaceutical assistance program, Medicare (Part D or otherwise), Medicaid, Medigap, VA or DOD, or TriCare (regardless of whether EpiPen® Auto-Injector is covered by such government program); if the patient is Medicare eligible and enrolled in an employer-sponsored health plan or prescription benefit program for retirees; or if the patient’s insurance plan is paying the entire cost of this prescription."
So it doesn't help the uninsured, people on Medicare, and a bunch of others. So who does qualify?
|
|
daveg
Trail Wise!
Michigan
Posts: 565
|
Post by daveg on Apr 27, 2016 21:07:57 GMT -8
Evacuation, transport to a medical facility, obtain medical help -- certainly good and perhaps life saving advice when one suffers anaphylaxis. But many years ago when I was taking a Wilderness First Aid class, the instructor emphasized that when one is in the backcountry any assistance or rescue is probably hours away at best and often much longer.
So I take my Benadryl and epipens with me and hope that if I get stung by a bee and react those meds will be good enough for long enough. But I also realize they may not be. It's a calculated risk.
Several years ago my daughter insisted I start taking nitroglycerin tablets with me on my hikes. I've never had a heart problem but I'm getting old and still do some very strenuous hiking and she worries. The instructions that came with the nitro said to take no more than three in 15 minutes and if the chest pain persists to seek medical assistance. Right.
|
|
RumiDude
Trail Wise!
Marmota olympus
Posts: 2,361
|
Post by RumiDude on Apr 27, 2016 22:46:39 GMT -8
Several years ago my daughter insisted I start taking nitroglycerin tablets with me on my hikes. I've never had a heart problem but I'm getting old and still do some very strenuous hiking and she worries. The instructions that came with the nitro said to take no more than three in 15 minutes and if the chest pain persists to seek medical assistance. Right. How the hell did you talk your doctor into giving you a script for nitroglycerin if you don't have any heart problems? Nitro is a vasoldilator. Rumi |
|
|
|
Post by immadman on Apr 29, 2016 6:55:40 GMT -8
The instructions that came with the nitro said to take no more than three in 15 minutes and if the chest pain persists to seek medical assistance. Since it is a vasodilator, nitro can cause a precipitous drop in blood pressure. However, its vasodilation properties are primarily why it is given for chest pain as it decreases the workload on the heart. The downside is, if it drops too low or the MI is in a particular region of the cardiac muscle, the drop can cause more damage due to lack of oxygenation in that part of the cardiac muscle. Chest pain of the cardiac variety is, primarily, caused by lack of oxygenation reaching the cardiac muscle. I would also strongly suggest, if you do not already do so, carry aspirin with you in addition to the NTG. If you should experience any chest pain, take 325 mg of aspirin. If you are already taking low dose aspirin, go ahead and take 4 each (comes up to 324 mg). The aspirin is an anti-platelet and helps to prevent clots from forming in the case of a narrowing of the coronary arteries. Apologies for getting too medical. I also did not mean to insult anyone's intelligence... Madman |
|
