Anaphylaxis and Epinephrine
Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog- anaphylaxis and epinephrine. In Beyond Primary Care blogs we highlight healthcare news, advice for medical conditions, and how membership for care works! Beyond Primary Care is an insurance free, membership based family medicine clinic. Beyond Primary Care is the highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne counties giving families and employers peace of mind about healthcare costs by providing affordable and accessible primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to talk about severe allergic reactions, namely anaphylaxis and epinephrine.
Anaphylaxis
Anaphylaxis is a severe, sometimes life-threatening, allergic reaction that occurs within minutes to several hours of exposure an allergy-causing substance (allergen).
In any body allergic reaction, your immune system will respond to the presence of an allergen (whether food or environmental) by releasing histamine and other body chemicals. These chemicals cause the symptoms of allergies, in their mild form are annoying, such as the runny nose of hay fever (allergic rhinitis) or the itchy rash of poison ivy.
Unfortunately though, the symptoms can progress and be much worse and involve the entire body. Anaphylaxis is the most severe allergic reaction. In anaphylaxis, body chemicals cause serious skin symptoms, such as hives and swelling, as well as severe breathing problems, such as swelling in the throat, narrowing of the lower airways and wheezing. Anaphylaxis is a life-threatening medical emergency.
The Physical Reaction
There are different shapes and forms of a severe reaction. Symptoms of anaphylaxis usually occur within seconds to minutes of exposure to the allergen, but symptoms can be delayed for several hours.
Feeling light headed, faint, difficulty breathing, couching, wheezing, weakness
Confusion, anxiety, panic, or a feeling of impending doom
Measurable symptoms such as rapid pulse or profuse sweating.
Itchy hives, which may blend together to form larger areas of skin swelling
Swelling of the lips, tongue or eyes
Nausea, vomiting, stomach cramps, diarrhea
Paleness, bluish skin color
Throat swelling -like a golf ball stuck in your throat, hoarseness
Treatment
Symptoms of anaphylaxis usually require treatment with epinephrine, by injection. People who have had anaphylaxis can carry a pre-loaded syringe containing epinephrine.
Epinephrine
You have probably heard about this drug before, but some of what you think you know may not be correct.
Epinephrine is safe, and you already have epinephrine in your body
Epinephrine is a naturally occurring hormone. At-rest plasma epinephrine levels are 0.035 ng/mL. It is the hormone that is part of our fight-or-flight response. When you are scared or excited, and also when you are exercising, your epinephrine levels surge, but even when you sleep, there is a little epinephrine circulating in your body. Levels over 10 times that amount have been measured in persons exercising, and even higher than that in people under mental stress.
The standard adult dose of self-injecting epinephrine (0.3 mg of 1:1000 epinephrine) raises the level of epinephrine in the body from an average of 0.035 ng/mL to about 10 times that amount. It would require more about 20 such injections to reach a toxic level.
If you were given the injection right now, all that would likely happen is that your heart rate and blood pressure would increase to a moderate degree and that you might feel slightly shaky. Epinephrine is metabolized very quickly, and you would not feel this effect for long.
You Should Not Wait to Use Your Epinephrine
You might hope the allergic reaction won't be "that bad," and you might be right, but it's important to know that a delay in use of epinephrine is linked to poorer outcomes and prolonged hospitalizations.
You Should Not Be Afraid of the Epinephrine Device
The device itself might look big, but the injection needle is not. It's just like getting a flu shot. As mentioned above, the main side effect you might experience is feeling a bit shaky after using the device.
You Should Go to the Emergency Room (ER) After Using the Epinephrine for Anaphlaxis
You may have been told that you have to go to the ER after using your epinephrine device. That's not because of the epinephrine; it's because the allergic reaction probably requires further monitoring. In the past, I have talked about why NOT to go to the emergency rooms. Anaphylaxis is not one of those scenarios. Many patients also need more than one dose of epinephrine for anaphylaxis or other emergency treatments; that may be due to the severity of the allergic reaction or simply because the device was not used correctly (the most common mistake is not holding the device against your thigh for the time required for the full dose of medication to be delivered). So a trip to the ER is the safest thing to do after using epinephrine.
Epinephrine Cost
You may of heard EpiPen's manufacturer, Mylan Pharmaceuticals, had increased the price of a two-pack over several years to $600 or more—even for people with insurance. For some families—especially those who needed more than one EpiPen pack to protect their kids during severe allergy attacks—that price was still way too high. At Beyond Primary Care, we have our own auto-injectors and self- injectors pre-filled with epinephrine that we sell to our patients. Check out our video. (2022) Our auto-injectors are currently $125 for a 2-pack, and our self-injectors are $90 for a 2-pack.
What to Do?
Consider making an appointment at Beyond Primary Care. Beyond Primary Care is a Direct Primary Care clinic located in Ann Arbor, Michigan and cares for patients all throughout Washtenaw County, Wayne County, and Livingston County.
Scheduling
To make an appointment with Dr. Jeff O’Boyle please see our scheduling link.
