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epinephrine in thigh

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Take Two: The Importance of Carrying Two Epinephrine Auto-injectors

With Halloween around the bend, we wanted to share a quick PSA on the importance of carrying two epinephrine auto-injectors in case of an allergic reaction. 

Why? Let’s look at the facts.

In cases of severe anaphylaxis, one dose of epinephrine is often not enough. Up to 20% of people who receive an initial dose of epinephrine for anaphylaxis require a second injection. This can happen even without further exposure to the allergenic trigger! A second allergic reaction called biphasic anaphylaxis can occur between 1 to 72 hours (typically eight hours) after the initial reaction.

Despite these harrowing stats, most individuals do not carry two auto-injectors.

In a study of roughly 1,000 US patients and caregivers with epinephrine prescriptions, 82% said they do not carry two auto-injectors. Meanwhile, 75% of respondents reported previously administering epinephrine. Of those that sought emergency care, 45% did so because a second dose of epinephrine was unavailable. 

Education and awareness is also lacking. Only a quarter of respondents reported that they were advised to carry two auto-injectors.

But epinephrine is expensive.

We hear you. Epinephrine auto-injectors are not cheap, which can make it difficult to have multiple epinephrine auto-injectors on your person at all times.  

Fortunately, that’s starting to change. Increased market competition and PR scandals like the one that rocked Mylan have helped drive down the price. 

Additionally, below are some cost-saving options worth checking out. 

-      Check for discount codes and savings plans on manufacturer websites. 

-      Purchase generic epinephrine alternatives.

-      Explore mail-order pharmacy options (you may be able to receive a larger supply of medication at a lower co-pay amount if these benefits apply).

-      Price shop between local pharmacies—prices vary, especially between large chains and small pharmacies.

-      Ask your doctor about patient assistance programs. 

-      Switch to your insurance carrier’s “preferred” auto-injector (if applicable).

-      Double check that your pharmacy has applied all possible coupons at check out.

-      Ask your company’s HR department if they offer financial assistance to employees to cover prescriptions.

We hope you all have a SWEET and SAFE Halloween! And don’t forget to TAKE TWO!

-      Meg and the Allergy Amulet Team

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Why the Thigh?

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Most people that carry epinephrine to treat serious allergic reactions will tell you they were given strict instructions to inject the needle into their outer thigh. They may also tell you that the needle can be injected over clothing, if necessary.

For years I carried epinephrine because I received weekly seasonal allergy injections. Today I carry epinephrine for my food-allergic child. For a long time I didn’t know why I was advised to inject the needle into my thigh. My hunch is that most people don’t know why either.

Several years ago, the Journal of Allergy and Clinical Immunology published a study measuring epinephrine absorption in children with a history of anaphylaxis. The participants were randomly assigned to receive a single injection of epinephrine either subcutaneously (under the skin) or intramuscularly (in muscle).

Among children that received epinephrine subcutaneously, epinephrine absorption was considerably slower than for those that received the injection intramuscularly. 

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A few years later, the same clinical journal published this study. Their goal was to measure epinephrine absorption in adults intramuscularly versus subcutaneously, but also evaluate absorption differences between two different intramuscular sites: the thigh and the upper arm.

The results of this latter study (below) support the recommendation that epinephrine should be administered in the outer thigh. Greater blood flow in the thigh was considered the likely reason why the absorption rate was higher relative to the upper arm. 

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Failure to timely administer epinephrine during an allergic reaction is the leading cause of fatalities among the food allergic, which is why it’s so important to carry epinephrine if you have a food allergy. These findings further underscore the importance of administering the needle into the thigh, as delayed epinephrine absorption could have serious implications during life-threatening episodes of anaphylaxis.

So now you know, folks! Raise your epinephrine high to the sky, then swing it firmly into the thigh!

- Meg and the Allergy Amulet Team 

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