There is a risk to using EpiPens because they can fail to deploy properly, they can expose the wrong people to epinephrine, or the product inside might be expired or ineffective. An EpiPen can be a life-saving device for someone who is having a life-threatening allergic or asthmatic attack. Its purpose is to defend against anaphylactic shock, which is a severe response of the body to an allergen. A severe allergic reaction causes trouble breathing, coughing, wheezing, tightness in the lungs, chest pain, low blood pressure, weak and rapid pulse, dizziness, or fainting, and potentially death. Some examples of triggers of these allergies are kids/people allergic to peanuts, shellfish, bee stings, dairy products, etc. The EpiPen is an auto-injector which delivers a precise dose of epinephrine, which is adrenaline. This auto-injector provides temporary relief from the life-threatening condition anaphylaxis and gives the patient time to get to the emergency room. But the epinephrine can be dangerous if it is combined with some certain other drugs.
The injector itself can cause problems if it fails to work properly. In an article written found on drugwatch.com, Terry Turner, whose qualifications included being a member of the American Medical Writers Association (AMWA) and The Alliance of Professional Health Advocates member, said “Hundreds of people reported serious complications after device failures between 2009 and early 2017. In March 2017, EpiPen’s manufacturer recalled more than 80,000 possibly defective devices shipped to Europe, Japan, Australia and New Zealand.” (Turner, 2021). On the FDA website, as recent as 3/24/2020, there are issues with delayed injection, or no injection at all. The cause for some of these malfunctions were from using sideways force to remove the blue safety release, raised blue safety release, difficulty removing from the carrier tube, and user error. Premature activation can happen when a user tries to hold the device with one hand and tries to remove the blue safety release with their thumb in a sideways force. An example of this was reported in the Journal of Surgical Case Reports by Hatan Mortada (Division of Plastic surgery), Bandari Abdullah Ahmed (Plastic and Reconstructive Surgery Section), and Khalid Arab (Division of Plastic Surgery). The report talks about a 19-year-old boy who came to the emergency room with pain after he accidently injected his own thumb with the epinephrine auto-injector while trying to treat a family member. The problem with the injection into the finger is that it is impossible to determine how much of the dose was actually administered, therefore making it difficult to determine the proper antidote. The incorrect antidote can make the problem worse, and possibly lead to loss of the finger.
Another risk is accidentally injecting the epinephrine into the bone. Although this might be more of an issue more so with children than with adults due to the skin-to-bone distance (STBD) in children. As mentioned in a case report titled “Unintentional Injection To The Bone With a Pediatric Epinephrine auto-injector” by Mariam Ibrahim and Dr. Harold Kim, MD, FRCP(C), a practicing Allergist and Clinical Immunologist, there is recent evidence that children with a STBD less than the length of the needle are at a great risk of accidentally injecting the epinephrine into their bone during an emergency. While there is a standard laid out for the EpiPen Jr, which illustrates specifics like the child’s height and weight, there are some children that are outside of that range when it come to the STBD. This article talks about a child with multiple food allergies. At 7 years old this child had her second episode of allergic reaction, requiring the EpiPen Jr. She complained about pain in her thigh at the injection site. And then again at the age of 9 when she had her third episode. X-rays could not confirm if the bone had been injected, but the side effects of the epinephrine last two hours. She had the shakes, tachycardia, and fatigue right after the injection. Her doctors finally made her and her parents aware that based on her BMI (body mass index) she would need to use a modified technique going forward, in order to avoid hitting the bone with the needle in the future. (Ibrahim & Kim, 2018).
There is an article written about another risk. The risk is untrained users. Administering the dose at the proper time and location is critical. In the Pediatric Allergy and Immunology journal, an experiment was done to see how many people were able to use the auto-injector properly. Of the 224 interns that participated in the experiment, 22.6% were able to use the auto-injector correctly. (Bakirtas et al., 2011). There is a problem with parents and caregivers not understanding how to use the auto injector. It was found that most physicians do not know how to use the auto-injectors either. All due to lack of training.
And lastly there is risk of infection at the injection site. The worst being in the buttocks. The device’s label warns that injecting into the buttocks has resulted in gas gangrene, which is the death of body tissue due to lack of blood flow or a serious bacterial infection. It is rare but spreads fast. It gives off a foul-smelling gas and can be deadly if it is not treated.
The EpiPen is a life saving tool when someone is suffering severe allergic reaction symptoms. Doctors recognized the need to prescribe EpiPens to those sufferers. The amount of children with food allergies is on the rise, and EpiPen is valuable a buying the time needed to get to the emergency room for treatment.
In conclusion, while some people are confident in the benefits of using an EpiPen auto-injector, there are serious risks to be aware of. The EpiPens have failed to function properly, or malfunctioned causing injury. The needle length can be an issue for children’s use. There is a risk of infection due to bacteria on the skin entering into the injection site. And lastly, not everyone knows how to use an EpiPen autoinjector, which can be a serious delay in the time of an emergency.
References
Nicotra, J. (2019). Becoming rhetorical: Analyzing and composing in a multimedia world. Cengage.
Turner, T. (2021, April 17). Epipen complications: Device issues & drug side effects. Drugwatch.com. https://www.drugwatch.com/epipen/complications/.
Center for Drug Evaluation and Research. (n.d.). FDA alerts patients and health care professionals of EpiPen. U.S. Food and Drug Administration. https://www.fda.gov/drugs/drug-safety-and-availability/fda-alerts-patients-and-health-care-professionals-epipen-auto-injector-errors-related-device.
Mortada, H., Ahmed, B. A., & Arab, K. (2021). Accidental digital epinephrine injection injury: a case of conservative management. Journal of Surgical Case Reports, 2021(4), 1–3. https://doi.org/10.1093/jscr/rjab110
Ibrahim, M., & Kim, H. (2018). Unintentional injection to the bone with a pediatric epinephrine auto-injector. Allergy, Asthma & Clinical Immunology, 14, N.PAG. https://doi.org/10.1186/s13223-018-0257-6
Bakirtas, A., Arga, M., Catal, F., Derinoz, O., Demirsoy, M. S., & Turktas, I. (2011). Make-up of the epinephrine autoinjector: the effect on its use by untrained users. Pediatric Allergy & Immunology, 22(7), 729–733. https://doi.org/10.1111/j.1399-3038.2011.01195.x
Great, to the (POINT) info.
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