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FeaturesDec/Jan 2014 Issue

All About Epinephrine

Fear of Injection

Dooms would like people to be more comfortable administering epinephrine.

“There are a lot of psychological barriers to using the device,” says Dooms, who is a member of the adverse reactions to foods committee of the American Academy of Allergy, Asthma & Immunology (AAAAI). “It seems as if in a clutch situation when there’s a severe reaction, whether it be at school, on a field trip or even at home, a lot of people will suddenly become more afraid of the auto-injector than they are of anaphylaxis.”

He is concerned that some school staff and caregivers worry they might hurt the child with the auto-injector needle or that children are afraid of the needle. This delays administration of epinephrine, which increases the risk of a fatal reaction.

“The benefits of using emergency epinephrine outweigh the risks of an unnecessary dose,” Dooms says.

People with life-threatening allergies certainly have more choices than they did 25 years ago, when epinephrine was administered with a vial and syringe. The landscape changed for the drug when a former NASA engineer developed the EpiPen auto-injector. Now three brands of auto-injectors are available in the United States — EpiPen, Auvi-Q and Adrenaclick, plus the option for a generic version. The auto-injectors come in junior and adult doses.

Some of the design features of Auvi-Q, a new auto-injector introduced in January 2013, address the fear of using the medication. The device is the size and shape of a credit card and the thickness of a smartphone. It features a retractable needle and voice-guided instructions, as well as visual cues, to walk and talk you through the injection process. A mobile phone app for Auvi-Q turns your phone into a trainer, allowing you to show a video, as well as set up allergy profiles for every family member with a severe allergy.

In September, a partnership of two pharmaceutical companies announced it is working on a formulation for nasally delivered epinephrine. Still in very preliminary development, the device is aimed at treating anaphylaxis in those who are needle-phobic.

Next: Emergency Training

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