Dear Doctor: Between my sister and me, we have three kids with serious allergies (two peanut and one bee sting), and each of their schools requires us to provide them with an EpiPen for emergencies. Now there's a shortage and we can't find even one EpiPen, let alone three. What's going on? Are there any other options for us?
Dear Reader: As anyone with a serious allergy knows, an EpiPen can save your life. Whether the trigger is a food, a drug, an insect sting or bite, or another kind of allergen, the result can range from serious discomfort all the way to anaphylaxis, a severe and potentially life-threatening reaction that requires immediate treatment. Injecting the contents of an EpiPen into the thigh releases a calibrated dose of epinephrine, a chemical that eases the symptoms of an allergic reaction by narrowing blood vessels and opening the airways of the lungs. Although the relief from symptoms is swift, it's not prolonged. That's why, after an allergic reaction that requires the use of an EpiPen, it's important to immediately seek medical care.
Since last spring, there has been a national shortage of EpiPens available. According to Mylan, the company that markets the EpiPen, this is due to a variety of production and delivery issues. At the same time, with millions of kids headed back to school in late August and early September, pharmacies have seen a marked spike in demand. As you noted in your letter, schools require parents to provide one -- and often two -- EpiPens for children with known allergies. Add in sports teams and after-school programs, as well as the ones needed at home, and the demand is far outstripping the supply.
Parents are reporting that despite calls to pharmacies throughout their areas, they are unable to fill their prescriptions. According to data collected by patient advocacy groups, up to 80 percent of parents in 43 states have been either unable to fill their EpiPen prescriptions or were able to purchase only part of what they needed. A generic (and less expensive) version of the EpiPen, manufactured by Mylan, is also in short supply. Meanwhile, another generic ephedrine auto-injector, to be produced by the Israeli company Teva Pharmaceuticals, is not yet available.
The EpiPen shortage has resulted in action from the U.S. Food and Drug Administration. In late August, the agency extended the expiration dates of specific lots of EpiPens by four months. Although EpiPen is by far the best-selling epinephrine auto-injector on the market at this time, there are several other FDA-approved brands available, including Adrenaclick and Auvi-Q. Each requires its own prescription, so a visit to the family doctor or a clinic is necessary. However, these alternative versions may not be covered by insurance.
For information on pharmacies that still have a stock of EpiPens available, Mylan has asked patients to call its customer relations department at 1-800-796-9526. For more information about the alternative FDA-approved ephedrine auto-injectors, visit the agency's website at (sorry, they don't make it easy) www.fda.gov/downloads/Drugs/InformationOnDrugs/UCM520800.pdf.
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