Saturday, November 26, 2016

The How's, Why's, and When's To Using An Epi Pen

We have all seen it. "It" being a movie or television show character struggling to breathe, while others chuckle at their swelled and blotchy appearance. He is experiencing an allergic reaction, with the jeopardizing offender the typical peanut concealed beneath the wrapper of a candy bar. Soon, scared, ashen faces hover over the ballooned, almost unconscious character. He urges them to jab his thigh with the infamous yellow auto injector, recognized as an EpiPen.

Such an unfortunate event is normally attributed to anaphylaxis, a severe allergic reaction threatening multiple bodily systems. Media portrays this as humorous. Even the viewers are asphyxiated by their own laughter. However, anaphylaxis is no laughing matter.

I am not unfamiliar with the above scenario. Anaphyalxis happens to be a common manifestation of Mast Cell Disease. Anaphylaxis is caused by other circumstances too, like a true IgE allergy confirmed via skin prick or RAST/blood testing. 

Regardless of the trigger, anaphylaxis can be deadly. Thanks to the EpiPen, it does not have to be!!!

Fear normally associated with the use of an EpiPen seems to exceed that of the likely fatal anaphylaxis. Oh, the irony. The unknown is scary for both parties. Bystanders panic about how and why to administer an EpiPen, fearing their lack of knowledge may worsen the already dire situation. The EpiPen recipient frets over their body's response. What are the effects? How does it feel? What if something goes awry? Do these symptoms require epinephrine? I get it. I have been there. I can assure you that the detrimental effects of anaphylaxis are far greater than most epinephrine concerns.

How to administer an EpiPen: Downloadable PDF File 

  1. Remove EpiPen from plastic case.

  2. Ensure solution is clear.

    Discoloration is indicative of the medication being compromised.

  3. Take off blue cap.

  4. With orange end facing downward, jab EpiPen into outer thigh.

  5. Hold against thigh for 10 seconds to ensure full delivery. 

Why use an EpiPen?

Antihistamines are effective at treating allergy symptoms. They do not always stop a true, life-threatening allergic reaction once it is in process. This promotes Epinephrine to the drug of choice to reverse anaphylactic symptoms. It is available intravenously, inhaled, or through subcutaneous intramuscular injection. An EpiPen auto injector is a convenient method of receiving epinephrine subcutaneously in the outer thigh.

When do signs and symptoms warrant an EpiPen injection?

Download Signs and Symptoms PDF file.

Symptoms of anaphylaxis include:

  • Difficulty Breathing

  • Reduced Blood Pressure

  • Rapid or Weak Pulse

  • Wheezing

  • Dizziness, Lightheadedness, Loss of Consciousness

  • Hives

  • Flushing

  • Itching

  • Swelling (i.e. lips, face, airway, hands, feet)

  • "Lump in Throat" Sensation, Air hunger

  • Nausea

  • Vomiting

  • Diarrhea

  • Shock

View the self-assessment tool. 

If experiencing signs of anaphylaxis, even if allergen no exposure is identified, use the EpiPen. The tragedies from not administering Epinephrine are more plentiful than those from administering an EpiPen unnecessarily. It is better to be safe than sorry, unless stated otherwise by a medical professional.

EpiPen Use With Mast Cell Disease

Anaphylaxis can be a symptom of my condition, Mast Cell Disease. Mast Cell Diseases effect the mast cells in the body. In a patient with Mast Cell Disease, the mast cell count in the body may be increased, or there can be a normal number of cells that trigger easily. They become overly sensitive to the environment, bodily processes, food, etc. Mast cells are a type of immune cell/allergy cell. Since it is a cellular problem and not true allergies, patients tend to test negative for IgE allergies via blood. Because mast cells are allergy cells, many of the symptoms are allergic in nature and have the potential to progress into anaphylaxis. There does not have to be a trigger. Reactions can occur because of a spritz of perfume or simply because the sky is blue.

Anaphyalxis in Mast Cell Disease patients can present differently. In combination with normal anaphylaxis symptoms, it is not uncommon to also experience the following: high OR low blood pressure, seizures, stroke-like episodes, partial numbness/paralysis, dystonia, full body tremors, and more.

The odd mix of symptoms are confusing. Many symptoms Mast Cell Disease patients experience on a daily basis are "Epi-worthy" for the average Joe. Patients hesitate to use their EpiPens due to symptom variance and fear.

My First EpiPen

Other Mast Cell warriors often ask about the details of my first epinephrine redenzvous.

I awoke swollen on the day of my first encounter with an EpiPen. While swelling is a daily occurrence now, it was not then. Intravenous Benadryl, Solu-Cortef, and Pepcid were administered without significant benefit. I had an appointment scheduled at the outpatient clinic that morning. I knew this building reaction would lead to an EpiPen.

Mid-drive to my appointment, it was apparent my morning medication regime was epically failing. My vital signs were wacky. The swelling was increasing, not decreasing. My voice began crackling, accompanied with shortness of breath. The feeling of "impending doom" was unrelenting and my face was flushed. I was sick to my stomach. My limbs were tremoring and jerking. Mom and I were both a wee bit nervous, as there were no additional emergency medications to resort to. Never having previously used an EpiPen, I tried to hold out for my hospital appointment.

Upon arriving at the hospital, a nurse wheeled me to a bed where my vitals were recorded: high blood pressure, high pulse above 160 bpm, and low respirations dropping to 4-6.

Below are examples of my vitals when in a full blown reaction, or close to it. Some are in anaphylaxis, others just severe Mast Cell reactions. A few of these readings are on the Continuous Diphenhydramine Infusion and the remainder were recorded when not receiving continuous medication infusions.

My doctor at the time walked into the room. Similar to every other medical professional in Central Florida, none of us knew the proper recourse to take when I was not responding to the other medications. Story of my life.

We were hesitant to administer an EpiPen. Epinephrine is known to increase blood pressure and pulse. The medical staff claimed it would not illicit a positive response with incidents of high blood pressure and pulse over 200 in severe reactions. Chancing an increase was a risk.

That day, risk was irrelevant because all else had failed. I could not breathe well. The doctor then tore the blue cap off of my EpiPen. I mustered a "noooo," seizing the EpiPen from his hand. I needed to do it myself.

Leave it to me to react to the EpiPen itself. My already red, blotchy body lit up further upon injection. The symptoms worsened for a few minutes. This was no surprise. An EpiPen contains preservatives for stability. Mast Cell Disease patients, especially to my severity, are sensitive to preservative/filler ingredients.
(Now to avoid excipient reactions, epinephrine is drawn from a preservative free vial into a syringe and injected intramuscularly).
Eventually, the active ingredient did kick in. My respirations increased, swelling was continually reducing, and breathing came with ease. The high blood pressure actually returned to the ideal reading of 120/80. My pulse dropped to 130 bpm, stabilizing to around 100 bpm after another few minutes. The doctor exited the room, perplexed at the rapid stabilization he deemed "impossible" with an EpiPen just minutes prior. He was grinning. I could breathe. It was a win-win.

Before + After First EpiPen
Between knowing my own body and the established guidelines from my medical team, I no longer cower in terror over the EpiPen. My personal indicators of when to use the EpiPen are when no drugs efficient at slowing or stopping the escalation of severe symptoms, I am losing consciousness, or when my voice is going and I cannot breathe well.

Do not fear the EpiPen, people. They save lives. If needed, you will know. Trust me.