Policy, prescribing changes needed to protect patients with severe allergies
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Today, 1 in 50 Americans is at risk for anaphylaxis — a severe allergic reaction that can lead to death. Several states have acted and allow epinephrine to be available in more places and to be administered by more individuals than in the past.
This is a welcome and important development in protecting adults and children with serious allergies. But further progress must be made throughout the country. Some state laws limit or are not clear on who can administer epinephrine in an emergency. Most laws are also written too narrowly to ensure that new innovative delivery methods of epinephrine may be prescribed and administered.
It is time we take a comprehensive approach to doing all we can to ensure patient access to affordable, life-saving medications. We need to remove the barriers that prevent people from receiving the care they need. This is especially important for epinephrine, whose availability has been limited for more than a year.
These are far from hypothetical needs. Consider the story of Dillon Mueller, an 18-year-old from Wisconsin who died in 2014 after a severe allergic reaction from a bee sting. First responders did not have epinephrine, which would have saved his life. He was kept on artificial cardiopulmonary support following the bee sting before his parents made the heartbreaking decision to let him go. Dillon’s parents, George and Angel, then dedicated their lives to making sure this would not happen to other families. They worked with the Wisconsin Association of Osteopathic Physicians and Surgeons to create Dillon’s Law, allowing anyone to become trained and certified to carry and use an epinephrine auto-injector. Dillon’s Law provides full liability coverage for individuals who help someone having a severe allergic reaction.
Working with a team of dedicated individuals, they also created the Do It for Dillon Anaphylaxis Training Program, which is approved by the Wisconsin Department of Health Services. For more information about Dillon’s Law and the training program, visit EpiForDilly.com.
Recognizing the dangers that severe allergic reactions can pose to children, every state in the nation has enacted legislation to allow for the use and storage of epinephrine in schools. Eighteen states have laws that allow other facilities, such as day care centers, parks or camps, to keep stocks of the life-saving medication on hand. This is important, because severe allergic reactions can occur anywhere, not just at school.
Additionally, according to theNational Conference of State Legislatures, “states have also taken steps to address potential liability issues associated with a layperson administering epinephrine to someone who appears to be exhibiting the symptoms of anaphylaxis.” That includes Good Samaritan laws to protect people from liability.
These moves are not enough. All states must update their epinephrine laws. All states must expand the definition of epinephrine auto-injector to include new FDA prefilled syringes and future FDA-approved delivery systems. The incidence of anaphylaxis is increasing at a time of ongoing shortage of epinephrine auto-injectors.
That is why it is important for doctors, physician assistants and nurse practitioners to be clear on what they are prescribing. Specifically, it is vital that health care providers write patients’ prescriptions as “epinephrine injection” (not “epinephrine auto-injector”) so pharmacies can ensure that patients receive epinephrine device alternatives during their first attempt to fill their prescription. This will allow patients to have the most affordable product and to choose new innovative dosage forms of epinephrine. Patients should not be limited to one dosage form of epinephrine, especially if they cannot afford one brand and an alternative is available.
Advocates have met with some success in changing the language in Minnesota and Alabama, but we must reach policymakers far and wide to update language in state laws while ensuring health care providers are specific in their prescription writing.
These changes are needed sooner rather than later. We have seen an epinephrine shortage stretch to more than a year, causing parents to be understandably worried about whether they will have the medicine they need should their child have a severe allergic reaction.
Roughly 200,000 people receive emergency care for severe allergic reactions to food each year in the United States. Now, we must give patients, parents and the public health community as a whole all of the tools they need to make sure they receive the best care possible as quickly as possible.
Reference:
National Conference of State Legislatures. Increasing access to epinephrine. 2016. http://www.ncsl.org/research/health/increasing-access-to-epinephrine.aspx. Accessed October 30, 2019.
For more information:
Len Markman, DO, is past president of the Wisconsin Association of Osteopathic Physicians and Surgeons.
Disclosure: Markman reports no relevant financial disclosures.