# Anaphylactic shock



## PA Pete (Feb 2, 2005)

I have a beek backpack I keep stuffed with stuff I might need in the field or on removals. It contains two epi-pens prescribed prophylactically by my doctor. I also carry a small bottle of liquid Benadryl (I think it's for children) and a pill bottle of other stuff I might need like Ibuprofen, Naproxen, my allergy meds (Allegra), aspirin. I also have a spare flashlight, some bandaids, a change of clothes, some water, and a knife in there.

I have never had a serious reaction and I hope I never do, but having this kit (especially the epi-pens) gives me at least some peace of mind that if I'm in the middle of a field somewhere and have a reaction, I at least have a chance of making it to a hospital. Anyone with me in my bee yard gets a tour of my pack (especially the epi-pens) and a lesson on how and when to use them. 

As I mentioned, I also do removals. The homeowner also gets an epi-pen lesson along with an explanation of why I have them (just in case!) - which they have without fail appreciated.

Talk to your doctor and get a prescription for a pair (they come in a two-pack). The biggest pain of having them is that they expire within a year, so you have to buy them annually.

HTH

-Pete


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## muusu (Mar 21, 2014)

You keep a fire extinguisher in your kitchen with the hopes of never using it but its still there. 

I had never considered having an epi-pen as a precautionary measure but will now. An injury to myself I can live with (or not depending on severity), someone else getting hurt on my farm would be devastating.


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## BeeMoose (Oct 19, 2013)

I am a totally new bee keeper (only had them a little over a week). Even before I received my bees, I went to my doctor and asked for and received an RX for an epipen. If you look
on line you can find a manufacture's coupon that will leave you spending $10 or less for a two-pack. Do not think I am allergic, but pays to be ready.


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## JWChesnut (Jul 31, 2013)

Since the story is second hand, I suspect some details have been lost.

Anaphylactic shock from bees in children is vanishingly rare. (Check the epidemologic statistics yourself).

This is because Anaphylaxis must be "primed". The requisite antigens must be created and built up. Children are very, very unlikely to have experienced the exposure to create the antigens. The antigens are not present in the bloodstream in requisite numbers to induce a threatening condition until there has been some exposure.

Children are at risk for anaphylaxis from a host of other allergens (e.g. peanuts), where the exposure is repeated and frequent. Asthma is a co-factor in anaphylaxis, so the scenario of a naive bee-sting is not impossible, just very, very infrequent.

That said, I have personal experience with a child with an autistic condition being stung and going into a panic reaction that was difficult to "talk" the child down from despite no symptoms beyond a mild local reaction. It possible that this is the situation in this case -- a panic-induced asthma attack.


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## Tenbears (May 15, 2012)

What I want to know Is How many Joules in an Anaphylactic shock?


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## peterloringborst (Jan 19, 2010)

> Anaphylactic shock from bees in children is vanishingly rare. (Check the epidemologic statistics yourself).


Agreed. Also, I have made it a policy to _never_ carry an Epipen (even though I am allergic to peanuts and could get one any day). If you have one, you have to keep it up to date, even if you never use it. If you use it on a stranger, you are practicing medicine without a license, and if something goes wrong you could be held accountable. Keep benadryl close to hand, and call 911 in a real emergency.

Just my $.02


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## MsBeHaven (May 31, 2013)

I too have an epi-pen and an epi-pen jr for emergencies. As a registered nurse, I want to be prepared for emergencies rather than work one. 

And as for administration, when someone can't breathe, it's an emergency and the good sAmaritin laws will protect you if given in good faith.


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## WBVC (Apr 25, 2013)

JWChesnut said:


> Since the story is second hand, I suspect some details have been lost.
> 
> Anaphylactic shock from bees in children is vanishingly rare. (Check the epidemologic statistics yourself).
> 
> ...


Anaphylaxis may be rare but when it occurs it is 100% in that person. There are various types of immune response where one produces antibodies to an allergen. The mechanisms for anaphylaxis are not the same as for normal immune responses. As leukotrines are major players when one gets stung by a bee antihistamines such as diphenhydramine are of limited value.


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## PA Pete (Feb 2, 2005)

Tenbears said:


> What I want to know Is How many Joules in an Anaphylactic shock?


42 (millijoules)


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## PA Pete (Feb 2, 2005)

It is truly unfortunate we live in such a litigious society - thank you MsBeHaven for the info on Good Samaritan laws - I hope they do help should I ever need to use my pen on someone else.

Note that the Benadryl I carry is liquid, which may or may not be faster-acting than a pill, but I like to think it is. Pretty sure it's also expired - need to pick up a new bottle!

-Pete


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## peterloringborst (Jan 19, 2010)

> thank you MsBeHaven for the info on Good Samaritan laws


What info? As it happens these laws are different in different states. They apply primarily to para-medics and other trained volunteers. They do not prevent someone from suing you if your improvised medical assistance goes bad. They do not authorize you to buy an epipen for use on other people. An epipen requires a prescription and it is only authorized to be used on that person. If is expired and you poison someone, you could be held accountable. Frankly, I would not want someone to die in my hands, after doing the wrong thing. I always warn Newbees to get their own epipens if they are unsure. Administering an epipen for someone else to whom it belongs is a whole other matter.


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## tacomabees (May 2, 2013)

BeeMoose said:


> I am a totally new bee keeper (only had them a little over a week). Even before I received my bees, I went to my doctor and asked for and received an RX for an epipen. If you look
> on line you can find a manufacture's coupon that will leave you spending $10 or less for a two-pack. Do not think I am allergic, but pays to be ready.


A couple of things I think I know..

When I first started keeping bee's, I thought that I needed to have some epi's around, and talked to my Doc, who happily prescribed them "just in case"... I didn't think I was allergic, but also didn't know about my grandkids, etc.....but when I went to pick them up, they were going to cost me a couple of hundred bucks (others have found them for less), but that got me doing some reading.... Unless you know for sure that you are allergic to bee stings to the point of AS, you don't need them, everyone reacts to a sting....Locally (swelling at site), regionally (whole hand swells up), and systemically (AS)...Many people that I've talked to about bee's have said some version of "Oh, I'm allergic to bee stings!", but are mostly just confused to what that means when you ask a few more questions... "have you ever been stung?" "why, no", "Then how do you know you're allergic"? or, "yes, I have" "Then, did you have to go to the hospital?) "well, no, but I really swelled up and it hurt a lot!"

.....I'm not sure I would agree on the Good Samaritan rule for cover either, there are some differences on that family of laws from state to state. You might read up on those for your location. I don't know if I would administer a prescription drug (mine) to another person, or just get it out, ready to use and hand it to them and say "do this". Going into AS in not like a heart attack, it's generally progressive and keeping in mind, it's not a solution to the sting, just a little time in the bank to get somewhere else (ER). They do have a shelf life and a "best use by" date, but in the directions it also says there is a color change when they are no longer good. Stored properly, they appear to be able to exceed the "use by date"...After my first few stings, my reactions were less not worse...I also understand that the base of the poison for honey bee stings and wasp stings are very different, but don't know if that has anything to do on the efficacy of the dose in the Epi... I haven't been stung hundreds of time like others here, but I'm workin' on it.....02cnts


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## PA Pete (Feb 2, 2005)

peterloringborst said:


> What info?


Ummm... the suggestion that Good Samaritan laws might protect a good samaritan. I then used Google to research the law in my state. Wow. Really?


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## Santa Caras (Aug 14, 2013)

Tenbears said:


> What I want to know Is How many Joules in an Anaphylactic shock?


LMAO! so were back to that again? Did ya spell it right?? 
Electricity baffles me so that whole other thread was more amusing than informing. lol


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## jbeshearse (Oct 7, 2009)

peterloringborst said:


> What info? As it happens these laws are different in different states. They apply primarily to para-medics and other trained volunteers. They do not prevent someone from suing you if your improvised medical assistance goes bad. They do not authorize you to buy an epipen for use on other people. An epipen requires a prescription and it is only authorized to be used on that person. If is expired and you poison someone, you could be held accountable. Frankly, I would not want someone to die in my hands, after doing the wrong thing. I always warn Newbees to get their own epipens if they are unsure. Administering an epipen for someone else to whom it belongs is a whole other matter.


And with that response of completely wrong information any shred of credibility you may have had with me is gone Peter. 

Good Samaritan laws apply only to non medical Samaritans. Professional medical personnel are not protected and are required to apply their knowledge in a medically sound way. 

I guess some people they would rather watch someone die secure in the knowledge they won't get sued for trying to save someone. For me a life is more important than possible litigation. I just hope if I ever need emergency medical attention and a medical professional is not around that some Good Samaritan is there to help me and you are far away. 

You need to stick to replying to those things you might actually actually know something about and quit spreading false information with possible life threatining implications.


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## Michael Bush (Aug 2, 2002)

I saw a picture of an epipen once...

What will you do if someone gets run over by a car in front of your house? Do you have tourniquets on hand? Large bandages? This happens to about 60,000 people a year in the US. About 4,100 of them die. In one year 15,517 people are murdered, 20,000 die from the flu, 90 people die from lightning strikes and 54 people die from stings of some insect or another (probably most are hornets or wasps).


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## jbeshearse (Oct 7, 2009)

Michael Bush said:


> I saw a picture of an epipen once...
> 
> What will you do if someone gets run over by a car in front of your house? Do you have tourniquets on hand? Large bandages? This happens to about 60,000 people a year in the US. About 4,100 of them die. In one year 15,517 people are murdered, 20,000 die from the flu, 90 people die from lightning strikes and 54 people die from stings of some insect or another (probably most are hornets or wasps).


Michael, you make a good point about the overhype of the likelihood of death be beesting. BUT, most everyone does have a tourniquet and large bandages (belt and a shirt). Or we can use our finger to staunch blood flow, apply pressure etc. we do not have a comparable item that can be used I place of an epipen. 

Also for Peter, I was wrong Most if not all the Good Samaritan laws also cover medical professionals when they are rendering emergency aid in an unpaid capacity. 

I would encourage anyone who is interested or concerned to google "good Samaritan law" and your state name.


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## Tallykat (Feb 24, 2014)

For those considering an "epi-pen:" I do have one--the brand is Auvi-Q and it actually talks you through the injection. It was prescribed for me after I tested non-allergic to bees. Yes, I am one of those who always thought they were allergic to bees because I jumped off of a dog house when I was 7 into a "bees' nest" and was stung dozens of times. Then in college i was stung by an unknown insect and had a severe (but localized) reaction. The ER doc told me I was allergic to bees and wasps and I should have an epi-pen, but I only ever carried Benadryl because of the cost factor.

When I decided to become a beekeeper, I went to an allergist, who nearly laughed at me when I told him about my allergy. First of all, since honeybees do not nest in the ground, I was more likely stung by yellow jackets. Second, localized swelling, no matter how much, is not an "allergy" or in the same class as a systemic anaphylactic response. He did however recommend an epi-pen, not just for me, because you can convert at any time to an allergic response, but because my mom lives with me (and her 75 lb labrador). He did not tell me that the injectible was for me alone.

My allergist told me to keep it on hand, keep it up to date, and NEVER ADMINISTER IT unless specifically directed to by medical personnel. In other words, people do not get stung and drop to the ground clutching their throats--although I'm sure one person knows one person that it happened that way. You WILL have time to call 911. You WILL have time to give the details to a knowlegable person who can instruct you on whether you should give an injection or not. Epinephrine has its own risks and side effects. Any one given epinephrine will have to be taken to the hospital and observed--as much for the reaction to the shot as to the sting. Following the instructions of emergency medical personnel is not practicing medicine without a license.

I think it gives my mom comfort to know the epi-pen is on-site in case something happens. And yes, my vet told me that if the dog seems to be reacting to a sting, we can call a vet receive instructions on whether we need to use it. It helps that we had a coupon so it was no cost to us.


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## shinbone (Jul 5, 2011)

I feel sorry for the soul of the person who would rather watch someone die in front of them for fear of litigation than take a few simple steps to save their life.


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## tacomabees (May 2, 2013)

Double post...again


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## tacomabees (May 2, 2013)

shinbone said:


> I feel sorry for the soul of the person who would rather watch someone die in front of them for fear of litigation than take a few simple steps to save their life.


I don't think most people would stand there and do nothing from fear of an ambulance chaser, it would be because they don't know what to do, think about what you would do if you didn't have an Epi-pen at all? If I had visitors to my hive that were there to discover the joy of bees, I'd have asked them about any allergies. If something happened, then it's "Basic first aid"...move them to a safe place (further away from the hive), call for help, call 911, assess onset symptoms, maintain airway, if person is light headed or dizzy, have them lay down and elevate their legs (lowering of blood pressure is an onset symptom), unless you're seriously remote, or have T-Mobile (like me), EMR's are usually less than 10 minutes away...my soul is safe. I have OnStar in my truck...I press a button and they have my location, and will send help...


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## F6Hawk (Mar 31, 2014)

Ahem... a moment, if you will,good sir. Using 2013 stats, 16,259 homicides in the US, 11,078 of them firearm related.  (Perhaps you were quoting 2012 stats, or a national average. Speaking of which, gun homicides continue to fall, in spite of gun ownership rising. Good work America!) Less than 600 deaths from flu in the US in 2010 according to the CDC (flu deaths are typically very exaggerated in the media: LINK).

Penicillin is responsible for the most (75%) anaphylactic shock-related deaths.

If you suspect AS, get the person flat. Do anything to ease breathing. Head for an emergency room. Don't administer an epi pen unless you fear they are dying (can't breathe, cyanosis, etc.). If you DO administer epi, head for an E.R. ASAP. Administering epi when not needed can induce a medical emergency too. Epi pens are serious medicine for SERIOUS symptoms. A crying child is not one. If they are crying, they are breathing. Don't administer an adult dosage to a kid, use epi Jr. pens.

Seems like common sense stuff, but I was at a bee meeting recently and was shocked to hear a fellow state that he kept a pen in his pocket and would use it if he got stung. I gave a few facts like above, and hope that he changes his mind. Yes, I have a pen in the truck and in the house. Yes, I was nervous about stings at first. Yes, I will use one to save a person's life if need be. But having an epi pen at your disposal is like carrying a loaded gun. Effective tool when used correctly, or a lethal weapon if not.

More tidbits...

*How many people experience anaphylaxis?
*Anaphylaxis occurs at a rate of 21 per 100,000 people each year in the US.
Approximately 82,000 episodes of anaphylaxis occur each year in the US.
More than 57,000 Americans may experience anaphylaxis each year.

*How important is it to always carry an EpiPen (or Ana-Kit)?*
In a study of children who experienced anaphylaxis, 10 out of 13 fatal or near-fatal anaphylactic reactions occurred outside of the home. 
*NONE* of the children who died or nearly died had epinephrine with them, whereas all of the survivors received epinephrine within five minutes of developing severe symptoms.

*How fast does anaphylaxis occur?*
It takes only one to two minutes for a mild allergic reaction to escalate into anaphylaxis.
The faster the onset of an anaphylactic reaction, the greater the likelihood that it will be severe.



Michael Bush said:


> I saw a picture of an epipen once...
> 
> What will you do if someone gets run over by a car in front of your house? Do you have tourniquets on hand? Large bandages? This happens to about 60,000 people a year in the US. About 4,100 of them die. In one year 15,517 people are murdered, 20,000 die from the flu, 90 people die from lightning strikes and 54 people die from stings of some insect or another (probably most are hornets or wasps).


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## NCbeek (Mar 23, 2011)

The last patient that I used epi on for a medicine related reaction coded(clinically died) about five minutes later. Luckily we were in the hospital and headed for the ER at the time. They lived thanks to a well trained ER staff and multiple tubes and drug combinations. My point is... Epi is not a guaranteed lifesaving drug.
It seems to me that everyone should also be trained in CPR and what to do if someone chokes on a piece of steak at their house. Are you accountable if you don't know what to do in every medical emergency? Not everything turns out ok, some situations get worse. Shouldn't you be prepared in case the epi you just administered to grandma or the neighbors kid gives them a heart attack? I wouldn't administer epi to anyone outside (or inside for that matter) the hospital for whom it was not prescribed unless directed to by a Doctor or Paramedic. As stated above, there is usually some time. Get medical help on the way if you even think you need it. There are too many variables to every individual situation. Don't just think you give somene a shot and everything goes back to normal. It doesn't. You've just started something you are going to have to finish. Are you prepared for what comes next? Leave the epi pen in the cooler.


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## TWall (May 19, 2010)

The first course of action if someone is having more that a localized reaction to a sting is to head to the ER. If the reaction becomes more severe epi may help, it may not. At my work we recently had a patient come in who thought they were having an allergic reaction to something they ate. We began treatment which included administration of epinephrine. The patient initially responded to the treatment but, after about 30 minutes their symptoms worsened and they needed to be transferred to the ER by squad. Systemic, whole body, reactions are no joke, even if mild.

I personally keep clariitn redimelts and pepcid with me. I don't want to take benadryl while at an outapiary and worry about drowsiness. The H2 blocker, pepcid, will also help alleviate reactions.

Tom


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## tacomabees (May 2, 2013)

Here is the Good Samaritan Law in Wa. State: http://apps.leg.wa.gov/RCW/default.aspx?cite=4.24.300

To the casual reader, it looks like you are covered, but note that they specifically differentiate between emergency "care" at the scene and transport for "medical treatment" somewhere else, in the language....I think you'd have the real potential to get jammed up for administering an Epi here that was not prescribed to the person...


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## The Redneck Hippie (Mar 29, 2014)

F6Hawk said:


> *Don't administer an epi pen unless you fear they are dying (can't breathe, cyanosis, etc.). If you DO administer epi, head for an E.R. ASAP. Administering epi when not needed can induce a medical emergency too.* Epi pens are serious medicine for SERIOUS symptoms. A crying child is not one. *If they are crying, they are breathing.* Don't administer an adult dosage to a kid, use epi Jr. pens. ... Yes, I will use one to save a person's life if need be. But having an epi pen at your disposal is like carrying a loaded gun. *Effective tool when used correctly, or a lethal weapon if not.*





NCbeek said:


> *Epi is not a guaranteed lifesaving drug.* ... Shouldn't you be prepared in case the epi you just administered to grandma or the neighbors kid gives them a heart attack? ... *As stated above, there is usually some time. Get medical help on the way if you even think you need it.* There are too many variables to every individual situation. Don't just think you give somene a shot and everything goes back to normal. It doesn't. You've just started something you are going to have to finish. Are you prepared for what comes next? Leave the epi pen in the cooler.


I was an EMT with the local VFD/EMS for ten years, and have more than a few years of veterinary experience on my own animals (not a vet, just lifelong farm resident), and what they say is true. Epinephrine is a life saving thing when used in a true emergency, but can be a deadly thing when not used with extreme care. Yes, I have used epinephrine before, but only after learning the signs of a *true* emergency beforehand, learning contraindications, learning how to administer (how much, where to inject). There's much more to it than just "give 'em a shot and they'll be okay". 



sjbees said:


> For the last couple of years I've been playing ostrich and ignoring the possibility of an anaphylactic event. That's foolish, so am curious about what other beeks are doing to provide effective first aid in case of an incident.


 I'm going to talk to my doctor first. Full stop. I'll likely not buy an epipen since I keep a vial of epinephrine in the fridge for my animals and it's the same stuff, but even then I won't ever use it unless I had already called 911 and was in serious fear for my life or the life of the person in front of me. Same as I would do with an epipen. Same as everyone should do with an epipen. 

But, after all that, I wouldn't hesitate to use it when truly needed.


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## Tim B (Apr 16, 2009)

One thing I know for sure is that anaphylaxis is real and while the statistics may demonstrate it to be very uncommon, it can strike and it can strike seemingly randomly. In the first year or two I kept bees I had no problems with dozens of stings weekly. One day one hit me on the back of the hand. Within minutes my whole body was broken out and I was terribly itchy all over. I went to the doctor, got a shot and after a while the symptoms subsided. I've had no problems since. Last summer my wife took a sting from a stray bee and went on out to the garden to pick beans. Within minutes she was having a serious reacting similar to the one I experienced fifteen years earlier. For a couple of hours things were pretty serious. I suspect both were one time events. Perhaps the sting somehow penetrated a vein and spread the venom throughout our systems.


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## sjbees (Jun 9, 2007)

Thanks for all the replies, it appears there are three broad classes of attitudes, and below is my take on each of them:

a) Don't worry about it.
The downside worries me, no matter how small the risk, having someone die in my backyard is not something I could get over.

b) Keep an Epipen on hand and be willing to use it on others
There are legal and moral issues here that bother me, and this runs the risk of causing more harm than good.

c) Don't use an Epipen, use Benadryl and Emergency Services
Works for most people most of the time, but definitely not adequate for a severe attack.

Basically, all of is are in the same boat: we host a large number of venomous insects in in our backyards, and there are no guidelines to protect neighbors and friends.

JWChesnut wrote:

> Anaphylactic shock from bees in children is vanishingly rare.
> (Check the epidemologic statistics yourself).

You missed the point, it was a story which caused me to re-think the issue of how to handle someone being stung and going into anaphylactic shock in my backyard. The child was most likely zapped by a Yellow Jacket hovering over the lawn (children running around on a lawn are often stung) or, like you say, reacting to food eaten from the buffet. My quest has nothing to do with the incident, it is about what to have on hand in case of an event.

> I have personal experience with a child with an autistic condition
> being stung and going into a panic reaction that was difficult to
> "talk" the child down from despite no symptoms beyond a mild local
> reaction. It possible that this is the situation in this case --
> a panic-induced asthma attack.

It appears you did not read the sentence about the Emergency Ward where "the medic told the parents it was fortunate the child was given the injection."

> I have made it a policy to never carry an Epipen (even though
> I am allergic to peanuts and could get one any day). If you have
> one, you have to keep it up to date, even if you never use it.
> If you use it on a stranger, you are practicing medicine without
> a license, and if something goes wrong you could be held accountable.
> Keep benadryl close to hand, and call 911 in a real emergency.

Absolutely, and all of the above are reasons why Primatene Mist was so useful. Most people develop symptoms in the following half hour but Benadryl does nothing for someone who has a severe reaction, a jolt of adrenalin is the only lifesaver. A person who has a severe reaction can die within 5 minutes unless they get adrenalin.

The warnings expressed in various replies to this thread are valid, checking into them I found that if the Epipen is introduced into a vein, it causes ventricular tachycardia.

When I asked my doctor for an Epipen prescription 30 years ago he gave me a 5-minute lecture on what can go wrong if an unskilled person jabs himself or another with a needle. He also preached about the risk of introducing bacteria directly into the bloodstream because jabbing a sterile needle through a pair of jeans could pick up lots of nasty things. The lecture ended with him telling me Primatene Mist was the only safe source of adrenalin.

It seems very odd that in all the government's efforts to eliminate Primatene Mist from the market that there have been no investigations of its use by other than asthma sufferers. The focus on asthma which has viable alternatives is indicative of poor investigation.

The life of Epipens is a major inhibitor to casual ownershop but at http://www.oakstreetmedical.com/easyblog/entry/ask-a-doctor-is-my-Epipen-still-good it is suggested that even Epipens past their use buy date will work unless they have gone cloudy. The description at http://www.wemjournal.org/article/S1080-6032(13)00094-X/fulltext claims "studies in the medical literature showing that EpiPen epinephrine maintains 63% of its original potency 10 years after its manufacture" and provides a link to the paper at http://www.ncbi.nlm.nih.gov/pubmed/10808186.

The price of Epipens has been escalating out of all proportion to the cost of living, and are no longer available as single units but only as a pair (RRP is $330). It has been suggested that the auto-inject patent is to expire soon, and manufacturers are maximizing revenue before competitors gear up to provide a generic product.

This past week I've been investigating alternatives, and there are possibilities:

- Epinephrine Pre-filled Syringes: Requires enough skill to inject someone, but at <$10 apiece prescription-only, taking a First Aid class to learn how makes a lot of sense. This addresses only the cost issue, and resolves none of the other legal and moral considerations.

- Asthmanefrin: Uses a different chemical than Primatene Mist and has only about 40% of the active ingredient. Users complain that it is less effective than Primatene Mist, the company does not endorse its use to treat anaphylactic shock, and it is not recommended for children under 4 years. Amazon has the starter kit for $40.

- King LT-D Supraglottic Airway: An alternative to tracheal intubation, it has two cuffs that inflate to permit continued breathing when the throat is closing from anaphylactic shock. Amazon has them for $25-$45 depending on size (there are five to cover children to linebackers).

- A nasal epinephrine spray has been announced as having equivalent efficacy as the Epipen, with clinical trials to begin in 2014. That means there may be an alternative to injection by 2020. Is it just me, or does this sound an awful lot like Primatene Mist re-visited?

The safest and best alternative appears to be a set of King Airway devices, but it will take a lot more research than I've done this week before I commit to buying them.

When it comes to someone's life (especially your own), you have to consider that no matter how small the risk, the risk may be unacceptable. Two weeks ago CPR and Emergency response were not enough:

"Beekeeper Marko Bulic died on April 10 at the apiary in Croatia after fatal bee sting into an artery in the neck. The tragedy occurred when he reviewed bee hives...his friend reported he had been stung inside his protective headgear. Shortly afterwards he said he was not well and was having difficulties in breathing. Within five minutes he could not stand or sit and his skin became discoloured, bruised and swollen. Emergency services were called but it was too late, the paramedics despite constant CPR couldn’t save him and he died on his way to hospital.

At the post mortem, doctors confirmed the cause of death was anaphylaxis due to bee sting. Marko Bulic started with beekeeping last year and until the fateful day he received dozens of bee stings all over his body...Primarius Master of Sciencer Josip Loncar, a physician with extensive experience in Apitherapy for a comment explained [death] was caused by bee venom being directly (intravenously) injected into an artery. This lead to hypotension, broncho-spasm and so ultimately the beekeeper died from the effects of anaphylactic shock."


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## NY_BLUES (May 14, 2009)

Interesting that you bring up the king airway. If you aren't trained in inserting it, I wouldn't recommend it. They aren't toys that should be played with or taken lightly.


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## sjbees (Jun 9, 2007)

> If you aren't trained in inserting it, I wouldn't recommend it. 
> They aren't toys that should be played with or taken lightly. 

This is not about about toys, this is about ways to save the life of someone in severe anaphylactic shock. Why recommend against a no-prescription tool that helps someone breathe? Would you also recommend against CPR because it requires training?


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## shinbone (Jul 5, 2011)

"_They aren't toys that should be played with or taken lightly._"

Thank you for clearing up that confusion.


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## NY_BLUES (May 14, 2009)

sjbees said:


> > If you aren't trained in inserting it, I wouldn't recommend it.
> > They aren't toys that should be played with or taken lightly.
> 
> This is not about about toys, this is about ways to save the life of someone in severe anaphylactic shock. Why recommend against a no-prescription tool that helps someone breathe? Would you also recommend against CPR because it requires training?


No, but if you stick a tube into someones throat and put it in wrong, you can kill them. You are then liable for their death. Good luck in court with that one. A king airway is well past the scope of the good Samaritan laws here in NY. A king airway is put in by paramedics or higher level care, not Joe schmoe who bought one on eBay.
If you perform CPR on someone and you fail to revive them, you aren't going to be held liable. People perform CPR everyday and it doesn't work every time. An advanced airway on the other hand is a different story.
How many schools and public places do you see instructions for CPR? Most schools around here have posters of instructions for them and some public areas do too. How many instruction posters do you see for placing an advanced airway into someones traechea? None, because it does take training and that is something that advanced medical personel practice, not just do in the field. 
Would I perform CPR on someone to try to revive them, yep, have in the past and will in the future, no questions asked.
Would I place an advanced airway into someone to keep them from dying, I dunno, it would depend on the situation and the elements of the situation at the time such as having the necessary tools and lack of advanced medical personnel there to do it otherwise. Would I carry a set of king airways as my go to plan for AS? No. 
Get the Epi pen if you are concerned about AS, or get the kings and retain a good liability lawyer.


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## ycitybz (Jan 2, 2012)

peterloringborst said:


> What info? As it happens these laws are different in different states. They apply primarily to para-medics and other trained volunteers. They do not prevent someone from suing you if your improvised medical assistance goes bad. They do not authorize you to buy an epipen for use on other people. An epipen requires a prescription and it is only authorized to be used on that person. If is expired and you poison someone, you could be held accountable. Frankly, I would not want someone to die in my hands, after doing the wrong thing. I always warn Newbees to get their own epipens if they are unsure. Administering an epipen for someone else to whom it belongs is a whole other matter.


If the person is dying I am sure they won't mind you use an epipen prescribed for someone else. That's what is wrong with this nation. We have become a nation of pussies. I'm rolling the dice and not sitting there and watching someone die because I'm afraid of being sued. 
By the way, I carry two epipens and both are my daughters expired ones. I have them just in case something happens.


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## PA Pete (Feb 2, 2005)

Interestingly, yesterday my GF and I spent the afternoon at the ER after she had an anaphylactic reaction to several bee stings (3 or 4) on her hands and stomach - we were both very glad I'd taken the time to pack and bring along my knapsack containing meds and epi-pens.

After getting stung, GF went to the truck to relax while I dealt with the last hive. By the time I was done (15 minutes later) she was clearly having a systemic reaction. Puffy eyes, very red, hot, itchy ears, itching all over, hives, as well as local swelling at all of the sting sites. I had her immediately swig the liquid Benadryl, and we headed back toward town and my place. I did not at this point think her reaction was life-threatening, as she reported no problems breathing, no lightheadedness, etc. - just lots of itchiness pretty much all over. 

On our way to my place, she suddenly started complaining about severe cramps. This symptom wasn't anything I'd heard about before, and troubled me, so instead of home, we headed to the ER, even if only to sit in the waiting room, just to be safe. She also took two additional Benadryl tablets. (Yes, we later learned that cramps can be a symptom of anaphylaxis).

During the drive, she continued to tell me she had absolutely no difficulty breathing, but she was very itchy and the severe cramps continued. Given that she was alert, lucid, and reported no breathing difficulty, we did not choose to administer an epi-pen.

When we arrived at the ER we ended up waiting a bit before checking in. The Benadryl had kicked in and her swelling, redness, and itching reduced noticeably. The cramps had mostly subsided, but shortly thereafter she developed very painful heartburn. We decided to play it safe and check her in to be evaluated by a physician.

Long story short, the doctor told us the Benadryl was a good thing, and added a dose of Pepcid which as Tom mentioned above, blocks H2 histamines (those OTHER histamines most people forget about). She told us that in a systemic reaction situation, the combination of H1 and H2 antihistamines/blockers is better than either by itself.

She also told us that we made neither the right nor wrong decision by not injecting the epi-pen - there is just no way to know how any particular anaphylactic reaction will progress.

After an additional shot of a long-lasting (3-day) steroid followed by an hour of observation, we were sent home, and she's been doing fine (though her hand and stomach are quite itchy).

I've always believed it is best to be prepared. My pack full of meds provides me with OPTIONS that I was very glad to have on Saturday. I plan to get a new Epi-pen, re-stock my liquid Benadryl (which did seem to work faster than the pills), and add Zantac to my kit as well. GF will see an allergist for a follow-up and to discuss whether this was likely a one-time event, and decide if any follow-up steps might be in order for her.

-Pete


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## Laurence Hope (Aug 24, 2005)

I carry a double epi-pen whenever I go out to the bees. I keep it in a fairly well temperature controlled package to help prolong its viability. I have done so since shortly after I began with bees. I have a newbee friend who recently went into a sever anaphalactic reaction from a sting. He drove to the nearest hospital, where after working on him in ER for quite awhile, they got him fixed up and told him he was about 5 minutes from death when he arrived. No matter the cost or the extreme unlikeliness of ever needing an epi-pen, I will always carry one to the bees. I never want someone (or me) to die from something that can be helped.
If any of you are military veterans, epi-pens can be obtained through the VA at a really reduced cost. When I found this out, I quit paying $200. and signed up for VA benefits and now pay $9.00 for my epi-pens, which I now also can afford to keep in date.


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## Michael Bush (Aug 2, 2002)

Everyone has to work things out for themselves of course, but I have trouble with the philosophy that no matter how small the risk I have to be prepared for it. I could go hiking and break my leg in a fall a die because I can't walk back to town. But I still go hiking. I could get hit by a car crossing the street but I still cross the street. A crash helmet while crossing the street would improve my survival chances, but I don't wear one. 40-50,000 people year die in car wrecks yet I don't know anyone wearing a crash helmet while riding in a car despite the odds being very high that you will be in a car wreck and there is no doubt the helmet will GREATLY improve your odds of survival. A fireproof suit while driving would also improve your odds. I really think you have to focus on the likely because there isn't enough time or money available to cover all of the unlikely things that can kill someone.

Baseball as an example:
http://www.livestrong.com/article/353714-baseball-injuries-statistics-for-practice-and-games/

"Of the 627,000 baseball injuries occurring each year, 117,000 of them occur in children age 5 to 14, according to the American Association of Orthropaedic Surgeons and the University of North Carolina. Baseball has the highest rate of death among children of that age group, with three to four deaths per year, according to Cooper University Hospital. The University of North Carolina has been collecting injury statistics and discovered that between 1983 and 2009, 52 high school baseball players suffered direct catastrophic injuries playing baseball. During the same time span, there were 15 indirect deaths during baseball play."


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## hilreal (Aug 16, 2005)

shinbone said:


> I feel sorry for the soul of the person who would rather watch someone die in front of them for fear of litigation than take a few simple steps to save their life.


Or the person who injects someone to find out their heart can't handle a quick dose of epinephrine and kills them when you find out it really wasn't an allergic reaction to a bee sting at all.....Tell your doctor if you have certain medical conditions such as asthma, depression, thyroid disease, Parkinson’s disease, diabetes, high blood pressure and heart disease, have any other medical conditions, are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed. Be sure to also tell your doctor all the medicines you take, especially medicines for asthma. If you have certain medical conditions, or take certain medicines, your condition may get worse.......


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## muusu (Mar 21, 2014)

A lot of the responses seem to be from people who think we are going to stab someone with an Epi-Pen if they stub their toe. 

Here is my situation. My farm is WAY off the beaten path. There is no cell service, the only way to call 911 is to haul ass to the house. The nearest town with a fire station (no hospital) is 12-15 minute drive. And on top of that I know a couple of people who are allergic to bees. So I plan to get a couple Epi-Pens and put them in a first aid kit near the apiary, for Emergencies.

Also consider this, not everyone who is allergic knows it. I know of someone who at the age of 42 discovered they are allergic to Yellow jackets (and very mildly to honey bees). Thankfully not deathly allergic, but still could have been in real danger if the reaction was any worse as they were alone when the sting happened and if they had been unable to get help would have died.

While I agree to some degree with Michael Bush and the others that you cannot be prepared for every contingency, I do not agree that simple things should be ignored. Should I wear a helmet crossing the street? Probably, but I am not going to. If I had venomous snakes at my house, would it be wise to have anti-venom of some kind available? Definitely. If I owned a gun range I would certainly have first aid measures available with the hope of never using them. Why is an Epi-Pen for an apiary considered such a wild notion?

I have never used my CPR training to save a heart attack victim, does that mean the time and money put into the training is a waste? I have a fire extinguisher at my house and change the batteries in the smoke detector but have never had a fire, am I wasting my time?

I really don't understand the negativity on this subject. I never thought about it, but I will say again, I think having an Epi-Pen is brilliant for anyone in the business of bees.

And just for all you number addicts out there, according to what I have found the rate of house fires in the U.S. compared to houses in 2012 was 0.003%. But I am willing to bet you all have fresh batteries in your smoke detectors despite the odds.


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## Michael Bush (Aug 2, 2002)

>Why is an Epi-Pen for an apiary considered such a wild notion?

If Epi-Pens were not sensitive to heat (breaks down quickly when hot), didn't have a short shelf life even when kept refrigerated, didn't cost $200 each, wasn't illegal to use on anyone but the prescribee, wasn't extremely dangerous and could kill you if used when you DON'T need it and anaphylaxis was a common risk rather than a rare one, then MAYBE it wouldn't be such a wild notion...


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## TNTBEES (Apr 14, 2012)

Very well said Michael.


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## Michael Bush (Aug 2, 2002)

>But I am willing to bet you all have fresh batteries in your smoke detectors despite the odds. 

My lithium 9 volt batteries cost about $8 each, can be bought singly, don't require refrigeration, have a shelf life of one decade (in the smoke detector), no one has died from them being used inappropriately, nor been sued nor arrested for using them on the wrong smoke detector. 

http://www.amazon.com/ULTRA-smoke-alarm-battery-U9VL-X/dp/B00004W3ZE/ref=pd_sxp_f_pt


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## muusu (Mar 21, 2014)

Michael Bush said:


> >If Epi-Pens were not sensitive to heat (breaks down quickly when hot), didn't have a short shelf life even when kept refrigerated, didn't cost $200 each, wasn't illegal to use on anyone but the prescribee, wasn't extremely dangerous and could kill you if used when you DON'T need it and anaphylaxis was a common risk rather than a rare one, then MAYBE it wouldn't be such a wild notion...


Well, we will just have to agree to disagree.

Each of us has to do what we think is right.

As my final thoughts on this subject. Refrigerating epinephrine as does more damage to it than not refrigerating, it should be stored at room temperature. Its true that using epinephrine could kill you, but from what I can find, that result is more rare than anaphylaxis itself. If it saves someones life, they are welcome to arrest me afterwards. Anaphylaxis may be rare, but it can be deadly to those that have it, and reports show it is on the rise, not declining.


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## Michael Bush (Aug 2, 2002)

>Well, we will just have to agree to disagree.
>Each of us has to do what we think is right.

Of course.

>As my final thoughts on this subject. Refrigerating epinephrine as does more damage to it than not refrigerating, it should be stored at room temperature

My glove box in Nebraska has never spent more than five minutes on any day at room temperature and most days it has not spent one minute at room temperature. In the summer it is very hot and in the winter it is very cold. Where would you store yours? A cooler seems to be the only alternative in the vehicle if you want any kind of shelf life at all and you'd have to take it back in the house every night. I don't have AC, and never have, so my HOUSE isn't even "room temperature" all summer... so now where do I store it? I'm sorry but until they have something that is reasonable in cost, can stand up to summer and winter temperatures and has a useful shelf life, I simply don't see the point in even considering the cost, the trouble, and the legal ramifications, for so unlikely of an event.


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