Pharmaceutical firm Mylan made headlines throughout 2016 for the price of its EpiPen®—an epinephrine auto-injector that can stop life-threatening anaphylactic allergic reactions in their tracks. When Mylan acquired the EpiPen in 2007, the device retailed for around $57 apiece; by 2016, a pair of EpiPens set consumers back by about $600. In January, the Federal Trade Commission asked Mylan to provide information to help the agency determine whether Mylan has violated antitrust laws.
So, what’s all the fuss about? Should employers be concerned about the price of EpiPens?
A Special Case: Anaphylactic Allergies
Lots of people have allergies—some people break out in sniffles when the pollen count is high; others can’t have pets because dog hair or cat hair makes their eyes swell up and water. Allergic respiratory and skin reactions to various chemicals have long been a concern in the workplace. But none of those allergies resemble the dramatic, life-threatening reaction that is anaphylaxis.
Anaphylaxis is a specific, extremely severe type of allergic reaction in which the body reacts so severely to an allergen that the individual goes into shock. Even if the first reaction is controlled with epinephrine, a second reaction called a biphasic reaction can occur up to 12 hours later.
Initial symptoms of anaphylaxis can look like milder allergy symptoms—a runny nose, a rash, or feeling unwell. But symptoms can then progress rapidly and affect multiple body systems. An anaphylactic reaction will involve one or more of the following symptoms:
- Difficulty breathing, tightness in the throat, hoarseness
- Hives or swelling (including swelling of the tongue and inside of the mouth)
- Abdominal pain, nausea, diarrhea, and vomiting
- A rapid heartbeat, sudden drop in blood pressure, dizziness or fainting
- A feeling of doom
- Cardiac arrest
Individuals who have a history of allergies or asthma, or who have had a severe allergic reaction, are at increased risk of anaphylaxis—but people who have never had a noticeable reaction, or who have always had mild reactions, can also have anaphylactic reactions.
For someone who is having an anaphylactic reaction, the treatment is a dose of epinephrine, administered quickly—and followed, in 20 minutes or less, with a second dose if the first dose is not completely effective. That’s where the EpiPen—and less expensive competitors that are beginning to appear on the market—come in. These devices are simple to use and inject a premeasured dose of epinephrine that can slow, stop, or even reverse the reaction, giving the individual time to get to the hospital and receive additional treatment to completely control the reaction.
Most of the talk around anaphylaxis and EpiPens centers on childhood food allergies. Stories about peanut-allergic children who ate something that they didn’t realize was dangerous, and whose lives were then saved—or lost—based on the ready availability of an EpiPen, have become a newsroom staple. But children are not the only people who have anaphylactic allergies; the onset of an anaphylactic allergy can occur at any age. Also, food is not the only potentially deadly allergen.
Individuals can develop anaphylactic reactions to:
- Foods. The most common triggers, the “Top 8” food allergens, are peanuts, tree nuts, milk, egg, soy, wheat, fish, and shellfish.
- Insect venom. The venom of bees, wasps, hornets, yellow jackets, and fire ants are the most likely to cause anaphylaxis.
- Medication. Some medications, including penicillin, aspirin, and nonsteroidal anti-inflammatory drugs such as ibuprofen, and anesthesia are known to cause anaphylactic reactions.
- Latex. Found in disposable gloves and some medical supplies and devices, this allergy is most common in patients with a lot of medical exposure.
There are conditions under which workers can be exposed to these allergens on the job—or when they might encounter others who are having anaphylactic reactions in the course of their work. Tomorrow we’ll look more closely at the implications of anaphylactic allergies for employers.