[legitster]

I had an interesting conversation with a doctor recently. They suggested that people have overreacted to the risk of anaphylactic shock. We automatically treat it as a life ending event, but I guess even if you go into shock it's a pretty long tail event that causes permanent damage.

All this to say its hard to even get an EpiPen now. People using it unnecessarily during any panic attack and ending up in the ER is a bigger risk than the allergy itself.

It might be fair to say these treatments would be just as much as a psychological treatment - you have millions of people living in constant fear that this could help.

[andrewchilds]

In my experience epipens and generics are easy to come by, and as a parent that has given epipens to a kid, passed out and deep in anaphylactic shock, and hearing ER nurses casually talk to each other about how many epipens they've given to kids that didn't make it, I think you might feel differently if you lived through that first-hand.

[legitster]

That's the thing, I grew up hearing stories all the time of people almost dying. It wasn't until my doctor turned us down for an Epipen after our kid went to the ER for croup that he actually explained how rare it was for allergies to kill someone.

Out of curiosity I looked at actual case rate numbers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/ Less than 200 a year and more than half from drug related allergies. That's getting into death from lightning strike numbers or deaths from chicken pox.

(Obviously, this doesn't factor in the specific risk to someone with a known allergy, or without access to Epipens/care. But still a pretty low risk compared to the attention it gets.)

I also found a statement put out just last year by the American College of Allergy, Asthma & Immunology:

> "Injectable intramuscular epinephrine is the first-line treatment for anaphylaxis. Epinephrine is touted as "life-saving," in particular because observational studies have identified lack of prompt epinephrine treatment as a critical risk factor associated with anaphylaxis fatality. Although association is not causal, few would argue that epinephrine is not the optimal treatment for anaphylaxis, and do we have sufficient proof to suggest that epinephrine is actually "life-saving"? Epinephrine indeed works swiftly to reverse such symptoms of an immediate allergic reaction. However, there are abundant observational data that many cases of anaphylaxis are inherently self-limited and may resolve within 1 to 2 hours in most cases with or without treatment. In this perspective, the intent is to address and reframe the reality of the evidence we do have for what epinephrine does and does not accomplish and provide a perspective regarding the common "dogma" regarding the drug. There is a danger in using terms such as "life-threatening" and "life-saving" for anaphylaxis and epinephrine treatment, especially under the caution of frequently cited rhetoric that subsequent reactions are likely to be progressively more severe or potentially fatal. Use of such descriptions risks negatively polarizing our patients and adversely affecting their quality of life, given these terms can potentiate unnecessary fear. Epinephrine is in fact a wonderful drug, but it is important to not lose sight of the evidence for what it actually does in anaphylaxis treatment and why it is important to use this drug in anaphylaxis, as opposed to an emphasis on what it does not do."

[andrewchilds]

From the 2017 study you linked to:

> The delayed use of epinephrine, identified as a significant feature in several reports of fatal food anaphylaxis, is perhaps the risk factor most amenable to modification. This has, in part, driven the widespread provision of epinephrine autoinjectors for the management of anaphylaxis, although controversy exists as to their use in less severe, nonanaphylactic allergic reactions.

Your logic seems to be "because anaphylactic deaths are low, epipens generally aren't useful". It may be true that they're used too often - knowing what to do in the moment when your kid is swelling up, having trouble breathing, throwing up, or passing out, especially if they're very young or not verbal, is a challenge and an experience I don't wish on anyone. But the way I interpret the data is that anaphylactic deaths are low precisely because epipens are so commonly used and there is so much awareness and training around when/how to use them.

[legitster]

That could very well be! There's not any research I can find that says "people with access to epipens die at X rate and people without die Y rate" so we have to take the manufacturer's claims at face value.

Regardless of how we are achieving it, it's just something where my perceived overall risk was much higher than the actual data justified.

[LUmBULtERA]

My son has a couple allergies. My anecdote (in the US): it was very easy to get EpiPens for him. Having decent insurance, it was also not expensive.