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EpiPen 101 for Elders

By Jessica Girdwain

For people who experience severe allergic reactions, an EpiPen is a true lifesaver. “The main function of the pen is to treat anaphylaxis and stop the most life-threatening symptoms. It doesn’t relieve all symptoms, but it’s an emergency treatment that will help someone survive the most severe part of a reaction—shock—and stabilize the heart before emergency help arrives,” says Rosemary Laird, MD, medical director of the Health First Aging Institute and The Center for Family Caregivers in Melbourne, Florida.

Venom from insect stings, such as from bees and wasps; pollen; and certain foods are common allergens that can cause people to go into anaphylaxis. Laird points out that although food allergies are common in children (peanuts are a good example), adults can have them as well, including allergies to shellfish and soy. Soy, which is increasingly added to processed foods, isn’t always recognized as an allergen.

For elders whose sensitivities make them particularly susceptible to anaphylaxis, it can be critical for them to understand the need for an EpiPen and its use. But physicians can provide important insight for older adults related to EpiPen use and guarding against life-threatening allergic reactions.      

Elder-Specific Concerns

People equipped with an EpiPen—including elders—are those who have had allergic reactions in the past that aren’t as severe as full-blown anaphylaxis, Laird notes. It’s important for physicians to tell their patients about the specific symptoms, including hives, itching, tongue swelling, and tingling lips, that would prompt them to use the pen. “Patients should know that the same swelling that happens in your lips and tongue can happen in the airway, which quickly creates an emergency situation,” Laird says. She recommends that physicians alert their patients that shortness of breath and wheezing are two sometimes overlooked symptoms of a severe allergic reaction.

Patients should be advised to call 911 and then use the EpiPen as soon as they sense these symptoms. “When you see a hive, you use the pen, you don’t wait,” says Laird. “Waiting may mean that, next, you might not be breathing, which can affect your brain and lead to death. You don’t have a long time to get that medication in.”

Because anaphylaxis is such an immediate and dangerous situation, older adults who have been prescribed an EpiPen need to use it despite any other health conditions. Physicians should remind older adults of the need to take certain steps after using the pen to ensure their safety and preserve their health.

“The way the medication works is that it blasts a very strong chemical, epinephrine, into your body,” explains Laird. Though this prevents a patient’s body from going into shock and the heart from shutting down and circulation collapsing, it does mean that the EpiPen wakes up the body and revs the heart. In an older adult, the medication can increase heart rate enough to strain the organ, especially in elders who are more likely to have heart disease. “For an 8-year-old using an EpiPen, this is no big deal. But for a 78-year-old person, this can be harmful,” says Laird.

EpiPen use is likewise a concern for diabetics because it can cause blood sugar to skyrocket, which creates problems if the patient doesn’t have insulin available to manage this increase. “Diabetes can get out of control after that,” notes Laird.

For those with Parkinson’s disease, symptoms such as shaking may worsen after using an EpiPen. For that reason, physicians should alert their patients that the elderly, especially those with heart disease, diabetes, and/or Parkinson’s disease, should go to the emergency department for monitoring after using an EpiPen.

While there may be concerns that a patient’s medications could interact with an EpiPen, one should still be used if a patient is in danger of experiencing an allergic reaction or anaphylaxis. Though this is another reason patients should go to the emergency department, “It’s not a big worry. If you’re truly having anaphylaxis, you’re concerned about saving your life, not worrying about any reaction among medications,” says Laird. “If they truly have anaphylaxis, then they will die if they don’t use it or get to the hospital within minutes. If they have this type of reaction, they should use one [EpiPen] no matter their health history.”

When prescribing an EpiPen, doctors should look over the patient’s health history and understand any additional risks. “If a patient is properly educated about the EpiPen, then they will use it if need be and deal with the potential effect later,” says Laird. Patients should also be aware that if they mistakenly use the EpiPen at the wrong time, they should still go to the emergency department.

Cognitive Impairment Concerns

Physicians should be aware of patients’ possible diagnosis of dementia or possible signs of cognitive impairment, which may affect their ability to correctly use an EpiPen. “Some patients who have memory loss, even at the beginning stages, forget to carry their EpiPen with them. If you don’t have it on you, it can’t save your life. Memory loss can pose a health hazard for patients,” Laird says. “If I know my patient doesn’t have good cognitive ability, I won’t put the patient in charge of the pen because they may use it incorrectly.” In similar cases, physicians may need to set up reminder systems for family members or caregivers to make sure the patient keeps the EpiPen with him or her. Physicians should also educate family members about how to help patients use their pens.

Patients should also wear a medical alert bracelet, “just so people know what’s going on. If the patient is found down, someone may see it and know to administer the EpiPen,” Laird advises.

Additionally, before a patient leaves the physician’s office with an EpiPen prescription, he or she should be given a paper copy of instructions for properly using the device. “Sometimes the instructions for using a pen are difficult for patients. For that reason, primary care providers should do everything they can to send a patient out with written instructions,” Laird says. Pharmacies may also have instruction sheets available for patients.

While there’s an impression that older adults don’t have many allergies, it’s important to note that allergy rates over a life span, from children to the oldest old, remain steady at about 15% of the population, according to Laird. If a patient does have a severe reaction or hives and an EpiPen is prescribed, Laird suggests that doctors send patients for skin testing so an allergist can pinpoint the allergen(s) causing the reaction. “That way, elders may be able to avoid allergens in the future and decrease their risk of reaction,” she says. It’s a preventive step that can make a big impact.

— Jessica Girdwain is a Chicago-based freelance writer who has contributed health-related articles to several national magazines.