Dr. Tony Johnson
Purdue University photo
Dr. Tony Johnson
Every time major medical news for people breaks, veterinarians stand nervously on the sidelines wondering when or if the latest recall, breakthrough or crisis will someday, somehow affect their patients.
The crisis du jour involves the EpiPen, a simple and easy-to-use device that many count on in case of a life-threatening allergic reaction known as anaphylaxis.
EpiPens contain a single dose of epinephrine, the fight-or-flight hormone released by the adrenal glands in times of crisis. It can be easily deployed within a few seconds to counteract the shock brought on by anaphylaxis. Things that can trigger anaphylaxis include insect stings, shellfish, nuts and eggs, to name a few. In susceptible people, the EpiPen can be a lifesaving device, so anything that makes it harder to obtain or replace — they have a short shelf life of a few months to a year — can mean the difference between life and death. Know a kid with a peanut allergy? Then you’re probably familiar with these devices.
EpiPen prices hovered around $100 for a two-pack until recently, when costs shot up to the there-goes-vacation level of $600-plus, prompting confusion, social media outcry and a congressional investigation. Public ire and the generally lackluster response by the company that markets EpiPen have been focused on the implications for human patients; nary a peep has been raised about the implications for pets who might benefit from a dose of epinephrine.
Yes, dogs and cats can get anaphylaxis, too. Anaphylaxis in pets may not be exactly the same as it is in people, and it may not be as common, but it does happen. As far as I know, it’s possible in all mammals.
There are no studies to help us know just how many pets suffer from severe allergies like those that can lead to anaphylaxis. Most of the studies that tell us the prevalence of human diseases and best therapies are funded by either the government or a pharmaceutical company, and sadly, pets are too small a market to justify the research dollars in most cases. In the absence of data, I can give you my perspective on pets and severe allergies.
In the course of a 20-year career as an emergency veterinarian, I’ve seen many, many cases of allergic reactions. They have run the gamut from mild, only needing some time for the swelling to go down, to severe, requiring epinephrine for treatment. Most fall into the mild category, but I’ve seen and treated some impressive cases. I’ve written many prescriptions for EpiPens (usually, the version known as EpiPen Jr., with a smaller dose of epinephrine) for worried dog owners to keep at home. I’ve also seen many unexplained deaths in pets over the years that would be adequately explained by anaphylaxis. Perhaps some of those deaths could have been prevented by the timely administration of an EpiPen.
When an EpiPen prescription ran about $100, most people would choose to buy the device to have on hand, and were willing to replace it when the medication expired. That's important because epinephrine doesn't maintain its chemical integrity and stay potent for very long. It’s too soon to tell, but I’m guessing with the price of EpiPens climbing, more pet owners are having to make a cost-versus-benefit analysis similar to that of parents of allergic children: Can I afford it? How much does love cost? What’s the right thing to do?
There are some alternatives to the EpiPen. You may be able to get a small vial of epinephrine from your veterinarian to keep in the fridge, along with a syringe for administration. With a little instruction from your veterinarian, you can be trained to give the injection properly. The downside is that this form of epinephrine may not last as long as an EpiPen, requiring you to run to your veterinarian several times a year. Also, depending on pharmacy laws in your state, it may not be legal for your veterinarian to dispense it this way. Couple that with the fear that many pet owners have of having to handle a needle, and you can see how this recent EpiPen imbroglio might have implications for the owners of allergic pets.
Of course, if your pet has had a severe allergic reaction in the past, talk to your veterinarian about your options.
Any time a pet or a human dies of a preventable disease, it’s a tragedy. Economics have always been more of a driving force in veterinary medicine than human medicine because medical insurance for pets is uncommon, so I worry about the effects of this price hike on pets who may need an EpiPen. The current crisis risks taking EpiPens out of the hands of pets owners and potentially endangering animal as well as human lives.
And the cost is more than lives lost. Having an EpiPen means you’re ready for the worst; you have a fighting chance. If they become less common, parents, patients and pet owners have one more reason to worry.
Have the EpiPens that I’ve prescribed saved lives, or even been used? I don’t have a good way to know — most of my patients see me in the emergency room, then return to their family veterinarian for more care. But even if they’re never used, they have another important function: peace of mind.
That peace of mind just got waaaaaay expensive. About the author: Dr. Tony Johnson is a 1996 graduate of Washington State University and is board-certified in emergency medicine. He is a consultant and medical director for the Veterinary Information Network and was on faculty at the Purdue University College of Veterinary Medicine for several years. He lectures internationally on emergency-medicine topics and practices in Indianapolis, Indiana.