Allergy Fact 15 - (DO NOT DELAY!)

*picture taken from www.foodallergyawareness.org

An update for Epi-Pens

There was an update regarding certain Epi-Pens having problems of not being able to slide out easily of their carrier tube. For more information regarding this, please click on LINK.

Discoloured Epi-Pen

Do check your Epi-Pens from time to time. The Epi-Pen injector on the right in the picture above is discoloured. The epinephrine solution has turned cloudy and opaque. It should not be used. The one on the left is still clear. Even though the Epi-Pen on the left has expired, I'm still keeping it as a back-up due to the Epi-Pen shortage situation.

The FDA issued a statement in August 2018 that some Epi-Pens could be safe to used FOUR months after expiry if kept in proper conditions. Click HERE to read about it.

Allergy Fact - 6 (Signs & Symptoms of Anaphylaxis)

* picture taken from here

Keep Your Expired Epi-Pens!

As there isn't news on when the Epi-Pens shortages will be over, we are now told to hold on to our old and expired Epi-Pens.

Click on LINK to read more about this.

Malaysia does not bring in any other adrenaline auto-injectors other than the Epi-Pen. With this worldwide shortage, that was what I was adviced. Just make sure that the liquid is clear in your Epi-Pen. There is a window on the pen where you can check.

Allergy Fact - 4 (Antihistamine or Epinephrine?)

*picture taken from HERE

Allergy Fact - 3 (Epinephrine Myths & Facts)

*picture taken from HERE

It's About Time!

The F.D.A. has finally approved a generic Epi-Pen!

The no-stock, malfunctioning pens and sky rocketing prices have gone on for far too long.

Click on LINK to read more about the generic pens.

EpiPen (Latest News)

Currently there's still no news on the Epi-Pen stock other than the news about the shortage:

EpiPen Shortage

Consumers Struggle to Find EpiPens

The US is Facing a Shortage of EpiPens

I was lucky enough to get mine from a doctor friend from Singapore as there is still no news about the pens over here in Malaysia.

The pens now come in twin pack. There's even a trainer pen that comes together with the pack.

If you're able to go over to Singapore, you might want to try getting your pens from there. Remember to bring along your doctor's letter and prescription letter.

Technology, Allergy & the EpiPen App

Imagine one day you're walking down the street when you suddenly breathed in some peanut-dust or got stung by a bee. You are about to go into a full-blown anaphylactic attack. And you don't have your EpiPen with you.

What's even worse, the ambulance can't reach you in time.

Researchers in a university in Israel have developed an app called EpiMada where people who are near you who carry an EpiPen can be notified via the app. They could administer epinephrine using their personal EpiPen to save you while help is on the way.

To read more about this, click on Epipen Locating App.

Shortage of EpiPens

The yearly hunt for new EpiPens begins one month before the ones I have expire. This year is no exception.

Imagine my horror when I was told that there hasn't been any new EpiPen stock in Malaysia for the past few months! My usual pharmacist at the hospital nearby told me that she had a patient who was on the waiting list for the past 5 months and had recently given up waiting!

There is only one company which imports the EpiPens into Malaysia and apparently they don't keep any stock of the pens. If there is demand, then only will they bring it in. And bringing EpiPens into Malaysia now requires TWO permits. Miss Pharmacist told me that she would contact the supplier to inquire and keep me updated.

She returned my call and told me that the situation was still the same. Currently there was no stock of EpiPens in Malaysia. I would be placed on the waiting list and no one knows what the time frame of the waiting list would be. She did not know anything beyond that.

I could not accept this kind of answer as it is ridiculous beyond words. The EpiPen is a life-saving drug.

I called the other hospitals to find out what was happening.

Hospital A came back with the same answer. They have not dispensed EpiPens for the past year as there was difficulty getting the pens. The pharmacist at Hospital A told me that they received a memo stating that EpiPens have been discontinued and no longer in production. I told her that this cannot be true. If it is true, what is the equivalent that has replaced the EpiPens? One cannot just leave the patients out there to die.

She said there was none.

I then ask her what do the doctors give patients who have life-threatening allergies when they are discharged from the ERs/wards?

She said there was none.

I almost went ballistic. I know that in UK, every person who has experienced an allergy attack is given an EpiPen when they are discharged. Don't tell me the allergies in Malaysia are different from the ones in UK? Our Malaysian allergies do not kill?! She then asked me whether is it a must for me to have this EpiPen. My blood was boiling at this point. I gave up and hung up.

Hospital B came back with the same answer: no EpiPens in stock or sight.

Hospital C was the same. So was Hospital D.

But all hospitals couldn't tell me why there wasn't any stock.

I then did some research online about this Malaysian pharmaceutical company who is the only licensed supplier to bring in the EpiPens into Malaysia. I called them.

I was transferred from one department to another department. I felt like I was going around on a merry-go-round. Round and round and round with no answer.

I was asked the same questions over and over again with every new person who answered the call that was transferred:

"Siapa ini?" "Who is this?"

"You dari mana?" "Where are you from?"

"Siapa suruh you call kita?" "Who instructed you to call us?"

"Apa pen itu?" "What pen is that?" You must be bloody kidding me to ask me what pen! You're a pharmaceutical company!

"Apa? Saya tak tahu lah." "What? I don't know lah."

And one of them even hung up on me before I could even finish my sentence.

Bloody hell.

I called back and I blew. I told whoever who answered the phone to stop transferring my calls from one end of the company to the other end. I told the person to transfer me to a person who knows what the hell an EpiPen is and that I want answers and I want them today! And I told the person if they were to hang up on me, they will see me in person. (I got the person's name.)

Yes, I was that pissed.

There was silence on the other end at first and then they transferred me to another department. The woman who answered this time told me that I needed to speak to a particular lady who is in charged of importing of medications. Apparently, only this lady would know what is actually going on. She gave me the lady's contact number.

So I contacted Miss-Only-She-Knows-What's-Happening.

She was very helpful and professional. And yes, there has been a shortage of EpiPens for the past few months due to the Mylan episode where the auto-injectors jammed and couldn't discharge the epinephrine. Due to that, Mylan stopped their production of EpiPens for a few weeks. Thus, the shortage of EpiPens is due to a backlog of demand. Too much demand and too little supply.

I have kept myself abreast of what was happening with Mylan and its scandal of increasing its prices and its auto-injector failure. But I did not know about this shortage! Miss-Only-She-Knows-What's-Happening told me that it's a worldwide shortage and even if I were to go to neighbouring countries, I would not be able to find one. She said Mylan has not replied her queries on when this would be over. What she can advice is that for us to hold on to our expired EpiPens. They would still function even though they are expired. BUT, you must head to the ER IMMEDIATELY without wasting any time after injecting yourself with the EpiPen. One does not know how much strength the epinephrine has after expiry. She also said that EpiPens have not been discontinued.

My pharmacist from the nearby hospital gave the same advice: Hang on to our expired EpiPens. Use them in anaphylaxis episodes. Head to ER IMMEDIATELY without wasting any time.

I did some online searching and found these:

Click on EpiPen Shortage in Canada.

According to the website above, two Epi-pens Junior are equivalent to one adult dose. Alternatively, one could carry an ampule (filled with epinephrine) and a syringe.

Click on EpiPen Shortage in Australia.

Click on EpiPen Shortage in UK.

The ER doctor who treated me at the hospital nearby my place told me if ever EpiPens were to be unavailable, there's always this old-fashion option:

You can carry this with a syringe in a pouch (that is you have some knowledge on how to break the vial and which syringes to use to draw the solution and to jab yourself with). And yes, the balls to do so too.

Good luck with your quest for new Epis.

By the way, Mylan now sells EpiPens in twin packs. One pen costs RM485. A twin pack would now cost you RM970.

Latest News on EpiPen Failure

Please click on LINK to read in detail. It is important that you keep abreast of what is happening regarding the EpiPens.

Do check on the state of your EpiPens regularly to make sure that they are not leaking.

Epi Pen Recalled

I received a call from the pharmacist of the hospital that I bought my EpiPens from. My Epipens are affected by the recall.

Do get yours checked.

Malfunctioning EpiPens

Many EpiPens are believed to have a problem which may cause it to not be activated. *Apparently there were two cases where the EpiPen failed to work.

*taken from HERE

There is a massive recall of the EpiPens.

You can take a look at the picture below and check to see whether yours is affected.

*picture taken from HERE

Click on LINK to read more about this.

Epi-Pens

First, the good news.

There were still a handful of Epi-Pens at the Sime Darby Medical Centre Subang Jaya (some of us still call it SJMC) on Wednesday. The expiry date is June 2016.

Here's the bad news.

They now cost RM400 each.

If you're in need of an Epi-Pen, I suggest you get a prescription and head there ASAP. These needles run out pretty fast.

The Epi That Was Two Months Later

I ordered Joel's Epi-Pen in early August. It only arrived this week. I really cannot understand how a life-saving injection can be given such low priority. Who knows in the end we would have to carry syringes and vials of epinephrine. And that would be so sad.

AMINES Part 6 - Biogenic Amines in Food (Epinephrine)

Our human bodies have two types of neurotransmitters which are epinephrine and norepinephrine. These two are involved in neural communication.

Epinephrine is also called by another name, which is adrenaline.

Epinephrine is a hormone which is secreted by the medulla of the adrenal glands. Fear and anger (which are strong feelings) will cause epinephrine to be released into the bloodstream. This will cause an increase in the heart rate, muscle strength, blood pressure and sugar metabolism. This reaction is called the 'Flight or Fight Response'.  I'm sure all of us have gone through episodes of fear/anger where the aftermath is us panting for breath and racing hearts.

Norepinephrine belongs to a neurotransmitter group called the catechlolamines. Click on LINK.

Synthesis

The production of both of these neurotransmitters start with tyrosine (which is another neurotransmitter).

Below is process of how tyrosine is turned into epinephrine.

• The enzyme tyrosine hydroxyls turns tyrosine to L-Dopa. 
• The enzyme dopa decarboxylase turns L-Dopa into dopamine.
• The enzyme dopamine ß-hydroxylase turns dopamine into norepinephrine.
• The enzyme PNMT turns norepinephrine into epinephrine.

Ephedra Equisetina (Ma Huang)

Our bodies produce epinephrine. It is in fact an extremely regulated hormone in the body. 

Did you know that there is a desert shrub called the Ephedra Equisetina that produces the ephedrine protein which acts very similar to epinephrine and affects the same reactors too? It is also known as the 5000-years-old Ma Huang which can literally translated as the yellow cannabis. 

Traditionally, the indigenous people used this desert shrub to treat asthma, hay fever and even the common cold! This shrub contains active constituents of alkaloids ephedrine and pseudo-ephedrine. 

• The ephedrine helps to relieve asthma and stimulates the sympathetic nervous system.
• The pseudo-ephedrine acts as a nasal decongestant. 

Chemically, the alkaloids are related to the amphetamines.

Dietary Supplement

1. Diet Pill

As the epinephrine receptors recognizes the ephedrine molecules, ephedrine also plays a rolls in breaking down glycogen in the liver. (Glycogen functions as the secondary long-term energy storage). Because ephedrine is able to do this, the Ma Huang shrub is a popular dietary herbal supplement. It suppresses the appetite and stimulates the thyroid gland by increasing the thermogenic metabolism (the heat production of our body). Epinephrine will be released into the blood stream by the adrenal glands, causing an increase in body temperature which in return, burns more calories.

2. Athletic Performance Pill

Theoretically, taking the ephedrine pill could boost the athletes' performance during short  routines. As the ephedrine metabolizes quickly, it is not suitable for sports that last hours. Ephedrine opens the lungs, enhances muscle contractility and increases blood glucose levels. It is akin to the body's 'adrenaline rush'. It is in theory that this could help athletes perform better. Bear in mind though that drugs are banned from the sporting world!

3. Side Effects

Ephedrine increases the blood pressure and heart rate. Those with a weak heart could suffer from heart failure or a heart attack. It can also cause dizziness, insomnia and headaches. The FDA proposed that supplements with epinephrine should not be taken for more than 7 days.

Foods With Tyrosine & Epinephrine

As epinephrine is a product from tyrosine, let's take a look at foods which have tyrosine or epinephrine.

Since the body produces most of the tyrosine that we need, the other food option would be foods that are rich in phenylalanine (which the body also converts into tyrosine). To read more about phenylalanine, click on LINK. 

Thus, foods that are rich in both tyrosine and phenylalanine are red meat, poultry, seafood, eggs, dairy products, and soybeans.

Some of the foods that are high in tyrosine are:

1. Raw, dried spirulina seaweed
2. Soy products
3. Avocados
4. Eggs
5. Cheese
6. Almonds
7. Bananas
8. Pork

Click on LINK for detailed list of foods with high levels of tyrosine. 

Medically Speaking

The epinephrine injection is used to treat severe allergic reactions (anaphylaxis). I can personally say that this injection has indeed saved my life twice. 

A norepinephrine injection is used to treat severely low blood pressure.

Epi-Pens: It's The Same in Singapore!

Apparently the same situation where Epi-Pens are concerned in Malaysia is happening in Singapore too!

Click on link to read more!

Anaphylaxis (YouTube)

I found a few interesting YouTube videos explaining about anaphylaxis.

This video below should be watched by everyone who works in the medical line!

The Epi-Pen Practice

If you have family members (or even yourself) who are in the dark on how to use the Epi-Pen, you can practice by using an expired Epi-Pen on an orange!

Click on the video to view.

Caution:

Because epinephrine is a strong vasoconstrictor, accidental injection into fingers, hands or feet may result in decrease 
or loss of blood flow to these areas.




This is the new Epi-Pen look:

Be careful of your fingers and hands if you do decide to practice on an orange!! You do need ALL 10 digits!!!!