Injections delay for allergy patients

Anaphylaxis sufferers and doctors are calling for improved stock levels of life-saving auto-injectors.

Allergy sufferers warn some patients are having to wait days to get their hands on life-saving adrenalin injections.

Doctors say an inadequate supply system and the short shelf life of epinephrine auto-injectors, known by trade names including EpiPen, are affecting availability.

Jacquie Miller had to wait 10 days for an adrenalin syringe for her six-year-old daughter, Jessica, who was diagnosed with a severe allergy to cashews three years ago.

"I've never had to use her EpiPen, but her last one did break recently and when we went to Al Noor Hospital for more we were told the order was going to take 10 days," said the mother of three from Abu Dhabi.

"The hospital pharmacy didn't give me any reason as to why there was no stock readily available. They said it's not a product that they stock here and when I went to the normal pharmacies, they said they don't stock them at all."

Dr Bassam Mahboub, the head of Dubai Hospital's allergy and respiratory department and the vice chairman of the Emirates Allergy and Respiratory Society, said the injections should be in constant supply.

"They should be available, but they are not. People usually have to go through a lot of hassle to buy them so I would recommend that pharmacies and hospitals prescribe them," Dr Mahboub said.

Dr Gerald Stiles, the head of the paediatric unit at Al Noor Hospital, said low stock levels were the result of an imperfect supply system coupled with a short expiration date. Some auto-injectors have a shelf life of about 20 months.

"The trouble with the auto-injectors is that they only last a short time. At the pharmacy, we get them in batches that are already halfway towards their expiration date. So while you can get them, it's not a good system of supply."

Health chiefs have called for improved stock levels. However, the US-based distributor of EpiPens, Dey Pharma, has no plans to make them readily available in the region, according to Dr Mohammed Abuelkhair, the head of the drugs and medical products regulation department at the Health Authority - Abu Dhabi (Haad).

"We have contacted the company previously and they said that distributing the product in the Middle East - not just the UAE - is not in their plans at this point," he said.

Auto-injectors are available at all government hospitals and Haad is also continuing to look for alternatives to the ones they already stock.

A normal delivery takes between two to three weeks, said Dr Abuelkhair, who added that the exact quantity available at any given time would be hard to determine.

"The most important issue is that there should be a sufficient quantity to respond to the needs of the patient."

Roughly the size of a pencil, an adrenalin injection could be the difference between life and death for those suffering from anaphylaxis, a condition which occurs when the body reacts severely to certain drugs, foods, or insect stings. The injections can be administered by anyone.

The most common allergic reactions to food are caused by nuts such as peanuts and cashews, fish, shellfish, dairy products, eggs and wheat and sesame. People can also be highly allergic to wasp or bee stings and various medicines, such as penicillin.

Private hospitals and school clinics that need to increase their supply can contact government hospitals or the Ministry of Health.

Some sufferers are wary of using auto-injectors, which come in two different dosages - one for young children, the other for teenagers and adults, said Dr Fares Hamad Zaitoun, who divides his time between Beirut and the allergy and immunology department at the Advance Cure Diagnostic Centre in Abu Dhabi.

If given an overdose of adrenalin, patients can experience a rise in blood pressure or an irregular heartbeat. However, said Dr Zaitoun, no one should ever forgo the option of using an auto-injector.

"Time is of the essence in these cases. The most important factor to determine whether someone survives a severe allergic reaction is how quickly they are given adrenalin."