Researchers Review Effects of Heat, Cold on Epinephrine

 

What health issue did the study examine?

The study analyzed previous studies looking at the effects of temperature changes on epinephrine. Epinephrine is the only treatment for anaphylaxis, or severe allergic reactions.

What do we know about this issue so far?

Epinephrine is a colorless liquid. It is temperature sensitive. Auto-injector labeling instructs storage at room temperatures (68-77 degrees Fahrenheit, or 20-25 degrees Celsius). Trips are allowed between 59 to 86 degrees F. Families and patients may find those instructions difficult. The researchers noted that storage in emergency vehicles may also be a challenge.

What question did researchers try to answer?

Researchers wanted to know what is understood so far about the effects of extreme temperatures on epinephrine.

What methods did the researchers use?

Researchers looked for studies that already discussed this subject. They found nine studies. The studies included auto-injectors, as well as the types of liquid vials used by emergency personnel.

What did the researchers find?

Heat weakened epinephrine, but only with prolonged exposure. Constant heat resulted in a larger change. None of the studies that evaluated epinephrine exposure to extreme cold found significant weakening. None of the studies looking at real-world temperature changes detected significant weakening. Real-life temperature changes as a result of trips may be less harmful than previously suggested. Only two small studies involved auto-injectors. The researchers said all 40 devices tested fired correctly.

What does this study mean for me?

More research is needed, especially to understand how extreme heat and cold affects epinephrine auto-injectors. However, if your epinephrine auto-injector was exposed to extreme temperatures and is the only device readily available in an emergency, you should still use it. It will not be harmful, but be aware it may not be as effective. As always, if you have anaphylaxis, use your epinephrine and call 911.

Ask your allergist if you have any questions about how to use or care for your epinephrine auto-injector.

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Reference:

Parish, H.G., Bowser, C.S., Morton, J.R., Brown, J.C. (2016). A systematic review of epinephrine degradation with exposure to excessive heat or cold. Annals of Allergy, Asthma & Immunology.

Medical Review May 2016.

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New research looked at the affect of freezing on EpiPen® auto-injector devices:

Will your epinephrine auto injector still work if it gets frozen?

Probably, but still best to avoid freezing.

SEATTLE (November 16, 2018) – If you are one of the millions of people in the U.S. who has a severe allergy and carries an epinephrine auto injector (EAI) you may have wondered if it will still work if it gets left in your car in winter and freezes. Turns out it will still work, according to new research being presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting.

“Since many people who live in cold climates use an EAI, we wanted to explore the effects of freezing on how an EAI functions,” says Julie Brown, MD, abstract author. “Lead author and researcher Alex Cooper took 104 same-lot pairs of EAIs and froze one of each pair for 24 hours, while the other was kept at recommended temperatures as a control. Once the frozen devices were thawed, they and their controls were injected into meat.  The meat and devices were weighed both before and after firing.  The change in meat weight and device weight was similar between frozen-thawed devices and their controls, indicating that freezing did not affect how the EAIs functioned once they were thawed.”

A new study has been released that looked at the affect of heat on the epinephrine concentration in EpiPen® autoinjectors:

EPIPENS MAY LOSE POTENCY WITHIN HOURS WHEN STORED IN HEATED CAR

Small pilot study from JACI: In Practice, an official journal of the AAAAI, demonstrates autoinjectors left in vehicles during sunny days may be less effective.  


MILWAUKEE, WI – Patients may want to think twice before leaving their EpiPen inside their vehicle, according to a small pilot study published in The Journal of Allergy and Clinical Immunology: In Practice(JACI: In Practice). The study found even a single, short-time exposure to heat in a car during a sunny day can decrease epinephrine concentration in autoinjectors. If such degradation turns out to be progressive or cumulative, it could result in significant underdosage of epinephrine during anaphylaxis.

<snip>

Alarmingly, the study concluded that despite the decrease in epinephrine concentration in the EAI there were no recognizable changes in the solution’s appearance.

harrywdog posted:

Thank you for this research.

I'd like to suggest a similar study on how time affects this drug. Specifically, how far past the  expiration date is still okay?

 There are already two studies that have examined this issue: 
Simons FE, et al. J Allergy Clin Immunol. 2000 and Rachid O, et al. Ann Allergy Asthma Immunol. 2015.

 

Nice summary, something I know many of us are concerned about especially as we approach the summer.

I'm curious what "prolonged exposure" means ~ Does it mean constant heat for hours at one time or hours over multiple times?  I assume it means hours, but could it mean days or some other measure of time...?

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