If the new guideline is EpiPen first, access should not be a luxury

On a Friday in May I dropped off my kids at school, said a prayer for their safety and health like I do every morning and went on to see my patients in the clinic. That afternoon, I got a call from the school telling me my older son was having a severe allergic reaction, with hives covering his arms and face. The panicked administrator told me their algorithm recommended epinephrine administration, but the EpiPen my son keeps on campus had expired the previous month.

Epinephrine injection, commonly known as the “EpiPen,” is a life-saving drug for kids and adults with allergies. My son has had nut allergies and asthma since childhood, and while we always carry an EpiPen and provide one for the school, thankfully his reactions had never been severe enough to require an injection. 

At his most recent allergy appointment, the allergist had told me about the new “Epi First Epi Fast” recommendation by the American Academy of Allergy, Asthma and Immunology emphasizing earlier use of EpiPen instead of waiting for anaphylaxis, the traditional indication of severe life-threatening allergic reaction, to prevent complications from delays and reduce emergency room visits.

While I appreciated the clinical evidence supporting this shift, I questioned how, as medical professionals, we can recommend an earlier and more frequent use of a medication that remains unaffordable for most people. I am a physician with good insurance, but every year we have faced higher out-of-pocket cost for my son’s EpiPen.

This is because Mylan (now part of Viatris), the company which until 2025 held the patent for the auto injector delivery device, continues to hold the........

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