Beesting allergy/epi-pen protocol

May 9, 2007 8:21 AM

How can I get a doctor to prescribe me an EpiPen for beestings, when the same doctor refuses to test me for beesting allergies for fear of triggering anaphylactic shock?

Posting for a friend:

I was diagnosed with an allergy to beestings at an early age when I reacted strangely to a sting. I was given EpiPen to carry with me all through school. Since then whenever I have tried to get a prescription for EpiPen, doctors refuse to prescribe me one because I haven't had an updated allergy test-- but the same doctors also won't perform a beesting allergy test, saying it's an unnecessary risk because exposing me to the allergen may cause my next exposure to result in a much more extreme reaction. I have been refused several times now for this reason.

A friend of my father's was able to send me two EpiPens a couple of years ago, but those are expired and I don't know what else to try. Should I really never undergo an allergy test? Should I just wait until my friends graduate from medical school and can hook me up?

I live in New York City and have health insurance.

posted by hermitosis to health & fitness (19 comments total)

How many doctors has your friend gone to? EpiPens should be easy to get and I think most doctors would write a prescription without hesitation if you told him/her that you were allergic to beestings and needed an EpiPen. Try another doctor.
posted by billysumday at 8:28 AM on May 9, 2007

Four doctors so far have declined to prescribe or test her.
posted by hermitosis at 8:29 AM on May 9, 2007

In my experience, having gone to doctors and allergists in many states and cities, I've always just been able to state that I have food allergies and that I need an EpiPen - and always they've given me a prescription. I think your friend needs to stick with one doctor and develop a relationship - maybe a GP who is also an allergist - and determine if there are other allergies she needs to be worried about. The reactions of the doctors seem very odd to me and I wonder if something else is going on. If they were truly worried that the next contact you have with a bee could result in anaphylactic shock, then they would prescribe an EpiPen for you.
posted by billysumday at 8:39 AM on May 9, 2007

All I had to do to get an EpiPen was describe a serious but unknown anaphylactic reaction to food (my mouth and throat swelled up wherever the food had contacted tissue, had to go get atropine and other good stuff at the med tent). No testing necessary, my doc just wrote me a scrip on the spot. EpiPens (to my knowledge) can't be abused, so I'm not sure why the doctor would be hesitant to prescribe one.
posted by hackwolf at 8:42 AM on May 9, 2007

I know outdoorsy folks whose doctors have given them epipen prescriptions, even though these people have no history of allergic reaction. They told the doctors that they go on long backpacking trips and that they'd like to have the epipen in their first aid kit, just in case. In their case the story was true, but your friend might be able to obtain a prescription using this story even if it's not true for her. (Not that I'm a fan of lying to doctors, but it strikes me as strange that my friends could get the epipen with much less official "proof" of needing one, while your friend can't.)

It's my understanding that epipens are basically easy-to-administer syringes of adrenaline, which means they can be attractive to people who might want to abuse them. Doctors might be extra cautious about prescribing them if your friend has any history or appearance that might hint at "possible abuser". Not that I'm accusing anyone of anything here, just saying that a conservative and grown-up appearance (as opposed to lots of facial jewelry and your favorite beer-brand t-shirt) might help when making these requests of the doctor.
posted by vytae at 8:43 AM on May 9, 2007 [1 favorite has favorites]

sound weird they wont prescribe the epipen , but if they want concrete proof of an allergy, it is possible to do a blood test to determine how allergic you are to something.

my daughter had a severe reaction to the peanut stick test, so they drew blood and sent it to johns hopkins (and i am in the midwest so location is not an issue). the results came back in the not severe range and were very specific on the level of allergy she has.
posted by domino at 9:02 AM on May 9, 2007

I had a very strange reaction to a sting when I was a preschooler - terrible hives. I've always taken an antihistamine after a sting since then, since that's what worked when I had the reaction. I've asked about an epi-pen, but doctors won't prescribe one. I suspect you need to see a specialist to get one.
posted by acoutu at 9:04 AM on May 9, 2007

If you are set on keeping this doctor, which would not be wise, you could also tell him that you think his actions constitute malpractice. This is not a word doctors like to hear, but it seems to fit this situation.
posted by caddis at 9:44 AM on May 9, 2007

Beestings is something else. The spelling you want is ‘bee stings.’
posted by Aidan Kehoe at 9:51 AM on May 9, 2007 [1 favorite has favorites]

This surprises me. I've always had bad peanut reactions, never had an epipen, until a couple of scares right before I left grad school. Upon getting out to my new job, I asked for one in my initial appointment/physical, and got it no questions asked.

Maybe try saying "peanuts" instead of bee stings, if you don't mind a little productive fibbing. Otherwise, make an appointment. with a doctor who will prescribe it (and ask when you call--tell the receptionist if they won't give you one or schedule tests so that you can get one, that you're moving on.)
posted by stevis23 at 10:37 AM on May 9, 2007

Are you going to a regular doctor or an allergist? Allergists are more likely to give them out. I have one and I've never even had a systemic reaction.
posted by chairface at 10:38 AM on May 9, 2007

My doctor gave me an EpiPen based solely on the fact that I'd had an allergic reaction to mangoes in the past. Granted, I've been with the same doctor for various other ailments for about 2 years, but he didn't require an updated allergy test, and I know that my records don't contain any record of a test. If it helps, I told him that I was going to a tropical location and was afraid of accidentally getting mango in something served to me. He prescribed two of them and sent me on my way.
posted by elquien at 10:51 AM on May 9, 2007

FYI: According to Wikipedia, they can be purchased without a prescription in Canada.
posted by dcjd at 11:38 AM on May 9, 2007

There are three risks the doctors are probably looking at:

A) Risk of worsening the allergy by doing the skin test.
B) Risk of a person abusing the epi-pen.
C) Risk of something bad happening if the person gets stung by a bee and has no epi-pen.

It sounds like the doctors all think A and B are more likely than C. This is probably because they think your friend's reaction was local, not systemic or anaphalyactic. Sometimes the words you choose to describe the symptoms make a big difference. If she had any of the anaphalyactic symptoms like throat swelling, be sure to tell the doctor that.
posted by selfmedicating at 11:41 AM on May 9, 2007

Oh, and in other news, I can't spell. Anaphylactic.
posted by selfmedicating at 11:43 AM on May 9, 2007

If your doc won't give you a prescription, ask for a referral to an allergist. Also, the advice to describe your previous experience is good. Do not, on the other hand, lie to your doctor in order to get drugs; it sets a very bad precedent. As far as abuse is concerned, epinephrine is not a recognized drug of abuse and that would be almost nonexistent as a concern. It has been many years but my father had a severe reaction to a wasp sting but not anaphylaxis and had no trouble getting an epipen; what your doctors are telling you does not make a lot of sense to me and you should ask for a better explanation.
posted by TedW at 12:00 PM on May 9, 2007

I concur on going to an allergist. My daughter has a severe allergy-related disease (which I won't go into now) that requires her to have epi-pens with her at all times. They can do the test with potentially life-threatening allergens as long as they have epinephrine present to administer immediately. Just ask your Dr. for a referral. We have used a pediatric allergist there in NY (we're in AZ) who I'm sure would be happy to provide a reference for you for an adult allergist if you would like. Send me a private message if you want that info.
posted by mattholomew at 12:21 PM on May 9, 2007

My allergist (in NYC, upper East side) prescribed me an EpiPen without doing any tests, for precautionary measures after a bad allergic reaction. He is particularly pro-pen due to them falling out of favor with EMTs and in ERs, which he feels is a hazardous trend. Email me for his name & info.
posted by sonofslim at 4:08 PM on May 9, 2007

I know this is a long shot, but have your parents kept the medical records from the first time you were stung? Has the doctor? Is this the same doctor you were seeing as a senior in high school? If so, they can send you a copy which you can show to your current doctor.
posted by brujita at 11:03 PM on May 9, 2007