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PostPosted: Sun Mar 01, 2009 11:08 pm 
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Joined: Thu Feb 26, 2009 12:05 am
Posts: 641
Location: AB, Canada
We're still in the learning curve stage of living with a severe peanut allergy (son diagnosed 1 week ago). I can't quite figure out how to make sure the epipen isn't ever outside of the safe temperature range. For instance, if we're going for a walk in the snow, and it's around freezing, do we take it with us and risk exposing it to cold temps, or do we leave it at home at room temp (if we're just going for a walk in the park - no food)? I'm sure the one in my purse has already been exposed to temps below 15.

Just wondering what other people do to get around the temp issue. I can also imagine that if we're outside in the summer, it might go above 30.

Any suggestions would be appreciated!
Becky

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DSs 7,7,9 all PA


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PostPosted: Mon Mar 02, 2009 2:24 am 
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Joined: Tue Jun 26, 2007 2:45 pm
Posts: 797
Location: Vancouver, BC
Hi Becky,

I was worried about this at first, too, even though our city (Vancouver) has a milder climate than most north american cities. I phoned the company that makes epipen to ask what would happen if it were stored outside those temperatures and their answer wasn't helpful. She simply said they had not done studies on epipens exposed to those temperatures and therefore couldn't guarantee that they would work properly.

I seem to remember reading the Complete Peanut Allergy Handbook, and coming across this topic. I believe the author (and allergist) said you should take reasonable precautions to make sure it's not exposed to extreme temperatures, but it's not a matter of having to throw the thing out if it's kept at 10 degrees for a few hours.

I also asked our allergist and he said the same - try to ensure it's not left in the car in the heat of summer or dead of winter, and tuck it inside your jacket when you're out skiing, but don't worry too much about it. I specifically mentioned my daughter's preschool isn't heated on evenings/weekends, and there are two epipens kept there. He said that since they are inside a first aid kit, inside a backpack and inside a cupboard, their temperature wouldn't be as cold as the outside temperature. He said it's better to keep them there rather than take them home everyday and risk forgetting to bring them one day.

I have read other threads on this and other allergy forums and pharmacists have also said that in severe cold, the liquid can become crystalized, which would render it ineffective, so you should check for that if it's been outside in cold weather for some time.

Some people in extreme temperatures use coolers or insulated carriers to help regulate the temperature. Neoprene does insulate to some degree, and so would those baby bottle warmer pouches. I think there are also people who put a thermometer with a memory function inside their epipen pouch to check what temps the inside of the pouch has been exposed to. I've heard that it's perhaps the mechanism that wouldn't work when at freezing temperatures, but that it would work again once warmed up.

Sorry, this doesn't really help, but I think it's one of those things where you use your common sense, find your comfort zone and do what's convenient for your family.

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DD 2004 Allergy to peanuts, egg, sesame, and new: lentils and chick peas
DS 2006 Allergy to peanuts, tree nuts, milk, egg, kiwi fruit, eczema


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PostPosted: Mon Mar 02, 2009 7:30 am 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6455
Location: Ottawa
Becky, does you coat have an inside pocket?
Here's what we do (not very scientific but...)
1. dd wears an Epi-Pen, this one is always kept inside her coat so it's never too cold or hot.
2. Others are kept in a fanny pack which is carried in the back pack if just in and out of the car.
3. If we are going to be outside for more than 30 minutes, the fanny pack is worn under my coat.
4. We check the fluid in the Epi-Pens to make sure it hasn't changed colour.

I wouldn't worry about the Epi-Pen at the school over the weekend but I would ask for it during long winter holidays (Christmas or March break) it might be handy to have an extra one if you plan to do any travelling at this time as well.

Maybe this is a good use for expired Epi-Pens, how long would they freeze in the freezer?

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Mon Mar 02, 2009 11:26 am 
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Joined: Thu Feb 26, 2009 12:05 am
Posts: 641
Location: AB, Canada
Thanks for the replies, I was able to find some studies that address the issue, and I think I'll go with the 'try to keep it in the range as much as possible, and check often for discoloration or precipitate'.

Here are a few articles, if anyone is interested:

http://publicsafety.com/article/article ... Section=18
http://www.pubmedcentral.nih.gov/pagere ... dex=1#page

It's interesting to note that this is a problem for health care professionals, not just parents. I was suprised that ambulances are exposed to such temp extremes, but it makes sense. I worked in biochem research for quite a few years, and will do some more reasearch regarding the temperature sensitivity.

Susan, I'm pretty sure that freezing solid would greatly reduce their activity (epi may not go back into solution). I also read somewhere that it could damage the spring/injection mechanism.

So much to think about! I have a follow up appt today, I hope the RAST results are back. If not, I'll just ask 101 questions.
Becky

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PostPosted: Mon Mar 02, 2009 1:50 pm 
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Joined: Tue Jun 26, 2007 2:45 pm
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Location: Vancouver, BC
Wow, I'd never read such indepth information on this topic - this is a bit concerning. Thanks for posting these links.

I was wondering whether Epipens are the 1:1000 or 1:10 000 concentration, as in one study this made a difference - anyone know? The Epipen website just lists the two dosages (regular and Jr version) as 0.30mg and 0.15mg, respectively.

So it seems that leaving them over the winter months in an unheated school for the weekend or a longer break is a bad idea.

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DD 2004 Allergy to peanuts, egg, sesame, and new: lentils and chick peas
DS 2006 Allergy to peanuts, tree nuts, milk, egg, kiwi fruit, eczema


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PostPosted: Mon Mar 02, 2009 3:31 pm 
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Joined: Fri Oct 10, 2008 9:40 pm
Posts: 2034
Location: ottawa
I can't seem to find where I saw this product (could well have been in an AL magazine) but I've seen an epipen pouch advertised where the case is gel lined. I remember reading that it's specific purpose was to keep the temp. from becoming too cold or too warm.

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DD 12 yrs -no allergies
4 yr old DS - asthma/eczema Anaphylactic to Peanuts, all tree nuts, sesame , all pea/lentil legumes, gelatin.
Allergic to trees, grass,ragweed, feathers, dander, mold and dust.
Outgrew eggs, fish, shellfish


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PostPosted: Mon Mar 02, 2009 4:06 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
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Location: Ottawa
Was it this one?
http://www.allergicliving.com/forum/vie ... =insulated

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Mon Mar 02, 2009 11:43 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
Posts: 1643
Location: Toronto
Alison's Mom wrote:
So it seems that leaving them over the winter months in an unheated school for the weekend or a longer break is a bad idea.


Check whether or not your school is left unheated. i had spoken to the principal, and at our school the caretaking staff works during the holidays, so the building is heated.

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self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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PostPosted: Tue Mar 03, 2009 8:52 am 
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Joined: Fri Oct 10, 2008 9:40 pm
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Location: ottawa
Susan, I am not sure, could be but I don't think so. I saw it a while back. Later today I'll hunt and see where I could have read about it. Somehow in my 100's :D of allergy related bookmarks I seem to have lost it.
Living with such hot humid summers and cold winters I remember thinking what a great idea especially if outdoors a lot.

I'll get back to you.

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DD 12 yrs -no allergies
4 yr old DS - asthma/eczema Anaphylactic to Peanuts, all tree nuts, sesame , all pea/lentil legumes, gelatin.
Allergic to trees, grass,ragweed, feathers, dander, mold and dust.
Outgrew eggs, fish, shellfish


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PostPosted: Sat Mar 07, 2009 4:09 am 
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Joined: Tue Jun 26, 2007 2:45 pm
Posts: 797
Location: Vancouver, BC
AnnaMarie wrote:
Alison's Mom wrote:
So it seems that leaving them over the winter months in an unheated school for the weekend or a longer break is a bad idea.


Check whether or not your school is left unheated. i had spoken to the principal, and at our school the caretaking staff works during the holidays, so the building is heated.

Well, our preschool is definitely not heated during evenings and weekends. I mentioned this to the teacher when I went to pick up the epipens that we keep there in order to have with us during our holiday. She said that it does get to be 8 or 9 degrees in there when it's really cold outside.

I'm not sure about the main school, where my DD will be at Kindergarten next year, but I'll check before she starts.

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DD 2004 Allergy to peanuts, egg, sesame, and new: lentils and chick peas
DS 2006 Allergy to peanuts, tree nuts, milk, egg, kiwi fruit, eczema


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