In the s inventor Sheldon Kaplan recognized that modifications in the pen could turn it into a lifesaver for civilians, especially those susceptible to anaphylactic shock, where a fast response can mean the difference between life and death. The EpiPen gradually replaced a World War II innovation, the Ana-Kit, which contained measured doses of epinephrine ready to be delivered by syringe and needle.
Before World War II, treatment required drawing up and measuring epinephrine from a vial, a time-consuming and error-prone method. Epinephrine—also known as adrenaline—is a hormone. One extract from the inner part of the adrenal gland increased the blood pressure of a dog.
Almost as soon as it was discovered, physicians and pharmaceutical entrepreneurs began seeking uses for this substance. By Solis-Cohen had begun to use an adrenal substance to treat patients with some types of asthma, a condition then still being defined. He gave his patients tablets but complained about the unnecessary animal substances they contained that could cause diarrhea.
He joined the hue and cry for purity. In a article Solis-Cohen named the scientists who responded to this need. It was first artificially synthesized in by Friedrich Stolz. Epinephrine is a "fight or flight" hormone, and plays a central role in the short-term stress reaction. It is released from the adrenal glands when danger threatens or in an emergency. Such triggers may be threatening, exciting, or environmental stressor conditions such as high noise levels or bright light see Fight-or-flight response.
An example of noise-induced trigger of epinephrine release is tinnitus. The fight-or-flight response caused by tinnitus is a contributor to physical stress seen in tinnitus-patients, [4] exacerbating the case. When secreted into the bloodstream, it rapidly prepares the body for action in emergency situations. The hormone boosts the supply of oxygen and glucose to the brain and muscles, while suppressing other non-emergency bodily processes digestion in particular.
It increases heart rate and stroke volume, dilates the pupils, and constricts arterioles in the skin and gut while dilating arterioles in skeletal muscles. It elevates the blood sugar level by increasing catalysis of glycogen to glucose in the liver, and at the same time begins the breakdown of lipids in fat cells.
Like some other stress hormones, epinephrine has a suppressive effect on the immune system. Although epinephrine does not have any psychoactive effects, stress or arousal also releases norepinephrine in the brain. Norepinephrine has similar actions in the body, but is also psychoactive. How emotions can trigger sudden death or heart attacks is an active area of medical investigation. People can live a normal life without any adrenaline. People that had their adrenal glands surgically removed get pills to replace the cortisol and aldosterone the two hormones produced in adrenal glands that are essential for life , but they do not need any treatment with adrenaline.
Life is possible without it. However, those people would most probably not be able to exert themselves to a maximum that they could when they still had their adrenal glands. Short after discovery of adrenaline, it was found that it could help in cardiac resuscitation.
Adrenaline was used in treatment of many problems such as asthma, anaphylactic shock, croup in infancy to give a few. Dentists use adrenaline by injecting it into the gums, together with the local anesthetic, as adrenaline enables the blood vessels to let a local anesthetic stay longer in the teeth. Clinical Brain Imaging Neuroscientist Sylvain Baillet on CT scanning, the way MRI works, and other techniques that revolutionized medicine Anaphylactic shock is still treated by adrenaline in its pure substance.
However, most of the drugs on the base of adrenaline are medical improvements. The hormone cannot be given orally, because it gets metabolized in the liver before it ever reaches the blood. People have developed chemical analogue of adrenaline, that is available orally or that can be inhaled for asthmatics.
Adrenaline for injections for cardiac resuscitation was initially produced from tons of adrenal glands from beef or sheep, but now it is chemically synthesized. The use of adrenaline in a treatment of cardiac arrest — to start the heart going again — is probably the most known.
In the US, cardiac arrest kills several hundred thousand people each year. Many of these deaths are due to ventricular fibrillation, often caused by a heart attack. For more than years, adrenaline has been used as a drug in cardiopulmonary resuscitation in an effort to revive these people. Although not conclusive, several recent studies have suggested that adrenaline may not be desirable in cardiac arrests.
Just a few years ago, an editorial in the Journal of the American Medical Association suggested that it would be useful and ethical to conduct a serious clinical trial to find out if adrenaline was either beneficial or harmful during cardiac arrests. If a sportsman wants to take a doping, he or she will not use adrenaline directly, but will use related drugs.
One of the most important is clenbuterol, which is an adrenaline-like drug. In Europe, it was heavily used in the cattle feed to increase the size of muscles and to lower the body fat.
Many Olympic athletes have been banned from competition for taking clenbuterol. This used to be a problem for those athletes who have asthma, but recently, the Olympic officials allowed certain adrenaline-like drugs to be used by asthmatic people. As adrenaline substitute is inhaled through lungs the concentrations are still too low to affect muscles much.
Contrariwise, there are drugs that block the effect of adrenaline — beta-blocking drugs like propranolol. Those are also banned in some Olympic sports, particularly in shooting. Adrenaline, when you get excited, can make your hands shake.
Read more: Parents want all ambulances to carry EpiPens ». The AuviQ, a smaller and more discreet auto-injector, equipped with a voice function that talked a patient through its deployment, was recalled last year for delivering inconsistent doses of the drug. Adrenaclick is the only other auto-injector still available to consumers.
It retails for about a quarter of the price of the EpiPen and its manufacturer also makes a generic version. Mylan announced several weeks ago that it will be pushing through its own generic. But as the first and longest-lasting auto-injector on the market, doctors and patients alike have come to trust the EpiPen brand over any other device. The Adrenaclick is deployed a little differently, so a person using it for the first time would have to re-orient themselves to unfamiliar instructions.
Until the FDA wades through a backlog of other auto-injector applications — or until a novel delivery system like an under-the-tongue tablet is approved — epinephrine technology seems to have stalled. Some doctors are now suggesting patients cut costs by carrying kits composed of epinephrine and syringes, a system that Kaplan, who died in , must have thought would be relegated to the history books.
Learn how to use an EpiPen to treat anaphylaxis. Get tips on recognizing the symptoms, helping an adult or a child, and much more. The Auvi-Q epinephrine auto-injector will be available again early next year, more than a year after the main competitor to the EpiPen was voluntarily….
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