Denise Ure was midway through an afternoon snack when she tasted the peanut.
Driving home from work in peak hour traffic, she had opened up a prepackaged bag of coconut cashews, a snack she had been eating for years without problems. Despite her peanut allergy, tree nuts are safe for her to eat.
Upon tasting the peanut, she spat the nut mixture into a vomit bag she kept in the car and waited to see if she would experience any symptoms of a severe allergic reaction.
"I had a couple of choices. Pull over and call 911 and use the EpiPen, or drive to the hospital using a low traffic route and use the EpiPen if my body started displaying objective signs of anaphylaxis," Ure wrote in her blog.
As she wasn't experiencing any symptoms of anaphylaxis, she chose to drive to the nearest hospital.
"I had my auto-injector hovered over my leg, and ready to inject, but I could not rationalize using it without my body displaying objective signs of anaphylaxis," Ure told Healthline.
Ure never developed symptoms that day she deemed bad enough to justify using the EpiPen. But she says the price of the auto-injector was just as much a factor in her decision not to use it.
"There is psychological resistance to using an EpiPen. You don't want to waste a very expensive auto-injector on a false alarm," she said.
EpiPens vs. syringes
Ure is one of many allergy sufferers across the United States who finds the cost of EpiPens to be prohibitive.
The August 2016 issue of Consumer Reports shows that the cost of EpiPens has increased by about 450 percent since 2007.
The cost of a two-pack of the lifesaving device is now more than $600, according to prescription price search site GoodRX.
As a result, some people are resorting to manual syringes as a cheaper alternative. A few ampules of epinephrine and some syringes can be purchased from most pharmacies for around $20.
Dr. Richard Lockey, director of allergy and immunology at the University of South Florida, said it is an option he has given to his patients to help with the cost.
"In some cases it can be prohibitive and that is why we give them an alternative, a one cc vial of epinephrine with a syringe and instructions as to how to use it. It works. It just takes a bit more time," he told Healthline.
A life-threatening condition
Anaphylaxis is a life-threatening allergic reaction that can occur within seconds or minutes of exposure to an allergen.
Chemicals released by the immune system during the reaction cause the body to go into shock with airways narrowing, blood pressure dropping, and breathing becoming difficult.
Symptoms of anaphylaxis include a skin rash, a rapid and weak pulse, nausea, and vomiting.
Common triggers can include peanuts, shellfish, insect bites, and certain medications.
Adrenaline, also called epinephrine, is the first line treatment for anaphylaxis. It is commonly injected into the thigh via an auto-injector called an EpiPen.
It is estimated 15 million people in the United States have food allergies.
An allergic reaction from food sends someone to the emergency room every three minutes. That accounts for more than 200,000 visits per year.
Time is of the essence
Speed is crucial when responding to anaphylaxis. Some doctors are concerned cheaper alternatives like a manual syringe may be putting patients in danger.
"The main risk for patients using syringes and ampules is that it takes time to draw up the proper dosage and also takes training and a certain skill level," Dr. Stanley Fineman from the World Allergy Organization, told Healthline.
"Prior studies have shown that emergency room nurses are quite efficient at drawing up the specific dose of epinephrine quickly, but others, including physicians, may take as long as one to two minutes to draw up the proper dosage," he said.
For allergy sufferer Lisa King, switching to a cheaper alternative like a manual syringe is not worth the financial savings.
"There simply isn't time to draw out a syringe ... this is time needed to get to the ER," King told Healthline.
"I've used my EpiPen and it's quick and works almost immediately ... I wouldn't have been able to fill the syringe in time," she said.
But Lockey says for those who struggle to afford an EpiPen, a manual syringe is a good alternative if the patient is properly trained to use it.
"In many parts of the world, they do not have a choice. It all boils down to educating the patient to use it early, when things are under control," he said.
Ure says the cost of EpiPens is causing thousands of people across the United States to live in fear.
"I have heard from a lot of people who can't afford this lifesaving medication, and there is so much suffering," Ure said. "People who have life-threatening allergies and can't afford the outrageous cost are terrified because they could die. For someone without reasonable health insurance, this is a potential death sentence."
By Elizabeth Pratt
The original article can be found on Healthline.com.