Epipen storage in hot weather

[Pea1985]

So we have been given epipens for our son's peanut allergy. I note it says they mustn't be stored over 25c but also can't be refrigerated. How do you keep them cool in the heat? I live in the UK so not a regular issue, but what about when we're on holiday or the occasional heatwaves we get in the UK? How much does it matter really?

You need one of these ( various sizes available), just needs soaking in water www.diabeticsupply.co.uk/products/frio-duo-wallet-black

Mine have been fine in the U.K. in a Medpac, but lots of people use Frio pouches when they go anywhere hotter.

You can check the state of the Adrenalin in the viewing window, if it's clear it's fine. If it starts to go cloudy it may not be as effective (but if nothing else is available it's better to use a slightly degraded one than use nothing at all).

Excellent thanks, the Frio looks ideal

Assuming you have 2 Epipens (as you should) you’ll need the larger Frio bag https://www.diabeticsupply.co.uk/products/frio-large-wallet-blue

I get really wound up by the temperature requirements for epi pens. It's basically impossible to achieve when it's hot in the UK, and I have no idea what people in much hotter countries do.

Frio wallets and the like only achieve about a 2-3 deg C reduction in temperature, and as you aren't supposed to refrigerate the pens, it's impossible to keep within the 20-25 deg C range.

Also for pens that are permanently left somewhere (we have a set in the school classroom) I can't expect the teacher to remember to refresh the water in the frio wallet each day during summer.

Thankfully the 20-25 deg C temperature range is not based on any research into the affect of temperature on epinephrine, and is actually just the standard US FDA room temperature guidelines.

I guess it's in manufacturers interests to have a narrow range, as it makes people more likely to buy replacement pens if the range is exceeded.

There is a very good paper (https://www.annallergy.org/article/S1081-1206(16)30130-2/fulltext) that covers a lot more detail into the effect of temperature on epi pens. The main message thankfully is that epinephrine is a lot more robust to temperature excursions than the standard recommendations, and the manufactures need to do some actual research and adjust the guidelines. Low temperatures especially had no measurable impact, and if anything helped to preserve the epinephrine. There is no evidence that storing them in the fridge is in anyway harmful.

The problem with epi pens is that you don't ever use them, until they are needed in an emergency, and you need them to work, so you wouldn't detect if they were degraded. This makes people very anxious about following the rules correctly.

Unlike e.g. insulin which is also affected by temperature, but a diabetic would notice their insulin wasn't being effective and adjust their dose, so it's a bit less critical. You can also store insulin in the fridge.

It would really help if manufacturers put a temperature sensitive measure on the pens so you could tell if they had exceeded a high enough temperature. I've put a bluetooth temperature probe in our pen case so I can tell what temperatures they are at, but again that isn't possible for the set we have in the classroom.

Relying on the liquid being clear isn't enough, that paper above shows that there were significant degradation of epinephrine without being visually detectable.

We live somewhere hot. Ds has epipens for peanut allergy. Tbh it’s never occurred to me. We were given allergy storage pouches that are red for at home and kindergarten, and they don’t insulate at all. I have never been told to store them anywhere specific. It’s 30-35 degrees+ here June-October usually so it’s def been warm if outside with us. Indoors it’s rarely above 25 so at kindergarten and in house it’s fine.
Other children who have allergies at the kindergarten use the same allergy pouches gives by doctor