By Dr. Anthony Policastro

Some things never seem to change. There was a news article on May 2 about a woman on an airline flight. She became ill. A physician on the flight diagnosed her as having an anaphylactic reaction. All she needed was a dose from an Epipen. This particular airline did not carry Epipens.

What they do carry is liquid epinephrine in vials and syringes to draw it up and inject it. The woman was saved because the physician knew how to administer the drug.

There is a movement to require all airlines to carry Epipens which are self administered injections. That would certainly solve the problem of availability. What it would not solve is the issue of deciding when to give the Epipen to a passenger.

I have what is called exercise induced anaphylaxis. It is caused by eating wheat and then exercising. Unfortunately, there is no real correlation about how much wheat and how much exercise will set off the anaphylactic reaction.

I can eat wheat and not exercise. I can exercise and not eat wheat. I cannot exercise after eating wheat.

About 20 years ago, I was flying back from Las Vegas. I stopped at an in-airport restaurant for lunch and had some nachos. The walk to the gate was less than a quarter of a mile. I walked casually without any real aerobic exercise.

I got on the flight. The plane took off. I then began having an anaphylactic reaction. I knew I needed my Epipen. However, it was in the luggage compartment in my suitcase.

I called the flight attendant over and explained I needed to get an Epipen. She told me to wait a minute. The next think I knew she was on the overhead speaker asking if there was a doctor on the flight. She returned and I explained that I was a doctor. Another gentleman also responded explaining that he was an orthopedist.

I told her that I could handle the situation if she would get me the Epipen. She explained that she could only give it to me after contacting medical control on the ground.

I accompanied her to the front of the plane. She called medical control while I looked through the emergency kit. I found the Epipen about the time she got through to medical control. She explained the situation and they told her they would call her back.

I knew from experience that the Epipen takes exactly 15 minutes to work. It was noon. I went ahead and took the Epipen while we waited for medical control to call back. By 12:15 I was predictably starting to feel better. Medical control did not call back until 12:25. They told the flight attendant to give me Benadryl.

I had her explain that I had Benadryl in my wallet. I had enough previous reactions to know that this was beyond Benadryl and their suggestion would not work. They reluctantly agreed to have me use the Epipen (25 minutes after I had already used it) as long as a doctor signed for it. I knew how to use the orthopedist on board.

The real question is that even if there had been an Epipen on board, what would it have taken to get medical control to approve it. Would they have done it in a timely fashion? Would they have agreed to use it instead of Benadryl?

Having an Epipen on a flight is an excellent idea. However, it does not go far enough to solve the problem. If medical control has to be reached for a solution to the issue, it might be too late to use the Epipen by the time a decision is made.

Final COVID update- The World Health Organization declared the emergency phase of the COVID-19 pandemic as over on Friday, May 5. That week Sussex County only had 16 new cases for the week. From here on out, we can expect it to behave like the influenza virus with a surge each winter.