Doctor bemoans shortage of life-saving device

Doctor bemoans shortage of life-saving device

Staff reporter

Sunday, January 26, 2020

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With about 25 per cent of Jamaica's population having some form of allergy, consultant allergist Dr Vincent Crump is alerting those in public health system and the Jamaican public at large, to the shortage of EpiPens on the island.

What is known as an auto-injectable device used to deliver epinephrine (aka adrenaline) to someone having a severe allergic reaction, Dr Crump, in an interview with the Jamaica Observer last week, said that the life-saving device is hardly ever available in Jamaica given that the Government is currently not importing them, and neither are most pharmacists.

“The problem is that the shelf life of these EpiPens is about one year, and the pharmacists are reluctant to carry them in their stock because they are worried that they are going to be expired and they would have wasted their money carrying them in.

“In other counties, what they do in the public health care system is they discuss with the allergists roughly what percentage of the population is at risk of anaphylaxis (a severe allergic reaction) and then work out roughly the number of Epipens that need to be imported, knowing that there will be persons who will need them.

“But the problem at the moment is that because we don't have the EpiPens in Jamaica, we are unable to give a good indicator of how many people. As a start they should at least carry two or three EpiPens, and then replace them as they are used up.

“I don't think there should be any excuse not to carry them into the island,” said Dr Crump.

The standards and regulations division at the Ministry of Health did not comment on the availability of the EpiPen in public hospitals and health centres in time for this report, but registrar of the Pharmacy Council of Jamaica, Radcliffe Goldberg confirmed that the EpiPen is not readily available locally.

“To the best of my knowledge, it is something that has been available but it is not the most popular drug at this point in time. Usually there is a distributor and if the clientele is there, they will import and supply the pharmacies who order them. But it in my view it is being used more frequently nowadays,” Goldberg told the Sunday Observer.

The consultant allergist said this is a problem because of the prevalence of food allergies in Jamaica, especially among younger children, naming peanuts and nuts in general as the most common foods that cause an allergic reaction in children.

“We see a lot of food allergies here in Jamaica, the most common of which would be shellfish allergy. While in younger children the common food allergy would be milk, eggs and peanuts.

“Food allergies can be minor in terms of hives or just eczema. And then you can go to the most extreme form of food allergy which is anaphylaxis. This is a food allergy where usually a child eats the food they are allergic to and they can die within minutes of eating that food,” said Dr Crump.

“Normally these allergies present as eczema, hives, diarrhoea and vomiting in a young child. We see children presenting very early with peanut allergy for example. And if there is family history of allergies and the child has eczema, that is usually a sign that that child is at risk of a food allergy,” he added.

However, when it comes to a life-threatening allergy, Crump said that while it is much less common in Jamaica for children with a food allergy to have a life-threatening reaction, he has seen cases in his practice when parents have had to resort to buying the life-saving device abroad, an option not affordable to poor families.

“I have seen a couple of patients here where they had an anaphylactic reaction; they were given antihistamine orally and the child recovered, but only because they were lucky to have survived. I can think of two cases like that with peanut allergy where one parent wasn't aware that they should have an Epipen, and the other parent knew they should have an EpiPen but didn't have one because they are not available locally.”

“The other problem with the EpiPen is that they are expensive. So what happens in other countries is that the Government will fund it or subsidise it so that it is not so expensive. But at the moment, a lot of patients have to buy them up in Miami and bring them in. And I have heard of patients paying up to US$150 for an EpiPen that only lasts 12 months­­–and for some families, that is a lot of money,” said.

Dr Crump, therefore, called on the Government to subsidise the cost of EpiPens, especially for children who are most at risk of having a serious allergic reaction.

“About one per cent of Jamaican children have peanut allergy. But what it means for that one per cent is that parents with children with food allergy are terrified to send their child to school because they don't know when they are going to have an accidental exposure.”

“We need to get the Ministry of Health to look into funding or part-funding the EpiPens, because while there are a lot of people with food allergies... the number of people who are at risk of dying of food allergy is still small.

“We are talking about a very small, high-risk group of the population, usually children, who would need this. So it would not be an exorbitant amount of funding that is going to be required,” he said.

Having worked previously in the United Kingdom and New Zealand, the Jamaican allergist argued that, locally, there is not enough awareness surrounding allergies, even among medical practitioners as well as the general public.

For example, Dr Crump said common ailments such as eczema, asthma, and rhinitis, or what Jamaicans call sinus, are not usually recognised as symptoms of an allergy.

“Most people think of eczema as just a skin disease. But in a high percentage of people with eczema it could be due to a food allergy, especially in children. Eczema in children, especially when it is severe and difficult to treat, one should definitely think of a food allergy then.

“The worst reaction is to have a food allergy with asthma. Those are the children that are more likely to die from a reaction. So if someone was at risk for peanut anaphylaxis, if they also happen to be asthmatic, which a lot of them are because allergies run in families, and once you have one allergy you're at a higher risk of having another. So a child with asthma is at higher risk of having a peanut allergy as well,” he added.

According to Dr Crump, about 15-20 per cent of children present with eczema, while about 20 per cent of the population suffers from asthma, something which he said are key symptoms of allergies.

“For the moment that is the percentage we are guessing because we haven't actually done a proper study in Jamaica, but based on the prevalence of other allergies that we've seen in Jamaica which has about the same prevalence of allergy say in the UK or New Zealand–where I worked for 15 months before coming back to Jamaica,” he said.

Dr Crump said that in countries where studies have been done on deaths from food allergies, almost all of the children who die from a food allergy were asthmatic children whose asthma was not properly controlled.

“Whenever I see a child who has peanut allergy who also happens to be asthmatic, I make sure to emphasise the need for carrying an EpiPen because that is the child who is likely to die. Asthma is very prevalent in Jamaica, and asthma deaths on its own is prevalent in Jamaica.

“Oftentimes in Jamaica, when a child has an allergic reaction to peanuts it presents like asthma, so my suspicion is that some of the children who die from asthma, it could be due to a food allergy,” he said.

In summary, Dr Crump implored the Government to provide funding for the provision of EpiPens in the public health sector.

“I am quite happy to make a case to the Ministry of Health for children with food anaphylaxis to have a subsidy for EpiPens, because at the moment there are no channels for Epipens in Jamaica. There might be one pharmacy that gets them into the island now and again, but there is not a consistent supply for EpiPens in Jamaica,” he said.

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