By Kristen Chandler
People with life-threatening allergies and parents of children with severe allergies know that while carrying epinephrine is a necessity, it comes with its own set of challenges, such as what to carry it in and where, and temperature regulation. For those who are often at home, or for children in school, most of the time temperature control is not a problem. However, if you are going to be traveling or spending time outdoors for an extended period, temperature control is not as easy.
The storage temperature suggested by epinephrine manufacturers is approximately 77 degrees Fahrenheit. A temperature range from as low as 59 degrees to a high of 86 degrees is also accepted. Specialty cases are available to make carrying epinephrine more convenient, and insulated cases are an option that helps with temperature control. However, researchers wanted to know just how much exposure to the elements affects epinephrine, and if there was possibly a wider range of exposure that epinephrine could withstand. The results showed that exposure to heat and cold may not have as much of a negative effect as once believed.
The team of researchers reviewed every previous study that had been conducted on concentrated epinephrine in sealed syringes or vials that were exposed to heat or cold at levels above or below the suggested storage temperature. They found nine such studies that met these requirements. The results were as follows:
- Exposure to heat did cause deterioration but only when the exposure was prolonged.
- If the epinephrine was constantly exposed to heat, deterioration was more likely.
- None of the studies showed significant deterioration of epinephrine that was exposed to cold, even freezing, temperatures.
- None of the studies showed any noticeable deterioration of epinephrine that was exposed to normal temperature variations.
Most of the studies were conducted on epinephrine in vial, syringe or ampule form. Two studies were performed on epinephrine in auto-injectors, with one study focusing on heat exposure and the other on exposure to freezing temperatures. Forty auto-injectors were exposed and, after exposure, the forty devices still worked properly.
In conclusion, exposure to real-world temperature variations (carrying epinephrine with you as you transition from indoors to outdoors, in vehicles and going from room temperature to a cooler or hotter temperature outside) may not be as damaging to epinephrine as once suggested. Exposure to freezing temperatures and limited amounts of heat did not deteriorate epinephrine in syringes, vials or ampules.
However, this was strictly an overview of previous studies. The researchers did conclude that more research needs to be done on exposure to particularly extreme temperatures. And since most of the studies were not conducted on auto-injector devices, more research is needed on the effects of exposure to heat and cold specifically on these devices.
Keep in mind that these are the results of research done on existing studies. Please continue to carry and store your epinephrine as directed by your doctor or pharmacist.
Manufacturers still suggest that epinephrine, especially in auto-injectors, be stored at room temperature (77 degrees Fahrenheit). Also, auto-injectors should not be refrigerated and should not be exposed to light. ALWAYS discard and replace epinephrine that is discolored.