Report follows inquiry into death of Dr. Pierre Drolet

QUEBEC CITY | Patients with a history of severe allergic reactions to bee stings should be prescribed a double dose of epinephrine and be better informed about how to store the drug and use auto-injectors, a Quebec coroner has recommended.

Coroner Jacques Ramsay’s report followed an inquiry into the death of Dr. Pierre Drolet, a 61-year-old retired physician who, despite injecting himself with an Epi-Pen, died within minutes of being stung on the nose by a wasp while playing golf with his wife and friends in the southern Quebec town of Magog in July 2003. Ramsay also suggested doctors try to enrol such hypersensitive patients in a vespid immunotherapy program.

Because Dr. Drolet was also using beta-blockers at the time of his death—which may have reduced the efficacy of the epinephrine—the coroner also recommended physicians re-evaluate the prescription of beta-blockers to patients who are hypersensitive to bee stings.

Because the late Dr. Drolet carried his Epi-Pen in his golf bag, where temperatures far exceeded those recommended for storage, and because the drug was five years beyond its expiry date, the coroner also recommended Canadian manufacturers of the product better inform users about how and where to store the drug, and create a system to remind patients when and why they need to renew their prescriptions.

Because recent studies show that a double rather than a single dose of Epi-Pen is far more effective in stopping an allergic reaction, the coroner also recommended the estimated 600,000 Canadians who suffer from severe allergic reactions to not just bees and wasps but ants, too, be prescribed either two Epi-Pens or a single Twinjector.

The coroner also suggested that hyperallergic patients who use beta-blockers to treat hypertension should, in the event they are prescribed two doses of epinephrine, be prescribed a single dose of glucagon.

To deal with delays that slowed both calls for emergency medical services and the arrival of paramedics to the victim’s side, the coroner also recommended golf courses review and/or put in place measures to facilitate emergency responses anywhere on the course.

Even if all these recommendations are adapted, however, allergy specialists say similar fatalities will continue to occur.

“Allergic reactions to venom are extremely rapid—death can occur within 20 minutes,” said immunologist and allergist Dr. Jacques Hébert, chief of allergy services at the Centre hospitalier université Laval here. “Adrenaline must be administered within minutes. If not, it may be too late.”

He added that, even when well stored and up to date, Epi-Pens don’t always save victims of wasp stings.

In North America, there are approximately 50 sting-related deaths every year; in Quebec, there are an average of one or two deaths every two years.

If a patient has a reaction to a bite that is more than local, Dr. Hébert said a thorough evaluation should be carried out to determine the severity of the reaction. In many cases, he added, patients will need to be put in a vespid immunotherapy program.

“These programs are 98% effective,” said Dr. Hébert. “That’s a lot better than relying on an Epi-Pen to save a life.”