Arguably, emergency medicine grew from the battlefield with rapid transport, triage and emergency interventions. Through the early 20th century, rotating on call physicians at hospitals managed emergencies with ambulance services provided by funeral home directors and hearses. Specialized training in emergency medicine was established through the 1960s and 70s. At this time, in comparison, battlefield medicine in the Vietnam War highlighted the weaknesses in civilian care which was soon to improve.
Through the 20th century, ER care for reactions to drugs and vaccines and sera were far more common than reactions to foods.
Serum sickness starting in 1891 from the first anti-toxin sera for diphtheria caused systemic reactions for many years – although primary research has not been conducted to know how many died. Reactions to aspirin began shortly after the drug was introduced in 1897 and between 1912 and 1928 reactions to phenobarbital occurred in about 3% of those exposed to it. Sulfonamides were ‘highly sensitizing’ in the late 1930s and after WWII a tide of people became reactive to penicillin reminiscent of the days of epidemic serum sickness (see Chapter 5).
In the last decades of the 20th century, allergy had become an expensive health concern. In the US by the 1980s, allergy had a price tag of $1.5 billion per year in medications, hospitalization and services. By 2013, that number had ballooned to $4.3 billion. This included 300,000 ER visits for children and 3.6 million prescriptions for Epipens.
Patented in 1977 and brought to market in 1980, the Epipen was designed originally for the US military as a life saving battlefield device. The civilian application of this portable, spring-loaded autoinjector has made it ubiquitous and lucrative. In 2011, following a tragic death of a child at school for whom an autoinjector was not available, Federal Bill S. 1884 was tabled to provide “incentives to require elementary and secondary schools to maintain and permit school personnel to administer, epinephrine at schools.”
There are 98,817 US public schools – the possible over-stocking of schools with autoinjectors is good news for allergy parents concerned that EMS may not arrive in time or if they are simply unable to afford the devices.
The soaring price of the EpiPen became a US national scandal in 2016 when Mylan, licensed to make and market the device, increased prices to about $600. for a two-pack – that are replaced annually. Possible gross revenue at these prices for the 3.6 million prescriptions alone sent Mylan shares north until Aug. 2016 when the company CEO was asked to defend the price hike before a House committee. There are no regulations on drug pricing in the US.
While those with severe allergy, and their parents, are grateful for these life saving drugs they are effectively tied to them forever. The notion of a cure is not the goal of the drug companies, but rather ongoing and costly management of allergy for the life span of the consumer.
 R. Suter, “Emergency medicine in the United States,” World J Emerg Med., Vol. 3, No. 1 (2012): 5-10.
 A. de Weck, et al, Allergic Reactions to Drugs (Berlin, Springer, 1983) p. 6
 Jackson, Asthma, p. 11.
 R. Jaslow, “Food allergies cost US $25 billion a year,” CBS News (Sept. 25, 2013).
 K. Tunney, “How Many People Use EpiPens in America?” Bustle (Aug. 26, 2016).