Hi Bob, Lloyd, and all,
    As an ambulance medic with many years of riding in the back of the rig,
I can understand both sides of the debate about the use of an EpiPen.  That
anaphylaxis can and does kill there can be no doubt.  That there can be very
serious side effects to the use of an EpiPen (including death) is also not
much of a debatable topic.  The key point is to recognise the time that the
use of the EpiPen is justified.  From the sound of things, Lloyd's doctor is
reluctant to prescribe the EpiPen because he feels that the people that have
one of these things may not be able to make the distinction between a
localized reaction coupled with stress and excitement verses a systemic
reaction to the venom.
    As I was taught, and as I teach, the bodies natural reaction to forign
substance is to try to lock it into place and deal with the suspected poison
a small amount at a time.  It does so by the release of histamine at the
sight of injury (sting).  Redness and swelling result as the substance is
locked into place.  As the substance disapates the swelling goes back down
and the site returnes to normal.  Over time, the body can learn that the bee
venom is really no big deal and the reaction to the stings can diminish to
the point of the body not getting excited at all about it.
    In the case of anaphylaxis there is a systemic (body wide) release of
histamine causing the body tissues to release histamine in the wrong places.
Blood vessels can dilate and cellular tissue become leaky causing a drop in
blood pressure and swelling in areas of the body other than the site of the
sting.  An example of this is the development of hives (the kind that don't
have bees in them).  If the site of swelling involves the airway, or if the
blood pressure drops too much, the impact on the body can be catastrophic.
    Epinepherine delivered by way of the Epipen has the effect of tightening
the blood vessels, incresing the heart rate, and dilating the passages of
the airway.  The first two effects listed can have a serious effect on a
weakend heart if there is nothing basicly wrong with the person except a
high level of excitement (hyperventilation and hence difficulty breathing)
and a very local reaction to the sting.  On the other hand, for someone that
is in true crisis from a systemic reaction to bee venom, the effects are
exactly what the person needs - an increase in blood pressure and a wide
open airway.  The key point here is the recognition of anaphylaxis.  I would
be willing to bet that Lloyds doctor would agree with Bob and a great
majority of doctors that if a heart patient over 40 is in anyphalactic shock
in the bee yard, they need their pressure and airway back by way of
injectable epinephrine.
    I think that all beekeepers that are concerned about sting reactions
should have the ability to recognise the signs and symptoms of anaphylaxis
before they go wandering around with a cure for it.  That is the point that
I think Lloyd was trying to make.

Steve Victors