#842: The Story Behind EpiPen, The Rise of Food Allergies, and What Doctors Got Wrong

Hello boys and girls, ladies and germs—Tim Ferriss here. This one shifted how I think about allergies, and I say that as someone who carries an EpiPen; Thomas Goetz is your guide to the wild rise of food allergies and the story behind EpiPen.

Who is living with this every day, and what does it actually feel like? Meet Alex, and then we’ll trace anaphylaxis from its discovery to the device built to stop it, and why public health advice may have backfired.

I’m Alex, nineteen, with a long list of allergies, and I’ve never eaten from a restaurant—I bring my own food. I once had tuna after careful testing, felt off at tennis, and when my face burned and breathing worsened, I hit my thigh with the EpiPen; within seconds the swelling and heat started to drop, and the hospital epinephrine finished the job.

EpiPen is a device that delivers epinephrine—synthetic adrenaline—fast. It sits in schools and backpacks because anaphylaxis, a severe allergic reaction, can turn deadly in minutes.

How did we even learn what anaphylaxis is? In 1901, researchers studying Portuguese man-of-war venom found that a second exposure could trigger a violent reaction instead of protection, a paradox that won a Nobel and named the condition.

Food reactions were rare for decades, but in the nineteen eighties and nineties cases soared in kids. The hygiene hypothesis suggested ultra-clean living might blunt immune training, and pediatric guidance leaned into avoidance—wait years to introduce milk, eggs, peanuts, and fish—which sounded sensible and turned out backward.

The immune system learns tolerance early, so withholding foods can prime it to misread them as threats. I kept seeing more peanut anaphylaxis, and it raised a simple question: what if early, steady exposure prevents it?

In Israel, babies chew peanut puffs from infancy, and they had far fewer peanut allergies than similar kids in the UK. It was a powerful clue, but observational; to change practice, they needed a randomized trial.

Where did epinephrine and the auto-injector come from? Doctors used early adrenal extracts for asthma, then purified epinephrine proved it could reverse the shutdown of anaphylaxis by opening airways and boosting circulation. A Cold War auto-injector became the template; in the nineteen seventies and eighties it evolved into EpiPen.

At eight, I sneezed nonstop after touching a feeder, hives exploded, my lips went blue, and breathing dimmed to panic. My mom slammed the EpiPen into my leg, and that dose likely got me to the hospital in time for more epinephrine.

The device saved lives and became big business. After Mylan bought it in 2007, prices climbed as expiration dates forced renewals, two-packs became standard, and school training and purchasing rules created lock-in; by 2016, a two-pack list price topped six hundred dollars.

If the price was fair, why cut it in half with a generic?

We moved to address high out-of-pocket costs and put out a lower-priced generic.

If it cost twenty bucks, schools wouldn’t need your charity; you jacked it up, then asked for thanks.

Back to the science—the LEAP trial randomly fed high-risk infants peanuts from early months, and by age five allergy rates fell from roughly fourteen percent to about two percent. In 2017, U.S. guidance flipped: introduce peanuts and other common allergens early and regularly.

Fear led us to delay foods and, ironically, helped cause the very disease we hoped to avoid; good science means changing course when the data say so.

Even with new advice, many parents still avoid early exposure and keep over-bathing, so allergies keep rising—and EpiPen revenue rose to nearly two billion dollars in 2023 with higher list prices. U.S. drug pricing remains opaque and largely unchecked, and Mylan merged into Viatris, while treatment is expanding to supervised exposure therapy.

Allergen immunotherapy can raise thresholds; in 2020, the FDA approved Palforzia for peanut allergy, and new baby foods aim to help families introduce allergens safely, including one co-founded by Dr. Gideon Lack. DrugStory is an independent production—share, rate, and help us make season two—and next up, Lipitor: are millions taking a daily pill without real benefit? We’ll see you next time; side effects of listening may include mild itchiness, wooziness, or wheeziness, so watch what you eat and carry your meds.