Response to Letter:

In response to the comments made by R. J. José and H. S. Jenkins, regarding our manuscript entitled “Anaphylactic reactions on the beach: a cause for concern?” the following should be stated:

We do agree that diagnosis of anaphylaxis is often difficult and that out-of-hospital use of epinephrine even by medical personnel is never without risk. Therefore, in any emergency situation, immediate attention from trained medical personnel with proper equipment should be immediately sought.

However, the use of epinephrine by basic life support personnel in out-of-hospital emergency settings has been previously proposed by others.1-3 Lifeguards generally fall into this category. Such a policy of epinephrine storage and use by non-medical personnel in settings such as schools and restaurants has therefore been established and could also prove to be helpful at the beach. Nevertheless, the question of safe epinephrine storage in this setting is very accurate. In fact, experience so far has proved problematic and a solution that could be universally followed by lifeguards has yet to be found.

Alexander D. Karatzanis 1 and George A. Velegrakis 1