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- Sample Letter for Carrying Self-Injectable
Epinephrine (EpiPen® or EpiPen® Jr. or Twinject®) Aboard Commercial Airplanes
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- DATE
- To Whom it May Concern:
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- PATIENT FULL NAME is a AGE/GENDER who suffers from a
life-threatening allergy to SPECIFIC ALLERGENS LISTED.
This is a severe allergic reaction that makes it
medically necessary for HIM/HER to carry an antihistamine
and self-injectable epinephrine (EpiPen® or EpiPen® Jr. or Twinject®),
at all times. Self-injectable epinephrine is prescribed by
a licensed medical professional. PATIENT NAME should have
this life-saving medication with HIM/HER at all times,
especially during times of travel away from home. In the
event of an exposure to even a minute amount of ALLERGEN
a severe allergic reaction may occur. Every minute is
critical in using this medication to treat the allergic
reaction and to prevent a life-threatening reaction. Use
of the self-injectable epinephrine can be life saving. Please allow
PATIENT NAME to have his or her prescribed epinephrine with HIM/HER on
board the airplane.
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- {{SUGGESTED TEXT FOR
ASTHMATICS}}
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- PATIENT NAME is also asthmatic and requires the use
of an albuterol inhaler in the event of an asthma attack
or allergic reaction. Please allow PATIENT NAME to carry
HIS/HER albuterol inhaler on board the airplane.
Additional information may be obtained from PHYSICIAN
NAME at PHONE or FAX.
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- Respectfully signed,
-
-
- ____________________________________________,
M.D.
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- M.D. OFFICE STAMP
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-

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Last modified on 8/17/05.
- [Copyright
© 2002]
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