Kids May Need Two EpiPens

A major study just out in the journal Pediatrics (Rudders, Susan Pediatrics, April 2010; vol 125: pp: e711-e718) has been making headlines in newspapers all over the country. Dr. Rudders' teams looked at 1255 children who were admitted to emergency rooms at two large Boston hospitals between 2001 and 2006. All the children were under 18, but the average age was closer to six. Just over half (52%) of the children had a true anaphylactic reaction. Of these 44% received epinephrine and 12% of these needed two shots. Some of these shots were given at home, some at the hospital.

That's an awful lot of anaphylactic children who received no epinephrine at all. A Reuters article summed up the study's findings of the failings.

What's troubling, the researchers say, is that half of the children with food-induced anaphylactic reactions did not get epinephrine either before getting to the hospital or while at the hospital. At the hospital, the children received antihistamines, steroids, intravenous fluids and inhaled medicines more often than epinephrine, "despite the lack of evidence" for their usefulness as a first-line treatment, the authors note.

Additionally, fewer than half of the children with food-related allergic reactions left the hospital with a prescription for self-injectable epinephrine and only 22 percent were advised to see an allergist.

Clearly, food-related anaphylaxis "continues to be under-recognized and inadequately treated," Rudders and colleagues warn. Estimates suggest that approximately 150 to 200 people die each year from food-related anaphylactic reactions, and delayed or lack of administration of epinephrine is often to blame.

UPI had a further important quote.

"Until we're able to clearly define the risk factors for the most severe reactions, the safest thing may be to have all children at risk for food-related anaphylaxis carry two doses of epinephrine," first author Dr. Susan Rudder says in a statement.

To offset costs, Rudders suggests, school nurses carry un-assigned extra doses of injectable epinephrine for the children who need them.

Anaphylaxis - Life-Threatening Allergy

I found an excellent article on anaphylaxis on the AAIR (Asthma and Allergy Information & Research) site. Information and Research. My heart is beating faster already.

And much good informtion there is.

How can you tell if someone is having anaphylaxis?
Anaphylaxis usually happens quickly.
Anaphylaxis can produce:

• An itchy nettlerash (urticaria, hives)
• Faintness and unconsciousness due to very low blood pressure. Unlike an ordinary fainting attack, this does not improve so dramatically on lying down.
• Swelling (angioedema)
• Swelling in the throat, causing difficulty in swallowing or breathing
• Asthma symptoms
• Vomiting
• Cramping tummy pains
• Diarrhoea
• A tingling feeling in the lips or mouth if the cause was a food such as nuts
• Death due to obstruction to breathing or extreme low blood pressure (anaphylactic shock)

And a table of epinephrine injectors.

What is the best treatment for anaphylaxis?

Although there are several important treatments, by far the most important
is:

Adrenaline (epinephrine)

There is one drug which will work against all the effects of all the dangerous substances released in anaphylaxis. It is adrenaline (epinephrine). For serious attacks, it is a vital treatment. You need to inject it; inhalers may no longer be an option.

There are special syringe kits to make injection easy:

Name of injection kit	Country (incomplete list)	Dose	Source	Comment
Epipen	USA, Europe	Adult 0.3 mg Child 0.15 mg	Dey Laboratories (USA) ALK (Eur)	Long-established
Anapen	UK	Adult 0.3 mg Child 0.15 mg	Lincoln Medical Limited, UK	Identical drug & dose to Epipen. Easy to use.
AnaKit	USA	2 doses of 0.3 mg: other doses possible	Bayer	Long-established. Red box also contains antihistamine tablets and flimsy tourniquet (for bee or wasp sting).
Anaguard	USA,also available elsewhere.	As AnaKit	Bayer	Syringe as AnaKit, pen-like container is compact and strong, no tablets or tourniquet.
Min-I-Jet	UK	1 mg, other doses possible	IMS, UK	Seems designed more for hospital use.

Goat Milk Allergies Are Real

Goat milk is the current hot fashion and so most of what you read about goat milk comes from people who are trying to sell you the stuff. Objectivity isn't their goal. Money is. Some are true believers, to be sure, but I wouldn't go first to true believers for my facts.

So it's not true that goat milk is good for people with lactose intolerance. And it's not true that goat milk is good for people with cow's milk protein allergies.

What is true is that goat's milk has a somewhat different set of proteins than cow's milk, so some people, the ones who are allergic to the specific proteins that are found in cow's milk but not goat's milk, can safely drink goat's milk. You can't know for sure who you are unless you get a very sophisticated test or actually try drinking the milk and challenging yourself.

What is less obvious is that the reverse is also true. If goat's milk has a different set of proteins and people are allergic to some proteins but not others, there must be people who are allergic to goat's milk but not to cow's milk. You never hear the goat milk crowd warning anybody about this, but it must logically be true.

And here's the case that show it. A story by Conor Sharkey in the Strabane Chronicle in Ireland reported the harrowing tale of Rachel Devine, who went into a coma on a holiday trip to Turkey after eating some ice cream.

The terrifying incident occurred in August when Rachel Devine (24) was holidaying in Turkey with her boyfriend. On the second day of their break, Rachel unwittingly bought an ice-cream made from goat's milk. Within minutes the law graduate's allergy to the milk took hold, bringing on anaphylactic shock and subsequently a heart attack.

As Rachel slipped into coma, she was rushed by military escort to the nearest intensive care unit before being transferred to a specialist unit in Ismear, 40 miles away.

The following morning her parents Stephen and Sandra flew out to Ismear to be told that their daughter's future hung very much in the balance.

Ten days later, Rachel was transferred by air amubulance to Altnagelvin and then Belfast's Royal Victoria where she remained in intensive care for almost four weeks.

...

"She and her boyfriend Chris had gone to Turkey on holiday and on the second day she bought an ice cream. She has only recently developed this allergy to goat's milk and just didn't realise.

"She could go down and buy an ice cream over here any day of the week and would be fine but didn't realise it was goat's milk she was eating out there. It just crept up on her.

I'm glad she's recovering. And I'll bet she'll never make this mistake again.

Don't you make this mistake either. While it's possible that you may be able to have goat's milk products even with a dairy protein allergy, don't test this theory out while on vacation in a country whose language you don't speak. Know your foods.

More Anaphylactic Reactions Than Previously Reported

A Mayo Clinic study reported that anaphylactic reactions reported in emergency room visits increased from 30,000 to 50,000 over the decade from 1990 to 2000.

The study, entitled "The etiology and incidence of anaphylaxis in Rochester, Minnesota," by Wyatt W. Decker, M.D., chief of emergency medical departments at the Mayo Clinic in Rochester, Minn. and his team, reported that there were 50 emergency room visits per 100,000 population per year caused by anaphylaxis.

The actual increase is probably smaller than a two-thirds rise because reporting was much better than in earlier studies.

"We don't think the incidence of anaphylaxis has doubled, but through the Rochester Epidemiology Project we were able to much more meticulously identify cases which in other studies might not have been identified," says Dr. Decker. "So this study gives us a more accurate picture of the magnitude of the problem. Still, we did see about a 10 percent increase in cases of anaphylaxis over the 10-year period of the study."

Other findings from the study include:

-- Children ages 0 to 19 are at the highest risk for anaphylaxis.
-- Insect stings accounted for 19 percent and medications for 14 percent of cases. The rest were due to some other cause (e.g., cats, latex, unknown).
-- None of the medical records involved a fatal reaction.