Best Advice From an Allergist and Immunologist Specialist

Epinephrine

"Use epinephrine early and often," was the message from Dr. John Oppenheimer, an allergist and immunologist from UMDNJ. I recently had the pleasure of hearing Dr. Oppenheimer speak and I was struck by a story he shared. He told us that his wife asked him why he often shouts into the phone, "Use it! Use it now!" That's the urgent plea from Dr. Oppenheimer when a parent or school nurse calls his on-call service wondering if they should use an epinephrine auto-injector for someone they suspect may be having an allergic reaction.  

"Use it" means "administer epinephrine now".

I've been there. When my child has said, "My mouth feels itchy", or "I'm getting a hive on my lip," I've grabbed the bottle of Benadryl in one hand and the epinephrine in the other and watched closely. Who wants to stick a needle in a child and call an ambulance unless it's absolutely necessary?

According to Dr. Oppenheimer, use of epinephrine early in the anaphylaxis state may diminish the effect of late-stage anaphylaxis. He said that anaphylaxis is under-diagnosed and under-treated and he made it clear that the first line of defense is epinephrine, not an antihistamine, when an anaphylactic reaction is starting.

He shared that the triggers for anaphylaxis are Food (33% of the time), Unknown (25%), Insect (19%), Medications (14%), Other (9%, includes cat dander, latex, cleaning agents, etc.). 

For me, Dr. Oppenheimer's talk was another good reminder. One quarter of the time, an anaphylactic reaction has an unknown cause. An antihistamine is not effective at halting anaphylaxis. While no one wants to use an epinephrine injector, it is our best defense against anaphylaxis.

It is comforting to be able to reach an on-call doc in a moment of uncertainty and panic. Call your doctor if you have the time. If not, talk to your doctor now, so you have a plan in place if an anaphylactic reaction occurs. 

Auvi-Q Epinephrine Injector is Coming

Auvi-Q Epinephrine Injector

I first posted about a credit card sized epinephrine auto injector over two years ago. In a December 2009 post, I wrote about two brothers and their company Intelliject. I was most excited about the potential for this new product for teens and young adults. This age group often doesn't carry their epi injectors because it's "inconvenient". An injector smaller than a cell phone- now that sounded convenient.

Fast forward to last week when I had the opportunity to see this new product. I was invited to Sanofi's U.S. headquarters in N.J. to see Auvi-Q^® up close and to provide feedback to the team that has been working on bringing this product to the market. It was a fun day for me as I had an opportunity to hear from Dr. John Oppenheimer on the current state of anaphylaxis (more on that later this week). I also got a history lesson on the new product and shared lunch with some fellow food allergy advocates.

Auvi-Q is short for Audio Visual Cues. As the name suggests, the device carries both visual and audio instructions for use. As soon as it is pulled from the case, a friendly and calm voice begins walking the user through the steps. Here's what I really like about this product:

• the size- it's even littler than I expected and is smaller than my smartphone. My tween really liked the shape and size.
• the audio helper- everyone is nervous about having to use an auto-injector device. A voice guide really decreases anxiety.
• no need to swing device into outer thigh- with Auvi-Q, the user places the device on the outer thigh and pushes firmly.
• hidden needle- the needle in this injector goes into the leg and within one second retracts back into the device. There was always something about having to withdraw the needle that was unsettling. No accidental needle pricks to worry about here either!
• has been waterproof tested- the product can sustain some water and still operate effectively. It does contain a battery for the voice recording, but even if the battery no longer works, the injector itself will still operate and release the medicine.

Here's a little amateur video we made to show how easy it is to use:

Auvi-Q is FDA approved and scheduled to go on the market in the U.S. by the end of March 2013. At this time, the cost of the device is unknown, however, two active devices and one trainer will be the norm for prescriptions. Many epinephrine injector rules will remain the same, such as approximately one year expiration dates, a viewing window to ensure the medicine is a clear color, two different dosages depending on body weight and the need to be aware of temperature extremes.

Check out what some other food allergy bloggers are saying about Auvi-Q:
Grateful Foodie- Inspiring- We Met the Auvi-Q
AsthmaAllergiesChildren- Thoughts About the New Auto-Injector
Multiple Food Allergy Help- Auvi-Q Epinephrine
Amazing and Atopic- The Audio Visual Lifesaver 
Learning to Eat Allergen Free- AuviQ is Coming Soon

You can sign up to find out when Auvi-Q will be available, or keep an eye on Food Allergy Assistant for further updates. Let me know if you have any questions or comments. I am thrilled to have more options in the toolbox for managing food allergies and anaphylaxis.

Full disclosure: My travel expenses and lunch were covered by Sanofi, although I am under no obligation to review this product...but I just wanted to!

Food Allergy Anxiety

Stress Eating

Anxiety:

A state of uneasiness and apprehension, as about future uncertainties...A state of apprehension, uncertainty, and fear resulting from the anticipation of a realistic or fantasized threatening event or situation, often impairing physical and psychological functioning. (The Free Dictionary)

As the new year settles in, some of my food allergy anxiety is surfacing. I feel like another year has come and gone and we're still not making the kind of progress I'd like to see. When I think back to over 10 years ago, I was so hopeful when the allergist talked about outgrowing many, if not all, food allergies. I felt so optimistic about a cure right around the corner. I anticipated the necessary life-changes to be temporary.  

Each new year reminds me that time is marching on. Recently, things have even slid backwards a bit as I've now stopped putting a baked egg in cake recipes because it was causing allergic symptoms. It's hard to know what is the right thing to do. We are, however, anticipating this summer and the start of peanut immunotherapy. 

Of course there's some anxiety to accompany that as well...sigh!

There have been studies over the years about food allergies and feelings of anxiety. Both the food allergic and their loved ones report feeling worried, nervous and fearful. Children with food allergies are often reluctant to try new foods and report feelings of loneliness due in part to social isolation. Parents and caregivers deal with their own anxieties- is he getting enough nutrients?, is she growing properly?, will he have friends who really understand?, will she get bullied?, will he be able to date and go off to college?

It's perfectly normal to experience anxiety about these things. We need to look for ways to manage the worry- beyond the chocolate bowl, that is! It's time to take a deep breath and take stock.  For our family, entering the teen years with food allergies is going to bring a whole host of new issues. I'm looking ahead to give my soon-to-be teenager the tools needed for this next part of the journey. Here's my toolkit:

• 504 Plan- continue to update and ensure that accommodations are being made at school.
• Knowledge- share what I've learned (and continue to learn) with my food allergic child and others to make sure everyone understands the seriousness and the stakes.
• Resources- There are great role models out there like Morgan from Allergic Child and Sloane from Please Don't Pass the Nuts. FARE offers a teen summit and website to help this age group navigate school, friendships and the real world. 
•  Patience- for family members and friends who "still don't get it". It is hard to truly understand something unless you live with it each day (yup, that's what I'll keep repeating to myself over and over).
• Fearlessness with a twist- we need to travel, eat out and try new foods, using a reasonable amount of caution and common sense. 
• Balance- family, friends, social activities, food and non-food events can all co-exist in a steady manner. Maintain a steady course.

Do we need anything else in the toolkit?  Even with the right supplies, there will still be times of stress. Just in case, I'd better throw in some of that chocolate- dairy, peanut and tree nut free, of course!

Colleges Required to Make Accommodations for Students with Food Allergies

College Dining Halls

College students (both current and future) with food allergies just got a little boost from the Justice Department. A recent settlement between the U.S. Department of Justice and Lesley University has cleared up a few issues for colleges and how they need to manage food allergies on campus. Under the terms of this settlement, colleges must do more than simply provide allergen-friendly options in their dining halls. To be in compliance with the American Disabilities Act, this settlement sends the message that colleges need to:

• ensure their Disability Services office (or similar department) addresses food allergies.
• work with food allergic students to develop individualized meal plans.
• provide reasonable modifications to students with food allergies.
• display notices concerning food allergies and identify foods that contain specific allergens. 
• allow students the option to pre-order meals.
• provide students with food allergies a separate area to store and prepare food to avoid cross-contamination.
• educate and train food service and staff about food allergies.

Current and prospective college students with food allergies should expect a dining experience comparable to that of their fellow students. I think this settlement settles it.