Anaphylaxis Legislation gets Presidential Seal of Approval

SRxA is delighted to announce that earlier this week President Obama signed into law the School Access to Emergency Epinephrine Act.  During a week in which Obama and his new healthcare.gov website have made headlines for all the wrong reasons, we thought it only fair to commend him on this important anaphylaxis initiative.

The School Access to Emergency Epinephrine Act is legislation that will help to protect schoolchildren who experience life-threatening anaphylaxis.

“This legislation is a significant milestone for food, venom and latex allergy safety in our nation’s schools,” says Tonya Winders, chief operating officer of Allergy & Asthma Network Mothers of Asthmatics (AANMA). “It will help save lives of children who experience an anaphylactic reaction for the first time or don’t have epinephrine auto-injectors readily available when anaphylaxis occurs.”

The measure provides a funding incentive to states that enact laws allowing school personnel to stock and administer emergency supplies of epinephrine auto-injectors. Epinephrine is the first line of treatment for anaphylaxis.

The School Access to Emergency Epinephrine Act was bipartisan legislation, first passing the U.S. House of Representatives on July 30, 2013, and then the U.S. Senate on Oct. 31, 2013, before heading to the President’s desk.

Allergic reactions to foods are the most common cause of anaphylaxis in community settings, according to the U.S. Centers for Disease Control and Prevention (CDC). Studies show that 16-18% of schoolchildren with food allergies have had a reaction from accidentally ingesting food allergens. In addition, 25% of anaphylaxis cases reported at schools happened in children with no prior history of food allergy.

As of today, 28 states have passed emergency stock epinephrine legislation and six have bills pending.  Let’s hope this legislation will spur the remaining states to follow as soon as possible.

Green states that have passed stock epinephrine laws or regulations:

Alaska, Arkansas, Arizona, California, Colorado, Florida, Georgia, Illinois, Kansas, Kentucky, Louisiana,Maryland, Massachusetts, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Oklahoma,Oregon, South Carolina, Tennessee, Utah, Virginia, Vermont, Washington, and West Virginia

Yellow states have pending stock epinephrine bills:
Michigan, New Jersey, New York, North Carolina, Ohio and Pennsylvania

Red states that have no stock epinephrine bills: 
Alabama, Connecticut, Delaware, Hawaii, Idaho, Indiana, Iowa, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Dakota, Texas, Wisconsin, and Wyoming

To find out more about anaphylaxis in schools please visit http://www.epipen4schools.com/ and https://www.anaphylaxis101.com/Resource-Library/Anaphylaxis-in-Schools.asp

Kudos to Canada

This morning, SRxA’s Word on Health salutes the Canadian city of Hamilton, Ontario, for its pioneering lead in anaphylaxis safety. Hamilton is destined to become the first city in the world to require all food service outlets to have life-saving epinephrine auto-injectors on hand for people with severe food allergies.

The move is being led by Hamilton Councillor  – Lloyd Ferguson, in hopes of avoiding sudden and tragic deaths like one this past spring of a Stoney Creek girl.

Twelve-year-old Maia Santarelli-Gallo had what her doctor said was a mild allergy to eggs and milk that had only ever caused her a runny nose. But last March, while eating an ice cream cone at a Hamilton-area mall with her father and older sister, Maia experienced a sudden, severe allergic reaction.

Her sister found someone with an epinephrine injector, but by the time it was administered, it was too late. Emergency crews took Maia to hospital but she was pronounced dead.

When Councillor Ferguson heard about Maia’s death, he decided to draft a ground-breaking motion to get epinephrine auto-injectors in every restaurant and mall in the city.

He says it’s high time that food providers have access to medicines that could help their customers who develop allergic reactions. He says if automated external defibrillator (AEDs) are now being installed in arenas and other community centers, it makes sense to have epinephrine injectors in areas where food allergy reactions are most likely to occur.

“It took us about 40 years to get defibrillators into public facilities and they have been a great success. This is the next step,” he says.

Allergy specialist Dr. Mark Greenwald, Allergist, and Chief Medical Officer of EpiCenter Medical would like to go further and see public awareness campaigns that would train the public on how to use epinephrine injectors, just as there have been campaigns encouraging people to learn CPR.

Greenwald has developed an online course called EpiPenTraining.com, to offer training on how to recognize allergic reactions, and how to use the injectors. He says such training is vital because during anaphylaxis, seconds count.

And anaphylaxis isn’t rare.  Allergic disease is the 5th most prevalent chronic disease among all ages, and the 3rd most prevalent among children. Every 3 minutes in North America, a food allergic reaction sends someone to the Emergency Room. Every 6 minutes, that Emergency Room visit is for anaphylaxis, that’s 10 patients per hour!

In 25% of people requiring treatment, the reaction is their first episode, and they are completely unprepared.  And for 50% of the people who die from anaphylaxis, the victims had life-saving epinephrine, but it wasn’t used or it wasn’t used in time. The other 50% didn’t carry epinephrine despite their previous allergic episodes.

Participants in the online course become SAVE certified – Save Anaphylaxis Victims in an Emergency.

Debbie Bruce of the Canadian Anaphylaxis Initiative was part of a program this past spring to get epinephrine injectors on all fire trucks in Mississauga. She says that like Maia, up to one-third of people who have allergic reactions outside the home did not realize they had a severe allergy and didn’t carry an epinephrine injector. She is now petitioning politicians  to come up with a national allergy plan.

“I think it is a new reality,” she says. “Reactions happen and we need to be prepared.”

Maia’s mother, Leah Santarelli, backs all efforts to make the public more aware of anaphylaxis and hopes the Hamilton city council passes Ferguson’s motion.

“There’s no guarantee that an EpiPen will save your life 100 per cent of the time, just like a defibrillator won’t save you 100 per cent of the time, but it is there as a safety measure,” she says.

The motion is currently being reviewed by the city’s health team; if approved, it should go before Hamilton city council in October.

We certainly hope that it does and that this trend will rapidly spread across the borders.  As Greenwald says – every second counts!

Avoiding Anaphylaxis this Advent

Christmas parties, meals out with friends and family, stockings full of candy, chestnuts roasting on the open fire…

While all this sounds like great fun, there’s a risk that more people than usual will be accidentally exposed to foods they are allergic too. Food allergies are common. An estimated 9 million, or 4%, of adults and nearly 6 million or 8% of children have food allergies with young children being those most affected.

Although childhood allergies to milk, egg, wheat and soy generally resolve in childhood, they appear to be resolving more slowly than in previous decades, with many children still allergic beyond age 5 years. And allergies to peanuts, tree nuts, fish, or shellfish are generally lifelong.

If you’re one of those affected by food allergy, what can you do to avoid accidental exposure this holiday season?

Remind people! Sure you might once have told your hosts that you have an allergy, but a gentle reminder is always helpful, especially at Christmas when things get busy and the alcohol starts flowing!

Just say ‘no’ – if you don’t know what’s in it, don’t eat it. And even if you do, can you really be sure there was no cross-contamination in the kitchen.

Bring snacks, rather than rely on your hosts to have food you can eat…or

Stay home. Host the party yourself – then you know it’s safe.

Bring your epinephrine auto-injector with you –and keep it close to hand! Make sure somebody else at the party knows you have food allergies, where your auto-injector is and how to use it.

Know the Symptoms – within minutes, an allergic reaction may turn into a life-threatening severe allergic reaction. Sometimes the reaction can occur in two phases, with another reaction occurring up to 48 hours after the initial reaction.

Use epinephrine immediately after you have been exposed to your allergy trigger – it may prove to be life-saving.  If you are even thinking should I give myself epinephrine, the answer is almost certainly yes!

After giving epinephrine, seek emergency medical attention – call or have someone else call 9-1-1 or your local emergency medical services.  In most individuals, epinephrine is effective after one injection. However, symptoms may recur and further injections may be required to control the reaction. Epinephrine can be re-injected every 5 to 15 minutes until the severe allergic reaction stops completely.

Do you have your anaphylaxis Action Plan ready?  If not, make it part of your holiday preparations. It could be the best Christmas present you give yourself this year.

Modern Family’s Emmy winning actress takes on the most important role of her life

Actress Julie Bowen, recently awarded her second Emmy for her role in the hit TV comedy “Modern Family,” started a more serious role last week: raising awareness about life-threatening childhood allergies and anaphylaxis.

The two-time best supporting actress in a comedy series and mother of three knows firsthand about potentially fatal allergic reactions. Her oldest son, Oliver, was 2 years old when he developed anaphylaxis as a result of a double-whammy exposure to a bee sting coupled with a bit of peanut butter.

“We had no reason to suspect we might have a problem. He had had peanuts before. And he had always been fine,” explained Bowen. “But then one day we found out that, no, he’s not.”

Almost immediately, Oliver’s face swelled dramatically. Other symptoms of anaphylaxis include chest pain; hives; breathing difficulties; tightening of the throat; lip and tongue swelling; nausea; dizziness and fainting.

Bowen’s husband, who was at home with the toddler, was terrified. “He knew it was bad.” Oliver was rushed to the hospital and immediately given an injection of epinephrine – the drug used for the emergency treatment of anaphylactic reactions that can follow exposure to allergens such as peanuts, walnuts, shellfish, bee stings, medications and/or latex.

Although any child can develop an allergy, or abnormal immune response, they are more likely to occur in people whose family members also have allergies.

Bowen now is spearheading the nationwide awareness campaign with the help of Mylan Specialty L.P., the pharmaceutical company that makes EpiPen^®.

“The goal is education,” said Bowen. “We, as parents, can’t always be with our children all day, every day. So we want the people around them to be educated.”

Thankfully, Oliver made a full and quick recovery. “Once he had the proper medicine, it was a very quick process,” she noted. “But today we always carry epinephrine with us wherever we go.”

Food allergies are the leading cause of anaphylaxis. The U.S. Centers for Disease Control and Prevention (CDC) estimates that food allergies in children have increased 18% since 1997. More than 9,000 children are hospitalized because of severe food allergies each year.

Many allergic reactions occur when children accidentally consume foods they’re allergic to at school. According to the CDC as many as one-quarter of anaphylaxis happens in students with no history of food allergies.

Parents and school employees shouldn’t dismiss a child’s complaints, Bowen says, “We want parents and teachers to know the signs, so that if you see them coughing, scratching at their throat some, or that they’ve got some rash, that you go ahead and look into it further.”

If you suspect your child may have an allergic reaction to anything, get it checked out. Call 911 and get medical attention immediately because there’s no way to guarantee that your child is never going to have an anaphylactic reaction.

The odds are not insignificant. “One to two children in each classroom could potentially be at risk for a serious food allergy,” says Dr. Carla Davis, an assistant professor of pediatrics in the section of immunology, allergy and rheumatology at Texas Children’s Hospital in Houston.  Of those, 30-40% would be at risk for life-threatening anaphylaxis.

Epinephrine is the first-line treatment, and caregivers must act quickly in order to treat effectively.  How quickly? Ideally, within minutes of the child developing a reaction.

For more information on anaphylaxis, visit the Food Allergy & Anaphylaxis Network.

Who’s to blame for your allergies?

Are you one of the 35 million Americans who suffer from seasonal allergies? If so you’re probably not cheering the official end of winter.  But before you start blaming Persephone – goddess of Spring, for your symptoms you may want to look a little closer to home.

Many of the everyday things you’re doing, from what you eat to how you clean your home may be interfering with relief from your stuffy nose, sneezing, sniffling or other symptoms.

“People with spring allergies often don’t realize how many things can aggravate their allergy symptoms so they just muddle along and hope for an early end to the season,” says allergist Myron Zitt, M.D.“But there’s no reason to suffer. A few simple adjustments in habits and treatment can make springtime much more enjoyable.”

The American College of Allergy, Asthma and Immunology (ACAAI) advises people with spring allergies to be on the lookout for five things that can aggravate suffering.

1. Eating fruits and vegetables – Many people with seasonal allergies also suffer from pollen food allergy syndrome (also called oral allergy syndrome), a cross-reaction between the similar proteins in certain types of fruits, vegetables and the allergy-causing pollen. 1:5 people with grass allergies and as many as 70% of people with birch tree allergies suffer from the condition, which can make your lips tingle and swell and your mouth itch.

If you’re allergic to birch or alder trees, you might have a reaction to celery, cherries or apples. If you have grass allergies, tomatoes, potatoes or peaches may bother you. Usually the reaction is simply annoying and doesn’t last long. But up to 9% of people have reactions that affect a part of their body beyond their mouth and almost 2% can suffer a life-threatening anaphylactic reaction.

2. Using the wrong air filter – Using an air filter to keep your home pollen-free is a good idea, but be sure it’s the right kind. Studies show inexpensive central furnace/air conditioning filters and ionic electrostatic room cleaners aren’t helpful – and in fact the latter releases ions, which can be an irritant. Whole-house filtration systems do work, but change the filters regularly or you could be doing more harm than good.

3. Opening your windows – When your windows are open, the pollen can drift inside, settle into your carpet, furniture and car upholstery and continue to torture you. So keep your house and car windows shut during allergy season.

4. Procrastinating – You may think you can put off or even do without medication this spring, but the next thing you know you’re stuffed up, sneezing and downright miserable. Instead, get the jump on allergies by taking your medication before the season gets under way.

5. Self medicating – Perhaps you’re not sure exactly what’s making you feel awful so you switch from one medication to the next hoping for relief.

This spring, your best bet is to see an allergist, who can determine just what’s triggering your symptoms and suggest the most appropriate treatment.

New Guidelines may help Food-Allergic Children Feel Safer

Food allergy affects up to 6% of children and results in an estimated 150-200 fatalities each year in the U.S. Accidental exposures are common and occur in homes, restaurants and schools.

Now a new study has shown that children who have experienced life-threatening anaphylactic shock from food have significantly different views of the risks associated with their allergies.

As these children mature into teenagers they become even more afraid of their food allergies, feel less confident about their surroundings and the level of information possessed by school personnel and even their parents.

High schools were perceived as less safe because of the lack of homerooms and unsupervised lunch areas. Elementary schools were considered safer because of the stronger presence of parents and consistent routines involving supervised lunch rooms, trained personnel, and communication strategies.

The study involved 20 children with severe food allergies.  They were interviewed about their experiences living with and managing a chronic medical condition that requires them to carry an EpiPen and remain keenly alert to their surroundings.

Both age groups identified environmental and social barriers that contributed to feelings of isolation, exclusion or being teased. Missing out on school activities, camps, or time with friends was common.

Young children relied more on parents and teachers to cope, whereas adolescents often anxiously fended for themselves by avoiding risky foods, educating others, navigating confusing food labels and quickly escaping from unsafe places. Some felt disempowered and overburdened and even developed symptoms like constant hand washing or waiting to eat until an adult was present who was available to drive them to the hospital.

SRxA‘s Word on Health is hopeful that new guidelines produced by the National Institute of Allergy and Infectious Diseases for both clinicians and patients will help.

They include a definition of food allergy, discuss co-morbid conditions associated with food allergy, and focus on reactions to food. Topics addressed include the epidemiology, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis.  In addition they provide 43 concise clinical recommendations and guidance on points of current controversy in patient management.

Love Hurts!

SRxA’s Word on Health team just returned from a memorable trip to Phoenix, Arizona.  In addition to managing a number of highly successful events, meeting many of our wonderful clients and spending some quality time with our Advisors; we were able to catch up with all the latest news from the field of asthma, allergy and immunology.

During one of the more memorable sessions, we learned that kissing and um, er, let’s just say, more intimate contact, can be fraught with danger for those with allergies, while in another we found out that everything from our makeup, to our cell phones might be making us sick.

Over the coming days we’ll be sharing the congress highlights with are readers, but in the meantime, let’s get back to kissing…

According to Dr. Sami Bahna, President of the American College of Allergy, Asthma and Immunology (ACAAI), while allergic reactions from kissing are relatively uncommon, they do occur.

Apparently, allergens from food substances can linger in a partner’s saliva up to a full day following ingestion, irrespective of tooth-brushing, rinsing, flossing  or other interventions such as chewing gum.

And if you’re one of the 7 million Americans who suffer from food allergies we’re not just talking about a passionate kiss. Even a kiss on the cheek or the forehead from a partner who has consumed an identified allergen can cause a severe reaction ranging from lip-swelling, throat-swelling, rash, hives, itching, and/or wheezing immediately after kissing.

And kissing isn’t the only form of romantic activity that can trigger allergic reactions in the highly sensitive. The ACAAI notes that sexual intercourse can pose its own hazards, given that some patients are allergic to chemicals found in spermicides, lubricants and/or latex condoms.  Even sperm can prompt an allergic reaction in some, as can the more general emotional and physical exertion of intercourse itself.

When it comes to semen allergy, Bahna said antihistamines can sometimes help with mild issues, as can immunotherapy treatments offered by allergists. Condoms can also help, as long as a person is not allergic to latex!

Despite these warnings, Bahna stressed, “I do not want this discussion to cause all people with allergies to live in fear. If your girlfriend or your wife is not very allergic to peanuts she won’t be affected by a kiss from a person who ate peanuts.”

Additionally, allergists can help determine what’s causing the allergy and find the right treatment. They have the training and expertise to treat more than just symptoms. They can identify the source of your discomfort and develop a treatment plan to eliminate it.

You can follow the ACCAI annual meeting on Twitter at #ACAAI2010.