“An Act relating to the maintenance and administration of epinephrine in schools and certain other facilities” was signed into into law by Iowa Governor Terry Branstad on Friday.
Senate File 462 provides for:
- Licensed healthcare professionals to prescribe epinephrine auto-injectors in the name of an accredited school or district;
- Schools to obtain stock epinephrine for administration by trained personnel;
- “Good Samaritan” provisions to indemnify such personnel from liability when administering epinephrine in good faith;
- Students to self carry and self administer epinephrine when necessary.
Unfortunately, the new law does not mandate schools obtain stock epinephrine and provides no funding for them to do so.
Food challenge: where the patient consumes a food they may be allergic to while the medical staff hovers nearby, ready to inject epinephrine if the symptoms of a severe allergic reaction appear. Low-tech, dangerous, and the only reliable way to test how severely someone may react to an allergen. Until now.
A blood test resulting from a study led by researchers from The Mindich Child Health and Development Institute and the Jaffe Food Allergy Institute promises to predict which people will have severe allergic reactions to specific foods. The study was published yesterday in The Annals of Allergy, Asthma & Immunology accompanied by a press release by Mount Sinai.
Current testing relies on skin pricks and blood tests that detect proteins called allergen-specific IgE produced by the immune system, though these cannot accurately predict the severity of reactions. The study reports that measuring another immune system component, the basophil, can accurately predict how a person will react to specific allergens. The basophil activation test (BAT) requires only a small amount of blood and provides quick results.
“While providing crucial information about their potential for a severe allergic reaction to a food, having blood drawn for BAT testing is a much more comfortable procedure than food challenges.” says first author Ying Song, MD. “Although food challenges are widely practiced, they carry the risk of severe allergic reactions, and we believe BAT testing will provide accurate information in a safer manner.”
Note that BAT testing is currently only approved for research study.
By now you’ve probably read the Allergic Living article about two families that have filed lawsuits after losing their sons to anaphylaxis. The details are horrific, as they always are when a child is taken by allergic reactions.
In one case, a boy of 16 from Minnesota died from an anaphylactic reaction when it turned out the pancake he was eating at a restaurant was contaminated with milk. The family did not have his auto-injectors on-hand and had to rush him home, but by then it was too late.
In the other, an 11 year old Alabama boy died from a severe reaction to a supermarket cookie. Though an employee assured the family that the cookie contained no tree nuts, it did in fact contain walnuts. His mother administered Benadryl once the symptoms presented themselves and at some point afterward administered his auto-injector, but despite being airlifted to the hospital he could not be resuscitated.
These deaths are every parent’s nightmare, especially for those of us who are part of the community of kids with food allergies. But if there is anything to be redeemed from these tragedies, it is what can be learned to prevent them from happening to other children.
With no disrespect or judgement meant for the grieving parents of these boys, and knowing nothing more about the circumstances that lead to their reactions, let’s remind ourselves of what we can do to prevent occurrences similar to these in the future.
On February 23rd at this year’s annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI) in Houston, a study was presented regarding incidence of anaphylaxis in schools during the 2013-2014 school year, confirming the need for stock epinephrine.
Of 5683 schools that responded to the study survey, a total of 919 anaphylactic events were reported by 11% of the schools. Here’s a quick breakdown:
Congratulations to the people of New Jersey with the signing of A304/S801 – NJ’s stock epinephrine bill – into law by Governor Chris Christie.
Epinephrine is the only drug used to treat anaphylaxis, a life threatening allergic reaction. “Stock” refers to epinephrine that is not specifically prescribed to an individual but can be used on anyone that is displaying symptoms of anaphylaxis.
We’re fighting a war out there… a war against anaphylaxis. If you have a severe allergy or care for someone who does, you’re on the front lines. So put on your helmet, be vigilant, and don’t forget your only weapon against the enemy: your epinephrine auto-injector.
Take 2 along everywhere… every time.
No doubt you’ve already broken a New Year’s resolution or two if you’re like us. (Though we do vow to get to the gym more often… eventually. No, really!)
Here’s our New Year’s resolution list for parents and caretakers of children with food allergies. These are much too important to break, and we hope you’ll join us in resolving to make 2015 a safe and happy year – with no mention of “child” and “anaphylaxis” in the same headline!
A study of 102 patients enrolled from adult and pediatric clinics showed that only 16% used their epinephrine auto-injectors correctly. Of the remaining 84%, more than half missed 3 or more steps for proper administration.
The most common errors included:
- Failure to hold the unit in place for at least 10 seconds after triggering
- Failure to place the needle end of the device on the thigh, and
- Failure to depress the device forcefully enough to activate the injection.
With the holidays upon us, the Asthma and Allergy Foundation of America (AAFA) has issued the following call to action:
Children suffering food-induced anaphylaxis (FIA) were less than half as likely to need hospitalization if they received epinephrine prior to visiting the hospital emergency department. This was the finding of a study published in September in the Journal of Allergy and Clinical Immunology: In Practice.
The study, conducted at Hasbro Children’s Hospital/Rhode Island Hospital, reviewed the charts of 384 emergency department visits for FIA during a six year period beginning January 1, 2004. Of these, 234 (61%) received treatment with epinephrine prior to the visit (the “early” receivers of epinephrine.)
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