Yesterday, National Public Radio’s All Things Considered aired a segment entitled “How Smart Marketing Transformed EpiPen Into A Billion-Dollar Product”. The 5-minute interview by host Robert Siegel of Cynthia Koons, a reporter for Bloomberg Business who published a report on the topic last week, is well worth your time especially if your family relies on epinephrine to stay safe. You can listen to it here:
Koons discusses how Mylan, the pharmaceutical company behind EpiPen, acquired the product in 2007 from a German firm and turned it into the household name we know today. She also discusses the cost of the product as well as Mylan’s aggressive campaign to have stock epinephrine located at schools and other places of public accommodation.
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By now you may have read of yet another food allergy-related tragedy, the passing of Simon Katz, a 16-year old student of Chatfield High School in Littleton, Colorado. He was rushed to the hospital on Monday after inadvertently taking a bite of a s’more made with peanut butter at a school homecoming celebration after suffering anaphylactic symptoms. He was pronounced dead at the hospital despite multiple shots of epinephrine and CPR administered by his father on the way.
This was the second report of a teen death due to anaphylaxis in a week, yet another horrific nightmare to befall a member of the allergic community. Our heartfelt and deepest sympathies are with the Katz family.
As we generally do when anaphylaxis-related tragedies appear in the news, we seek out the only good that can come from such reports, namely learning from the experience to prevent such occurrences in the future. Here are a number of extenuating circumstances that were reported in the media:
- Simon did not have his epinephrine auto-injectors on-hand
He had a habit of keeping his auto-injectors in his car, but he caught a ride to school that day with his friends. By the time his friends were able to transport him home, he was vomiting and suffering severe symptoms.
Early administration of epinephrine is paramount to the successful treatment of anaphylaxis and it should be administered as soon as symptoms present themselves, or immediately after inadvertently ingesting an allergen that has caused anaphylaxis in the past as directed by your physician. On the best day, Simon’s epinephrine was waiting in the parking lot and administration would have been delayed; on this, the worst day, his epinephrine was not available, possibly costing him his life.
- He was taken home instead of straight to the emergency department of the closest hospital
Simon was in the throes of a severe anaphylactic response to a known allergen, a medical emergency by any definition. While we sympathize with his friends who thought they were doing the right thing, they should have been educated to seek immediate medical attention for him.
- He consumed an unwrapped food that did not come from home
Simon’s father, David Katz, told reporters that s’mores were one of Simon’s favorite treats, but he mistakenly ate one that was made with Reese’s Peanut Butter Cups. It is presumed the peanut butter was the trigger of his allergic response.
Global News has provided additional details regarding the Andrea Mariano tragedy. The teen, who was enjoying her second day of campus life as a psychology student at Queen’s University in Ontario Friday, perished as a result of an anaphylactic reaction.
Ms Mariano, who was allergic to both dairy and peanuts, consumed a smoothie that was cross-contaminated with one of her allergens. It is unclear whether the smoothie came from a campus outlet or the university dining hall, and which allergen was the cause.
A student who had just begun her college studies at Queen’s University in Kingston, Ontario, died as a result of a severe allergic reaction, the school website reports.
The family of Andrea Mariano of Thornhill, Ontario indicated the cause of her death was anaphylaxis. While they provided no details as to the likely allergen trigger, Allergic Living magazine reports that Ms Mariano was known to have a severe peanut allergy.
The Queen’s University website stated that flags on campus will be flown at half-staff and that grief counseling is available through the University’s health services. Our deepest sympathies go out to the Mariano Family and friends of Ms Mariano.
We know that many parents of young adults with food allergies are concerned as they send their children off to school. We urge you to take every opportunity to remind them to protect themselves by following some basic guidelines:
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Last week, Lianne Mandelbaum – founder of the No Nut Traveler blog – was featured on NPR’s Here & Now to discuss the difficulties of traveling by air with a severe peanut allergy.
Lianne describes the need for early boarding, buffer zones, and stock epinephrine on every flight. The 10 minute segment entitled A Push To Make Flying Safer For People With Peanut Allergies is well worth the time and you can listen to it here:
An article summarizing the recommendations of an expert panel of allergists and emergency personnel was published last week in the Annals of Allergy, Asthma and Immunology, and what it had to say is of special importance to people at risk for anaphylaxis.
It should be noted that the earlier a person suffering anaphylaxis receives epinephrine, the less severe the reaction may be and the less likely the victim will suffer a biphasic reaction (a second reaction) later on.
The problem is that symptoms of anaphylaxis do not always present the same way, causing medical personnel to delay administration of epinephrine because they’re not sure the patient is indeed having such a reaction.
The panel recommends that patients receive epinephrine even if they do not meet all the established criteria for anaphylaxis if: (1) they have had a previous severe reaction or (2) they have had a known or suspected exposure to their trigger with our without symptoms.
Bipartisan legislation was introduced in the Senate Wednesday to help travelers coping with severe food allergies. The Air Access to Emergency Epinephrine Act, promoted by Food Allergy Research and Education (FARE), is cosponsored by a bipartisan group of senators.
The bill has three major components. It:
- Calls for airlines to maintain stock epinephrine auto-injectors aboard and train crew members to recognize the symptoms of anaphylaxis and how to administer the medication;
- Directs the Government Accountability Office (GAO) to conduct a study and report to Congress on air carrier policies related to passengers with food allergies. The report will cover a range of topics including the variability of existing policies, how they are applied, how staff are trained and how passengers learn about and utilize them;
- Directs the Federal Aviation Administration (FAA) to clarify that the epinephrine ampules currently included in medical emergency kits are intended for use during anaphylactic emergencies.
Yesterday, WRIC – the ABC affiliate in Richmond, VA – aired a report leading with a stock photo of an EpiPen®, claiming that epinephrine was in short supply. Since then we have received a number of inquiries from panicked readers concerned that auto-injectors will not be available when needed.
Though it’s true that the Food and Drug Administration (FDA) has indicated numerous epinephrine shortages on their website for months now, these are specifically for vials and syringes of the drug generally administered by healthcare professionals in a hospital or clinical setting. Despite the reported shortages from specific manufacturers, our understanding is that epinephrine is generally available when needed.
The FDA’s site makes no mention of a shortage of auto-injectors, the devices that sufferers of severe allergies carry with them for emergency use in case of a severe reaction. A series of calls to pharmacies in five states confirmed that they are readily available and that there are no warnings of pending shortages from their suppliers.
It’s been seven years since Brian Hom lost his son BJ to an anaphylactic reaction in 2008 while on vacation in Mexico to celebrate BJ’s high school graduation. Since then, Brian has been a tireless advocate for the food allergy community.
In memory of BJ Hom, please take a few moments to see this video entitled “Food Allergies Don’t Take Vacations”. Even if you’ve seen it before, this cautionary tale will remind you of the stakes involved when anaphylaxis strikes:
Our thoughts are with the Hom family. May Brian’s work and BJ’s legacy save the lives of many others suffering with severe food allergies.
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We read about the tragedies on a regular basis: yet another person succumbs to anaphylaxis because their auto-injectors were left home on a kitchen counter, in a medicine cabinet, or buried in a drawer somewhere.
Our readers know we border on obsessive when reminding people to Take 2 auto-injectors along everywhere… every time. Why 2? In case one malfunctions or a single dose is not enough to stop the progression of symptoms.
We want to know what you do to remind yourself or your family to Take 2.
Janet Sorrells Hagerman has an innovative solution she recently posted in the Peanut Allergy and Anaphylaxis Awareness Facebook group:
My kiddos self carry and sometimes have had a hard time remembering to grab their epipens before we leave the house. So this was my idea to help them remember their pens every time.
Sticky hooks on the door heading out to the garage. They have remembered them every time since. They can hook these insulated pouches on their belts or whatever they may be carrying. It’s in a great place to help them remember when they are walking out the door. Just thought I’d share if anyone else may have issues of kiddos forgetting their pens.
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