Q: I am a school principle, and I am concerned when I read that peanut allergies are becoming more common. My own son is also highly allergic to bees. Are there any new treatments for children who collapse due to an allergic reaction?
A: It is estimated that 1-2% of the general population is at risk for anaphylaxis - a severe and potentially life-threatening allergic reaction - caused by food allergies and insect stings. However, recent data provided on the websites of the Calgary Allergy Network (www.calgaryallergy.ca) and the Canadian Society of Allergy and Clinical Immunology (www.csaci.medical.org) indicates that the prevalence of food allergies has increased over the past few years.
There have also been reports of exercise-induced anaphylaxis at schools during gym time and on playgrounds during lunch break. In short, there are an increasing number of students with the potential to suffer anaphylaxis at school, or on the way to and from school.
In the article Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings (see http://pediatrics.aappublications.org/cgi/content/abstract/116/5/1134), C. Lynne McIntyre and her colleagues from the Boston Children's Hospital address an important issue: a significant number of allergic reactions (24%) have occurred in individuals who had no history of allergies. This finding also supports earlier studies that reported almost 25% of children with peanut allergies experienced their first reaction at school.
Peanut allergies remain one of the most common causes of food-related anaphylaxis.
One of the most detailed resources on peanut allergies can be found on the website maintained by Dr. John Weisnagel, who is an allergist from Quebec (see http://www.allerg.qc.ca/peanutallergy.htm). For a brief overview on why peanut allergies have increased in prevalence, you can read an article that was published in Real Life and archived in www.healthykids.ca.
Adolescent patients who suffer from peanut allergies need to pay special attention when kissing someone who has ingested peanuts. Researchers at the Mount Sinai Medical Center in New York presented data at a recent American Academy of Allergy, Asthma and Immunology (AAAAI) meeting, which showed no method of brushing teeth, rinsing the mouth, or chewing gum reliably removes the peanut allergen from saliva. The researchers concluded that the only way to protect oneself from anaphylactic reactions related to kissing was to have the non-allergic partners completely avoid peanuts (This may not be too difficult to do: a researcher was told by a peanut-sensitive female that a boy will do anything to get a kiss!).
At the same meeting, the outgoing president of the AAAAI, Dr. Estelle Simons from the University of Manitoba, introduced an anaphylactic education tool, which also included a declaration of a National Anaphylaxis Day in the United States. Currently, there are plans to extend this education tool to Canada using the AAAAI material as a prototype.
With warmer weather around the corner, I am reminded of an experience I had a year ago at an outdoor event. After I took a bite out of my sandwich, I experienced an intense pain in my lips, tongue and mouth. At first, I thought the mustard was just too strong. In retrospect, I realized there was an undetected wasp on my sandwich. I was able to "relax" after recovering from this nasty surprise, and felt fortunate enough to be free of any allergy (especially considering I was not carrying an epinephrine device).
Sadly, about 100 unfortunate people in the United States die each year from insect stings. For additional insights into allergic reactions caused by stinging insects, see the information provided by a world-renowned expert from Johns Hopkins University, Dr. David B.K. Golden (http://www.webmd.com/content/article/71/81294.htm).
Dr. Hugh Sampson, one of the most respected allergists in North America, developed a grading system for defining the severity of anaphylaxis. In this system, grade 1 anaphylaxis is characterized by milder symptoms, such as skin rashes or hives. Grade 5 anaphylaxis, referred to as a “dance with death”, involves more severe symptoms, such as collapsing due to a severe drop in blood pressure, cardio-respiratory arrest, or a loss of consciousness.
For anyone at risk for anaphylaxis, an epinephrine device remains the most important tool to halt this often near-disastrous “dance with death”. A relatively new and unique product called Twinject™ is now available in Canada (see www.twinject.ca). The Twinject™ is an auto-injecting device administered into the thigh, rather than the buttocks or blood vessels. It comes in two strengths of epinephrine, which is based on a patient’s weight: 0.15 mg for people 15-20 kg, and 0.30 mg for people more than 30 kg.
One of the main benefits of this new anaphylactic treatment tool is that it provides a second dose of adrenaline, hence the name Twinject™. It has been estimated that as many as one-third of children who have a grade 4 to 5 anaphylactic reaction will have a biphasic reaction; that is, they relapse after an initial improvement from the first dose of epinephrine.
Numerous studies have confirmed that both caregivers and some doctors are insufficiently aware of the correct use of epinephrine devices. Research shows that in close to 90% of school-related anaphylactic episodes, the medication is administered in the nurse's office. The vast majority of patients are then sent to the emergency department.
All school staff, including the bus drivers who take students to and from school, should have access to a written protocol to be activated should an unexpected anaphylactic episode occur. It is important to remember that when such a scary event unfolds, first inject the epinephrine, and then call 911.
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