Auto Injectors – Current Issues

Before I am talking about the two main issues in the UK with the AAI, I am listing the key facts about the 3 different AAI (Adrenaline Auto Injectors) available in the UK, EpiPen (R), JEXT and the Emerade. The latter is the latest addition to the market and comes in 3 doses and 2 needle sizes, which is unique.

Here is the summary of the key features:

Adrenaline Auto Injectors – UK Market 05/2014

EpiPen ®

Shelf life: 18 months (day of production to expiry date)

Dosage: Junior 0.15mg (>15kg-30kg body weight) and adult 0.3mg (>/= 30kg body weight)

Technique: Make fist and hold pen with firm grip in dominant hand, place away from upper outer thigh approx. 10cm, push in firmly, hold for 10 sec (count: 1 elephant, 2 elephants,…), rub in for 10 sec.

Storage: Room temperature. Not in fridge, not in car, not in hot places.

Excerpt from: http://www.epipen.co.uk/patient/

 

JEXT ®

Shelf life: 18 months (day of production to expiry date)

Dosage: Junior 0.15mg (>15kg-30kg body weight) and adult 0.3mg (>/= 30kg body weight)

Technique: Push firmly against the outer portion of the thigh. When you push Jext firmly against your thigh, a spring activated plunger will be released, which pushes the hidden needle through the seal at the end of the black needle shield, into the thigh muscle and injects a dose of adrenaline. Leave in for 10sec, rub in for 10sec.

Storage: Although Jext does not need any special storage instructions, it should be handled with care ensuring that it does not freeze.

Excerpt from: http://www.jext.co.uk/what-is/jext.aspx

 

Emerade ®

Shelf life: 30 months (day of production to expiry date)

Dosage: 0.15mg, 0.3mg (long needle), 0.5mg (long needle)

Technique: Press against the thigh. Hold for 5 sec. Then, massage the injection site lightly.

Storage: There is no upper temperature restriction. It may be kept cold but no not freeze.

Excerpt from: http://ww.emerade.com

 

Please keep in mind when receiving a prescription of any of the AAI, ensure you and everyone else taking care of the patient (including nursery staff, school staff, friends, family members) is properly trained on the device. Especially, when the prescription was changed to a different brand.

Also, regularly check expiration dates and repeatedly practice on the training device.

 Current issues with the AAI:

A shortage has been reported in regards to the EpiPen and the Jext. Read the Anaphylaxis Campaign’s statement here:

http://www.anaphylaxis.org.uk/living-with-anaphylaxis/news/adrenaline-auto-injectors-supply—-epipen-and-jext

Unfortunately, there is no mention of the Emerade, which is the latest addition to the UK market. Their manufacturer is currently trying to satisfy rising demand by increasing their capacities as soon as possible.

The reason for the shortage of the AAI in the UK may be due to the fact that EpiPen has been increasingly demanded since Jext had issues with their AAI end of last year/beginning of this year.

Moreover, the AAI are currently under investigation by the European Medicines Agency. Read the Anaphylaxis Campaign’s Statement here: http://www.anaphylaxis.org.uk/living-with-anaphylaxis/news/adrenaline-auto-injectors-to-be-reviewed-by-the-european-medicines-agency

From the Notice of Action, it seems the Regulators will be taking investigation into the needle sizes. In other words: Do AAI on the UK market fulfill the requirement of safe and efficient administration (true i.m. injection of the right amount) of adrenaline into the patient’s muscle? I am sure we will be hearing much more about the needle size issue.

What are your thoughts? Do these issues bother you? Would like to hear about your concerns.

Disclaimer:

The information provided is given in good faith. Every effort has been taken to ensure accuracy. All patients are different, and specific cases need specific advise. There is no substitute for good medical advice provided by an allergy specialist.

 

 

 

 

 

 

 

 

 

Last minute Easter bunnies…

With these tasty and easy cookie cutter biscuits, you ensure inclusion and fun for everyone!

 

Happy Easter! Buona Pasqua!Frohe Ostern! Happy Easter! Buona Pasqua!Frohe Ostern! Happy Easter! Buona Pasqua!Frohe Ostern!Happy Easter! Buona Pasqua!Frohe Ostern!

Easter Bunny Biscuits-free from the eight major food allergens. Enjoy.
Courtesy of allergy*Stars.com

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Butternut Squash Soup

I just saw this post from the great Lucy from Lucy’s friendly foods, and I got reminded that back in October, I took a couple of pics of our favourite soup… So here it is…An all time favorite in our house, and i am happy to share this easy and versatile recipe with you.

Ingredients:

1 Medium Butternut Squash or 1 large Hokkaido Sqash

1 Boiling potato

1 TBSP Olive Oil

1 Medium Red Onion

1 Clove of Garlic

1/4 tsp Cinnamon

1/4 tsp Sugar

1/2 tsp Salt

Chilli Powder if desired

2 TBSP Balsamico Vinegar

a Handful of Lentils (we prefer Beluga lentils)

1/2 -1 litre Stock (we use Kallo Onion Stock)

Directions:

Cut and peel the squash and potato, onion and garlic. In a large saucepan, heat 1 TBSP of olive oil on medium heat together with the onion and the garlic. Add sugar and spices. Add Squash and potato and let caramelize on medium heat. Turn Squash occasionally. Add broth until Squash is covered. Cover and let boil on low heat until thoroughly cooked. Blitz the Soup and place back in Saucepan. Add Vinegar and boil on low to get the acidity out of the soup for approx. 15min. In the meantime, place enough water in another saucepan to cook the lentils. Add salt at the very end, otherwise it will prevent the lentils from cooking thoroughly. Serve soup with lentils. You might like to add other ingredients like salmon, sour cream (not dairy free), coriander or shrimp. a hint of Pumpkin Butter/Oil works very well, too.

Enjoy!

 

 

NO DAIRY, NO PARTY ?! (part 2)

peek a boo – playing at Gymboree Docklands

Yes, there is a second part to the much discussed part 1. Thanks everyone who shared their thoughts on how catering facilities deal with food allergic customers. Particularly important is NUTMUMS.COM view of the subject in legal terms. Read her blogpost here.

But hey, let us not dwell in the past. We had a great 3rd birthday party with lots of lovely people, great acitivities, fun, laughter and, yes, food. Gymboree Docklands was kind enough to entertain our guests and let us cater ourselves. Well done, we need more of these friendly places.

So we catered ourselves. With allergy friendly foods. Lots of it. Everything was allergyBabe friendly, which means free from most of the top 14 food allergens (Gluten, Wheat, Fish, Shellfish, Egg, Dairy, Soya, Peanuts and Treenuts, Sesame, Lupin) and others (including Buckwheat, Pea, Beans etc). We had a 3 metre long buffet piled up with all kinds of safe things to eat, lots of fruit, vegetables, but also crisps, breads, cupcakes and biscuits. Popcorn was a big hit with the children as well as the grown ups. The best moment of all was watching allergyBabe wandering free around the room, independently helping himself to anything he wanted to. It was so wonderful to see him at ease, not having to worry about if he can eat the cracker, biscuit, crisp or bread in front of him. He looked so confident and proud. For the first time in years, our world outside our “safety zone” (the apartment) did not revolve around food.

It was an amazing 3 hours and I cannot thank all our guests enough who came despite the fact that we would have only allergen friendly food items. You made allergyBabe’s day truly special.

I wonder, if I hadn’t told them in advance, would they have ever noticed?

PS: Sorry for the lack of pictures, I was so involved in the party, forgot to take out the camera… .

Egg allergy and the MMR – is it safe?

Among the allergy community, there is a lot of doubt and uncertainty about the safety of the MMR vaccine in egg allergic children. This post sums up the latest research and recommendations.

What is the MMR?

The MMR Vaccine protects from measles, mumps and rubella. It is given around 12 month of age and again around 3 to 5 years of age. It is an active virus, consisting of weakened forms of the viruses.

Why is there a concern about giving the vaccine to egg allergic children?

The vaccine is cultured on embryo chick fibroblasts.

Though, it does not contain any hen’s egg protein. If traces of hen’s egg protein are detected, they are highly processed and their concentration is very low.

Recent studies:

MMR vaccination of children with egg allergy is safe:

a danish study published in 2013, investigating 32 children with egg allergy who had been referred to get their mmr vaccination (Priorix MMR) at hospital. None of the children had severe reactions

A review of a pediatric emergency department vaccination programme for patients at risk of allergy/anaphylaxis

Published in September last year, the authors claim their study being  “one of the largest studies looking at childhood vaccinations performed in a hospital setting for children who are ‘at risk’ of allergy, anaphylaxis or hypersensitivity”. A total of 374 patients (with a medical history of anaphylaxis, allergic reaction or strong suspicion of a severe adverse reaction against egg) contributed to the findings. All of the children received their vaccinations in a hospital setting. “Only six patients (1.3%) experienced an immediate reaction to a vaccination. All reactions were minor”. The authors conclude that “A significant number of referrals were unwarranted and the majority could have been safely managed in the community”.

Latest expert opinion (BSACI, 2007):

BSACI Recommendations for Combined Measles, Mumps and Rubella (MMR) Vaccination in Egg-Allergic children:

The MMR has an excellent safety-record and may be administered to all egg-allergic children in a primary care setting. As with any other immunisation, adrenaline should be readily available in case of rare and unpredictable anaphylaxis. MMR should be postponed if child is unwell. A hospital based application is necessary after a previous severe reaction to a vaccination (MMR or other) after a specialist assessment. It might be possible that the reaction occured due to an allergy to other components of the shot (gelatine (beef and lamb allergy) or antibiotics (neomycin or other)).

Other vaccinations and egg allergy:

Flu vaccine: updated every year, the content level of ovalbumin, varies every year, some jabs do not contain egg. A split dose (1/10 of single dose, than 9/10 of dose) of the vaccine might be an option. Consult your GP or specialist for up to date advise.

Yellow fever vaccine: unsuitable for children with egg allergy

So what is the verdict?

Latest research suggests that the likelihood for an egg-allergic child to react to the MMR vaccine is about the same as to any other non-egg containing vaccine. Reactions are rare but non predictable due to other substances like gelatine and antibiotics.

Even though the MMR seems to be a safe shot, it is always recommended to seek advise from your specialist if in any doubt. Every child reacts differently and the risk profile of your allergic child can be best assessed by your trusted allergist.

Sources: the anaphylaxis campaign, nhs choices, pubmed, bupa, bsaci

Please note that this post does not imply any medical advise. Please always consult your specialist.

Introducing: THE Hepi DAY…

courtesy of evolve-trainingsolutions.co.uk

THE Hepi DAY:
Every 10th of the month, we will take out our trainer pen and practice, practice, practice! Plus, take the opportunity to look through your emergency kit for out of date products.
Let’s get this Epipen Training going! Studies show you have to constantly practice to be prepared and able to use your adrenaline pen correctly! Why the tenth? To remind us to leave the needle in for 10 seconds…
Stay hepi

Sooner rather than later…

Maybe the most raised question in the allergy community: when is the right time to apply the epipen? No doubt it is the only drug able to break the vicious cycle, and its benefits outweight the risks. But actually when is the right time for it?

Even experts discuss the issue widely and have not come up with a formal consent. Based on experience, literature and recent incidents, this is one of the most sufficient answers I have encountered yet. So please take five minutes of your precious time and read this excellent advice by M.D. Phil Lieberman.

Food allergies and emotions – a bumpy ride

Bona fide of dealing with a food allergy

I have been sitting over this post for quite a while now.  Doing some proper thinking and finding the right arguments takes some time, and after completing the post, reality once more caught up with me, and had forced me to gradually adapt my wording, my thinking and my opinion.

This was supposed to be about how to deal with food allergies in a calm and rationale manner. It turned out to be quite different, as you may notice when reading further on. I was all convinced how stupid it is to get hysterical about foods allergybabe is allergic to, but, I admit, I adjusted my point of view. It is now a more complex approach I laid out and if you agree, I am happy. If not, I would love to hear about your views.

As a mum of an allergic child who had 6 anaphylactic reactions by the time he was 7 month old, not knowing what had caused his extreme reactions, I consider myself to completely understand the emotions and thoughts that constantly run in a parent’s head when taking care of an allergic child.

To any of you reading this from an outsider’s perspective (a friend of a friend with allergies, a care nursery teacher, a parent of a friend of an allergic child etc.) just let me try to explain why we are the way we are. Why we are so apprehensive about foods our children are allergic to, especially with peanuts.

The rationale behind the emotions involved in food allergy or: why we are entitled to occasionally freak out…

Anyone witnessing a proper anaphylactic reaction of his child will by any means avoid it to happen again. It is a very daunting and frightening experience.

Peanuts are one of the eight most common food allergens and are one of the foods that cause anaphylaxis, the most severe form of allergic reaction, which can lead to the individual’s death. And it does not matter how rare this event may be, if it could be your child.

Peanuts can hide every where, small amounts, invisible to the eye, can stick to a door handle, a toy at nursery, a food tray, a table cloth, a takeaway and can hide within an innocent looking biscuit. Tiny amounts can harm, and it is a natural reaction to be extra cautious about it.

Media and charity groups are covering the issue extensively, constantly reminding how lethal a tiny amount can be.

Twitter and other social media tools easily amplify and distribute an individual’s biased opinion.

As it is difficult to predict the likely severity of food-induced allergic reactions, parents and sufferers are on constant alert mode to avoid the allergen.

Statistics help to judge the likelihood of a reaction within a wider population, though they cannot predict an individual’s risk profile.

Is it in any way helpful to get hysterical over a legume?

Impartiality is the widely accepted approach to any medical issue.If doctors would panic, we would not get the appropriate care. That is why there are doctors, nurses and other professional medical staff. It is not the parent who has to act as a medical professional. But what to do if the parent happens to be a trained doctor? Who has had several encounters with life threatening situations, who quite routinely ran to a CPR when the telephone rang in that all to familiar high pitched sound, listening to a computer animated voice which told you where in the hospital the patient is about to depend on your skills and professionalism to get back to life? Doctors are trained to stay calm, not to emotionally get involved, to forecast what could happen next and decide how to proceed. As a professionally trained parent, you try to stay calm and still provide the emotional support for your child without overseeing best medical care.

Others may say as long as you do the right thing, nothing seriously can happen. And I believed it, too. And than, a young girl dies in a camp in California.  A young child who knew about her allergies, who did not take changes, who was very aware of the dangers.

Once I read a mother’s comparison of her child’s food allergies: Imagine a chef would prepare your meal, and just before doing so, he filled a rat trap with poison. He did not wash his hands afterwards, he used the same equipment, he used the very same plates etc. You would be horrified because there would be that real danger of getting severely poisoned.  See the picture. That is how we, the parents, see food allergies. We are on high alert. Always. Every single day. Because you just know, that one day, out of the blue, your child will have a reaction.

We all agree now that we have to avoid all contact with allergens. Do we have to avoid it by all means? I strongly believe in an individual’s right of freedom. Do not do anything for your own sake that involves restricting anyone else’s freedom. That is part of Germany’s Grundgesetz (German Constitution) and I am a strong believer in its profound value. How can it be applied to protecting food allergy sufferers? Where does individual safety and freedom end? Is society to be restricted for the sake of an individual’s health? Should the majority of people be denied to enjoy food because of a minority getting uncomfortable being surrounded by it? Where do we stop to demand and support from society? Is it ok to ban peanuts and other nuts from school halls and nurseries? Should the majority of people be denied to enjoy food because of a minority getting uncomfortable being surrounded by it? Do food allergic people have a right to ask for peanut free buffer zones on a plane? The questions do not stop here.

Can we allow grocery stores to sell peanuts? Is it ok to deny a child to feed the squirrels a handful of peanuts on the playground? Can we accept that other children will have a snack while playing on a common ground? Can a fellow tube rider have a guilt free snicker?

If you expect an answer, you are mistaken. I do not have an answer. But if you have ever witnessed a life threatening reaction, you will do anything to avoid it a second time.

You will do anything not to risk your child’s life ever again. Full stop.

I guess in the future, society will have to decide how high on a pedestal they put the individual’s needs and how much we are willing to limit freedom of the majority.

*This post was inspired by all the brave parents who care restlessly for their food allergic children and the following two articles:

http://www.princeton.edu/main/news/archive/S37/46/79G28/index.xml?section=topstories#top

http://www.sciencedirect.com/science/article/pii/S0277953613002657

This blog and its entire content is by no means intended to represent professional medical advice. Please contact your medical professional for any medical concerns you may have.

Which came first – the chicken or the egg?

This commonly known causality dilemma is one of the most fundamental philosophic questions evoking investigations about the beginnings of life and the universe in general since ancient times. So I found it quite interesting that latest research seemed to have found the solution to another, not so much philosophical but more immunological, interrogation:

“Which came first, eczema or food allergy”?

Or, in other words, is eczema the result or the cause of food allergy in infants?

Carsten Flohr, Gideon Lack et al. from King’s College London published their findings this July Journal of Investigative Dermatology .

To find out what causes food sensitization in young infants, they tested more than 600 three month old babies which were breastfed exclusively. The focus of examination was

– existence of atopic dermatitis (‘exzema’)

– severity of atopic dermatitis

– location of atopic dermatitis (flexural vs non-flexural)

– skin gene mutation, known as ‘Filaggrin loss of function’

– skin prick test (cow’s milk, egg, cod, wheat, sesame, and peanut)

Interestingly enough, children with eczema were significantly more likely to be sensitized (adjusted OR=6.18 (95% CI 2.94–12.98, P<0.001) regardless of the other examined factors as Fillagrin mutation and type of eczema. The severer the eczema, the more likely a child was to show a positive skin prick test.

This study shows quite nicely that in non-orally (exclusively breastfed) sensitized infants, atopic dermatitis is a major risk factor for food sensitization. It could mean that the skin and its immune structures (antigen presenting cells) lead to sensitization when affected by eczema.

Interestingly, this study is align with other findings of the group from King’s College London (Dr. H. Brough) which proved dust containing active peanut particles in the home of early sensitized infants.

To sum it up, London research strongly suggests that eczema is one of the key factors to develop a sensitization to foods in early life.

As always, this article does by no means professional advice. Please always consult with your health professional.