People need training in lifesaving epinephrine use

When Jane Able's 4-year-old daughter, Ellie, was diagnosed with a severe peanut allergy, the New Albany, Ohio, mother got trained in using an epinephrine pen and never leaves home without it.

The device contains an injectable dose of epinephrine, a hormone that can halt even life-threatening allergic reactions. But it's not only Able who needs to know how to use the device - so do teachers, babysitters, even the parents of Ellie's friends.

"I carry a 'trainer pen' with me and have them practice using it before I'll leave her," Able said. "I take every precaution."

For the parents of kids with food allergies, the news of the death of 7-year-old Ammaria Johnson - who died last month at her Chesterfield County, Va., elementary school after eating a peanut given to her by another child - came as a heartbreaking reminder of how vigilant they need to be to keep their children safe.

Currently, it's up to parents to get a prescription for an epinephrine pen and make sure that one is available for their allergic child at school, although there's a movement to change that. The School Access to Emergency Epinephrine Act, introduced in the US Senate in November and the US House of Representatives in December 2011, would encourage states to allow schools to have epinephrine on hand for use in any student who is having a serious allergic reaction.

Support

The law is supported by the Food Allergy & Anaphylaxis Network. "Data shows that up to 25% of all epinephrine administrations that occur in the school setting involve students and adult staffers whose allergy was unknown at the time of the event," according to the food allergy network.

EpiPen is a brand name for a commonly carried epinephrine device. Some other brands include Adrenaclick and Adrenalin.

For reasons that are unclear, food allergies are on the rise. Nearly 6 million US children - or about one in 12 kids - are allergic to at least one food, with peanuts, milk and shellfish topping the list of most common allergens, a study in the July 2011 issue of Pediatrics found.

Outside of clinical trials, there are no treatments for food allergies. So avoidance and education is the key to managing them, said Dr Roger Friedman, a paediatric allergist and clinical professor of pediatrics and allergy at Nationwide Children's Hospital in Columbus, Ohio.

That includes making sure parents carefully read food labels, that children know what foods to avoid, and that anyone who cares for the child takes no chances with baked goods or restaurant meals - or any other food product about which they're not entirely sure what it contains.

"It's very important when we have children who have severe food allergies that all people who come into contact with the child and all caregivers understand the potential severity of it," Friedman said.

Symptoms

Anaphylaxis is a systemic, or whole-body, reaction. Symptoms can come on within seconds or minutes, and worsen quickly. Symptoms can include abdominal pain and vomiting; wheezing, swelling of the lips, face and throat; difficulty swallowing; hives, itchiness and coughing. These symptoms can progress to a drop in blood pressure, an abnormal heart rhythm and even death.

"Epinephrine can't always stop a reaction, but it's darn good," Friedman said. "It's going to increase the chances dramatically of surviving a reaction."

Because repeat doses may be necessary to stop a reaction, it's recommended people with allergies carry two epinephrine auto-injectors at all times.

Using the pen

It's also important not to delay using an epinephrine pen if anaphylaxis is suspected, Friedman said. The longer a reaction continues, the harder it can be to stop.

However, many parents worry about whether they could actually use an epinephrine pen if needed. Epinephrine pens contain a short, thick needle strong enough to go through clothing, although it's recommended that you expose the skin of the thigh if possible.

No one likes the idea of jabbing their child, and if a child is having trouble breathing, it's easy to fear panicking instead of taking action, Able said.

"I've never had to use an EpiPen, but for my daughter's sake, I've run it over a thousand times in my head. If there ever was a reason to do it, I hope I could," Able said.

Some people also worry about harming a child if it turns out the epinephrine wasn't really needed. But epinephrine pens are safe and may cause a temporarily fast heart rate; that's about it, Friedman said.

That's one message Able tries to make sure her friends and relatives understand when she hands them her daughter's epinephrine pen.

"I always stress, 'Even if there is a suspicion she needs it, please give it. Don't hesitate. I will never be mad if you give the shot,' " Able said. "You can't hurt a child by giving that dose of epinephrine. But the consequences for not doing it could be fatal."

(HealthDay News, February 2012)

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