As many of you may know, food allergy symptoms can appear in a variety of ways. One of the most concerning symptoms of a food allergy is when a person goes into anaphylactic shock. In fact, food allergies are believed to be the leading cause of anaphylaxis outside the hospital setting. The CDC reported that food allergies result in over 300,000 ambulatory-care visits a year among children.¹ Because this is the most life threatening response to food allergens, we wanted to review what the signs of anaphylaxis look like.

Anaphylaxis – What to Watch For

The signs of anaphylaxis may occur within seconds of exposure, or be delayed 15 to 30 minutes or even an hour or more after exposure (which is most typical of reactions to aspirin and similar drugs). Early symptoms are often related to the skin and include:

• Difficulty breathing; wheezing
• Changes in consciousness (including confusion, light-headedness, or stupor)
• Rapid swelling throughout the body
• Hives
• Blue skin
• Severe abdominal pain, nausea, or diarrhea
• Flushing (warmth and redness of the skin)
• Itching (often in the groin or armpits)

Throat and tongue swelling, difficulty swallowing, and difficulty breathing frequently follow the above symptoms. Vomiting, diarrhea, and stomach cramps may also develop.

If you know a child or adult with food allergies and suspect they are having an anaphylactic reaction, the most important consideration is time. Calling 911 or driving the person to the emergency room are the first things that should be done. Also, it is important to have an Epi Pen on hand for those times.

How You Can Protect Yourself or Others

• Follow-up with your doctor or allergist if you or your little one had a severe reaction.
• If you’ve been prescribed self-injectable epinephrine (i.e., EpiPen® or Twinject®), carry it at all times. (Here’s a great recent post on EpiPen usage)
• Educate others about your allergy. Teach them what you need to avoid, the symptoms of an allergic reaction, and how they can help during an allergic emergency. (Check out this post I did on being a PAL to a person with food allergies.)
• Teach yourself and others how to use an epinephrine auto-injector. Practice until it becomes second nature.
• Wear medical identification jewelry noting your allergy.

Have you or your little ones ever had an anaphylactic reaction? If so, what have you done to help minimize the risk of such a reaction?

- Christine

While we usually write about common food allergy symptoms, such as diarrhea or eczema, more severe reactions like anaphylaxis are possible for many children and adults with allergies. Allergens that cause anaphylaxis include food, insect stings, drugs, latex, and even exercise.  When anaphylaxis happens as a result of contact with an allergen, a rapid immune reaction occurs that can quickly make breathing very difficult.  For those patients an immediate injection of epinephrine can prevent very serious complications.  Sometimes even the few minutes it takes emergency medical care to arrive is too long, and a personal device with automated injectable epinephrine, an auto-injector, such as the EpiPen® Auto-Injector, is essential.

The EpiPen, made by Dey Pharma, works by delivering a quick shot of epinephrine to the thigh.  There are also similar devices available, such as the Adrenaclick® and TwinJect®, both made by Shionogi Inc. Twinject is unique in that it has a built-in backup dose of epinephrine, which can take the place of two auto-injectors in an emergency.

Epinephrine helps the body to keep the airway open so that breathing does not become as difficult, allowing time for emergency medical care to arrive. But many parents worry that one auto-injector might not be enough or that something might go wrong that could require additional auto-injectors. For instance, someone nearby might experience a severe allergic reaction and need to use your child’s auto-injector. Or what if your child’s only auto-injector was unknowingly broken? What if the auto-injector were accidentally put in the fridge or left in the sun? What if the contents were cloudy? Or if it had expired? So many scary possibilities!

So, what is the right number of auto-injectors? The answer to that question depends on a number of factors. Bear in mind that the Twinject has two doses of epinephrine, but according to the company the second dose should only be used as a backup to the first dose and should not be saved for future allergy emergencies.

How Many to Carry?

On their websites, Dey Pharma and Shionogi recommend that patients at risk for allergic emergencies carry two doses of epinephrine. This is because up to 20% of patients who have an allergic emergency requiring epinephrine will require a second dose. At all times the injector should be kept close to room temperature, out of sunlight, and replaced by the expiration date. You can even sign up for an expiration date reminder on either of the websites. It’s a good idea to occasionally check the solution in the auto-injector to make sure it hasn’t discolored, which can be a sign of a possible loss of effectiveness.

If a long trip is planned, especially one overseas where similar products may not be readily available in pharmacies; two auto-injectors (or one that contains two doses) may not be enough.

Should you or your child carry more than two auto-injectors? Not necessarily. Additional backups would likely be for peace of mind. A second dose of epinephrine may be needed in an emergency, but more than two doses during an emergency should only be given with medical supervision. Some caregivers choose to carry two auto-injectors from different lots for added precaution.

Multiple Locations

Some patients who use auto-injectors prefer to carry the standard two with them and also keep backup injectors in one or more strategic locations. These might include an extra one or two at work, school, daycare, and/or a relative’s house. These are great because they can serve as backup in case someone forgets their daily go-everywhere auto-injectors. Just make sure you follow the recommended storage instructions everywhere you keep an auto-injector and check your backups for discoloration and expiration dates. Knowing that you have extra auto-injectors in places like this, in addition to the daily carry-with auto-injectors you have, may bring you more comfort.

How about you? How many auto-injectors does your family keep on hand, and where? Please share your thoughts in the comment section of this blog post.

- Rob

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