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PostPosted: Mon Sep 04, 2006 6:40 am 
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Location: Gatineau, Quebec
Childhood food allergies exaggerated, expert argues
Last Updated Fri, 01 Sep 2006 17:42:11 EDT
CBC News


Prescribing adrenaline-injecting EpiPens to children with food allergies may be fuelling anxiety in parents unnecessarily, a child health expert says.

Pro/con commentaries in Saturday's issue of the British Medical Journal debate the question: are the dangers of childhood food allergy exaggerated?

Food allergy is thought to be more dangerous and frightening than pneumonia, asthma or diabetes.

In reality, the number of deaths is small, at less than one per year on average in the United Kingdom, and only some are preventable, said Newcastle University child health professor Allan Colver.

Full story: http://www.cbc.ca/story/health/national ... rgies.html

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I do agree with the comment that people are not always being shown how to administer the auto-injector. See the OASG poll of the past few months at http://ottawaasg.com/OASG2006/modules.p ... er=&thold= (under Last 5 Surveys in box at right). Almost 50% of respondents said they were not shown how to use an auto-injector. That's not good.

However.... given that the medical community is not yet able to predict the severity of a reaction, what other choice do they have but to prescribe an auto-injector? Leave it to chance and risk someone having a severe reaction and NOT have epinephrine on hand? Who wants to take that chance? I'm glad the article touches on that aspect.

Also, again with the "In reality, the number of deaths is small, ...". Yes, BECAUSE A LOT OF PEOPLE ARE TAKING A LOT OF STEPS TO PREVENT REACTIONS. And of course making sure that they know what to do in case of a reaction.

I really shudder to think what it would be like if everyone on this forum (for example) stopped reading labels and just ate whatever they wanted - or gave any kind of food to their allergic kids.

Comments like this get up my nose because they completely ignore the fact that, as I said, people are taking a lot of steps to reduce risks and thus prevent life-threatening reactions.

K.

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Karen, proud Mom of
- DS1 (12 yrs): allergic to cashews, pistachios, Brazil nuts, potatoes, some legumes, some fish, pumpkin seeds; OAS
- DS2 (1o yrs): ana. to dairy, eggs, peanuts; asthma


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PostPosted: Mon Sep 04, 2006 7:36 am 
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Joined: Tue Mar 22, 2005 11:17 pm
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Location: Ottawa
I think if you were able to look at the number of people with food allergies and the number who died from anaphylaxis 15 years ago compared to today, I'd bet you'd find we have a higher prevalence of food allergies but the deathrate has declined.
I think that general community awarness, school suppor,t stricter label laws and information being available through the internet which parents to be more vigilant have done a lot in this respect.

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Mon Sep 04, 2006 9:03 am 
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Location: Clarington
How do you view the comments made at the end of the article by Jonathon Hourihane,professor of paediatrics and child health at University College Cork, Ireland?
He said,

"but it(food allergy) can erode or inhibit normal formative experiences in childhood and it impairs quality of life, " Hourihane said."


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PostPosted: Mon Sep 04, 2006 2:17 pm 
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Location: Ontario, Canada / Cambridge, UK
I don't know what to make of this article. It appears on the CBC website but it's mostly UK and Ireland-based. The issue seems to be about prescribing Epipens and their proper use. Are the doctors in England, Wales, Scotland and Ireland needlessly prescribing Epipens for people who have not been tested for allergies? If so, then the problem is the medical system, not the greater issue of allergies.

Then the article jumps to people not using the Epipens when they should or not keeping them up-to-date. It's confusing. If the article is trying to make a point about allergies being exaggerated... I don't see any convincing arguments. The only argument is the number of deaths, which is dismissed as "small" and the over-prescribing of Epipens.

I was hoping the complete article in the British Medical Journal offered more balanced information (with the pros and cons being discussed) but I don't think it does. See for yourself here: http://bmj.bmjjournals.com/cgi/content/ ... 3/7566/494

This article labels allergy sufferers/allergic children's parents as alarmist and only fuels the negative stereotypes that we all must deal with.

You may be interested to read the comments of Jonathan Shaw, organiser of the Allergy Show in the UK: http://bmj.bmjjournals.com/cgi/eletters ... 494#140745

If you also wish to send a response, you can do so here: http://bmj.bmjjournals.com/cgi/eletter- ... 3/7566/494

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16-year-old son: peanuts, nuts, raw egg whites, asthmatic
Self: allergic rhinitis, fragrance/chemical sensitivities, oral allergy syndrome


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PostPosted: Mon Sep 04, 2006 4:20 pm 
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Quote:
An adrenaline autoinjector could be provided if the child lives in (or is taking a trip to) an area which emergency services cannot reach within about 30 minutes? :shock:

Arguments can be made for and against general provision of autoinjectors. The main argument in its favour is that reactions are best treated within a few minutes (some say at the stage of early rash or tingling) rather than after waiting for an ambulance or seeking medical assistance.1 I think this claim is unfounded but accept that evidence is hard to obtain because of the small number of fatal reactions. Because having to carry adrenaline is a nuisance and the risk of a serious reaction is small, the burden of proof should be with those who propose the general use of autoinjectors.


Does he mean you can wait over 30 minutes after a reaction has started before you use the autoinjector.

Quote:
Even if autoinjectors could prevent all deaths, the cost of giving injectors (which have a shelf life of 15 months) to all UK children with food allergy (for both home and school) is estimated at £20m (29m; $37m) per life saved.4 This is in addition to the psychosocial cost of the anxiety.


I just wonder what a life is worth to him.

There is little scientific data because it is not ethical to deliberately give food allergens to an allergic person and I can't imagine many parents would go along with it if it was ethical.
I suspect that most Dr's would recomend an autoinjector for food allergens regardless, as the risk of litigation in the event of a preventable death is very real.

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Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb


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PostPosted: Mon Sep 04, 2006 4:41 pm 
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Location: Ontario, Canada / Cambridge, UK
Quote:
Even if autoinjectors could prevent all deaths, the cost of giving injectors (which have a shelf life of 15 months) to all UK children with food allergy (for both home and school) is estimated at £20m (29m; $37m) per life saved.


Oh god, what a pity that people's lives come to dollars and cents! In the UK, those who do not have private health insurance and can't afford health care services need to use the NHS (National Health Service) and obtain an exemption from the prescription charge. So they are just looking at it from a purely financial point of view. They would rather people go without Epipens than to exercise caution. I hope there will be some opposition to this from allergy organizations and patients. The NHS is funded by the Department of Health but also by taxpayers!

Quote:
Although the number of deaths is small, we should aim to prevent all deaths. This is not possible with our present knowledge; in striving to prevent all deaths, strategies should balance psychosocial and financial costs against general advice for all children with food allergy and more intense regimens for a few.


So who will determine who these select few are? It is a horrifying thought if the professionals involved in this report are the ones to prepare the guidelines. In "striving to prevent all deaths", they would be gambling with people's lives.

Susan, you mentioned litigation... in the UK, it's just not common practice to sue. And the ones who rely on the NHS are in the worst position to do anything about it through the courts. It's all quite frustrating, really.


Quote:
Summary points

The incidence of severe food allergy reactions in children is small and not increasing

The risk of death is very small

Many effective and simple measures are available to reduce risk

Many children grow out of food allergy, and clinical reactivity should be reassessed periodically

It is unclear what proportion of children with food allergy should be prescribed an adrenaline autoinjector

Autoinjectors generate anxiety in children and carers, and they should be prescribed only when a diagnosis of food allergy has been confidently established, usually by oral challenge


I don't agree with ANY of these points! And the author is a consultant paediatrician, professor of community child health, and chair of the British Paediatric Surveillance Unit???

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16-year-old son: peanuts, nuts, raw egg whites, asthmatic
Self: allergic rhinitis, fragrance/chemical sensitivities, oral allergy syndrome


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PostPosted: Mon Sep 04, 2006 5:32 pm 
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Storm, thanks for the full text link. I sent a response to this article quoting the AAAAI's news release from that org's annual conference in March: http://www.aaaai.org/media/news_release ... 030506.stm (scroll down to research highlights).

And what I'd remind people here of are the views of Dr. Estelle Simons, pres. of the AAAAI and authority on epinephrine and anaphylaxis: http://www.allergicliving.com/feature.asp?feature=19

Dr. Simons is certain a lot of anaphylactic reactions aren't even recorded as such in hospital. So the problem I have from the outset with the BMJ article is that, presuming the same holds true in Britain, the stats on anaphylaxis deaths are underreported in the first place (the AAAAI says "grossly underestimated"). If that's so, then his argument is flawed from the outset.

As for the part about the "liberal prescription" of auto-injectors causing anxiety in kids, that's complete conjecture on his part. Even anecdotal evidence that any off us would have would prove the professor wrong. Any allergic person I know, child or adult, feels more at ease around food with one handy.


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PostPosted: Mon Sep 04, 2006 9:18 pm 
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That article is troubling. The epipen *could* be anxiety-provoking for caregivers other than parents who would otherwise not feel responsible for taking action should a child in their care have a reaction. Also, the epi could be the cause for anxiety if people are unsure about how to work it or when to use it. But I couldn't agree more that having an epipen *and* knowing how and when to use it majorly *reduces* anxiety.

I suspect that allergy-related anxiety is related to the allergy rather than the epipen. I would imagine that most people considered at risk for anaphylaxis experiences anaphylaxis at least once during their lives. Maybe it's just me, but I think the prospect of near-death by asphyxiation a lot more stressful than carrying around a needle.

Thanks for writing a response, Gwen!


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PostPosted: Tue Sep 05, 2006 8:48 am 
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Location: Ontario, Canada / Cambridge, UK
Gwen,

Your response is posted on the website! Good job! :D

Scroll down to "Under-estimating the Risks of Food Allergy"

http://bmj.bmjjournals.com/cgi/eletters ... 494#140745

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16-year-old son: peanuts, nuts, raw egg whites, asthmatic
Self: allergic rhinitis, fragrance/chemical sensitivities, oral allergy syndrome


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PostPosted: Tue Sep 05, 2006 12:54 pm 
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Location: Gatineau, Quebec
gwentheeditor wrote:
Any allergic person I know, child or adult, feels more at ease around food with one handy.


I actually asked my almost-8-year-old the other day how he would feel if he wasn't allowed to wear his EpiPen at school (it was regarding a different topic), and he said, "Not good. I would be really nervous."

So both he and I agree that rather than causing anxiety, knowing that emergency medication is available helps reduce anxiety.

K.

_________________
Karen, proud Mom of
- DS1 (12 yrs): allergic to cashews, pistachios, Brazil nuts, potatoes, some legumes, some fish, pumpkin seeds; OAS
- DS2 (1o yrs): ana. to dairy, eggs, peanuts; asthma


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PostPosted: Tue Sep 05, 2006 1:00 pm 
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Good reply to the article, Gwen! :)

I also liked the reply by Jonathan Shaw, Director of The Allergy Show.

(Did anyone understand the post just above Gwen's?? I didn't!!)

K.

_________________
Karen, proud Mom of
- DS1 (12 yrs): allergic to cashews, pistachios, Brazil nuts, potatoes, some legumes, some fish, pumpkin seeds; OAS
- DS2 (1o yrs): ana. to dairy, eggs, peanuts; asthma


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PostPosted: Tue Sep 05, 2006 4:20 pm 
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Thanks Karen and Storm.

Karen, believe the point of the researcher in the previous post was that experts in her study gave such diverging views of when/if to give epinephrine that, she believes, the message to patients ends up confusing and inconsistent.


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PostPosted: Tue Sep 05, 2006 5:23 pm 
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Ahh... thanks for the translation from paper-ese into English. ;)

I have to say, I feel lucky to be in Canada. I do feel that the message is pretty clear and consistent, with regards to the new national anaphylaxis guidelines.

K.

_________________
Karen, proud Mom of
- DS1 (12 yrs): allergic to cashews, pistachios, Brazil nuts, potatoes, some legumes, some fish, pumpkin seeds; OAS
- DS2 (1o yrs): ana. to dairy, eggs, peanuts; asthma


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PostPosted: Tue Sep 05, 2006 6:04 pm 
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I know what you mean. Britain has so few allergists per capita that it's downright odd.


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PostPosted: Wed Sep 06, 2006 8:21 am 
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Location: Ontario, Canada / Cambridge, UK
gwentheeditor wrote:
I know what you mean. Britain has so few allergists per capita that it's downright odd.


It is odd. I live in the UK part of the year and find there is a lot of allergy awareness in restaurants and in food labelling. Maybe this is what happens when there is too much awareness... some doctors decide to create a backlash and state that allergies and the prescribing of Epipens are exaggerated. I still think that whole article has a purely financial point of view and the aim is to ease the "burden" on Britain's health system. It's a pity that something like this makes the UK look bad... when there are so many allergy groups doing such great work to create awareness and instigate change.

It is difficult to find an allergist in the UK. I have a friend who needed to find out if he was allergic to latex and tomatoes and it was difficult to find an allergist. He was referred to an allergist at a hospital but the staff there gave him the wrong information and he waited for an appointment that never materialized. And because he has private insurance and doesn't need to go through the NHS, it actually made things more complicated at that hospital. Needless to say, he asked for another referral, which he finally got. But in all, I think it took close to a year for him to get properly diagnosed. Thank god it turned out he wasn't allergic... but I hate to think of someone having to wait that long for a confirmation for a potentially life-threatening allergy. And this is with private insurance... imagine having no choice but to go through the NHS.

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16-year-old son: peanuts, nuts, raw egg whites, asthmatic
Self: allergic rhinitis, fragrance/chemical sensitivities, oral allergy syndrome


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