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PostPosted: Thu Feb 26, 2009 2:27 pm 
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Joined: Mon Oct 06, 2008 5:09 am
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I just got administered my anapen and I have some questions..

I asked my doctor several times when to use it. according to him he encourages people to use it quite freely, ie if you feel you are having hives, have trouble breathing - just use it, don't wait. he said he had patients who used it quite frequently. this differs from what I thought - that you only used it if you were about to collapse or when it got really really bad. do people really use them this freely? do you use it as soon as you feel a reaction coming? I feel like opinions differ on these subjects...

I've had these types of reactions (difficulty breathing etc) a few times but I usually just wait it out and hope for it to get better. I've had minor throat swelling but not so I am gasping for air. I have a tendency to wait a lot of things out - any sickness, I've been known to go without meds when I really need them for ages!

how long to you usually wait before you use your epipen/anapen? I am quite unclear on what counts as anaphylaxis, I've had many of the symptoms but It's never actually progressed into something life threatening. I think I'll be going abroad for a vacation this year and I really need to know how to interpret allergic symptoms a bit better... does it need to be life threatening for the anapen to be used?

thanks.


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PostPosted: Thu Feb 26, 2009 5:11 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
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Location: Toronto
I've never heard of an anapen. :?:

As for when the epi/anapen should be used -- unfortunately there is no *absolute answer*.

Due to my own personal history -- I wait. The reason is, I have had anxiety attacks which closely mirror anaphylaxis.

For my son -- we wait. The reason is, he has never had anaphylaxis, and his allergy is to insects -- a hive might just be a normal reaction to an insect bite and if we give him the epi every time he got bit by a mosquito I'd be very worried about the strain on his heart.

But, that's individual instructions based on our own personal histories.

************

I do not think epinephrine is a risk to a normal healthy heart -- but I'd be concerned about using it like an aspirine. (popping it at random) However, your doctor may feel that your personal history warrants it.

Waiting until you are *about to collapse* is waiting to long though -- by then you are incapable. Plus, preventing getting to that stage is easier then reversing it. The same is true of breathing difficulties. They can come on so slowly that you don't fully realize you are having difficulty breathing until you aren't. I had not realized I was incapable of taking a full deep breath, then suddenly I did -- gasped in a bit breath -- and that's when I realized I hadn't been able to. I do think I should have used my epi that time. I think I've been lucky a few times.

********

Sorry, this probably hasn't been very helpful at all. :?

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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PostPosted: Thu Feb 26, 2009 5:35 pm 
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Joined: Mon Oct 06, 2008 5:09 am
Posts: 34
anapen is basically the same thing - except you inject it slightly differently! I think its used mainly in Europe.

he didn't say use it when you get "a hive" - actually he didn't mention hives much, but he said as soon as I had breathing issues = anapen. I think for hives he recommends antihistamines, which should suffice. I seriously get hives every now and then from contact reactions and I don't bother, they itch for a bit then their gone! I don't even bother with taking an antihistamine when it comes to itching. After a while of having allergies I find that I don't really freak out over small reactions like this.

I don't know, this is very confusing! the information on the net is a bit conflicting regarding this subject...

thanks lots for the reply.


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PostPosted: Thu Feb 26, 2009 8:15 pm 
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Joined: Thu Mar 03, 2005 9:38 pm
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Location: Toronto
How often do you have reactions that cause any breathing issues?

I do think most doctors recommend using epi for reactions that cause difficulty breathing. The problem is, they can turn really bad really fast, so advising you to use epi does sound legitimate.

Did the doctor also advise you to go to the hospital any time you use the epi?

And, I know what you mean about letting little itchy reactions clear up on their own. For me, benedryl works really well but I hate the side effects. If it's minor, I just let it go on it's own. Though cold sometimes helps alleviate it too.

_________________
self: allergy to sesame seeds and peanuts
3 sons each with at least one of the following allergies: peniciilin, sulfa-based antibiotic, latex, insect bites/stings


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PostPosted: Thu Feb 26, 2009 9:28 pm 
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Joined: Sun Feb 08, 2009 11:22 pm
Posts: 16
Thanks for asking this question batabid! I was wondering the same thing. My doc just gave me a prescription for epipens...

I used to be ana to my allergy (hospitalized and everything) and probably still am, but I've never had an epipen. I totally forgot to ask my doctor the whens and wheres. He told me "you just jam it in your leg".


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PostPosted: Fri Feb 27, 2009 2:19 am 
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Joined: Mon Oct 06, 2008 5:09 am
Posts: 34
AnnaMarie wrote:
How often do you have reactions that cause any breathing issues?

I do think most doctors recommend using epi for reactions that cause difficulty breathing. The problem is, they can turn really bad really fast, so advising you to use epi does sound legitimate.

Did the doctor also advise you to go to the hospital any time you use the epi?

And, I know what you mean about letting little itchy reactions clear up on their own. For me, benedryl works really well but I hate the side effects. If it's minor, I just let it go on it's own. Though cold sometimes helps alleviate it too.


I get breathing issues every now and then - the last time I got it was about a week ago in the bakery section of the store. There is a huge ammount of flour dust in the air at these places. my throat was starting to swell aswell, but I got away from the area and it cleared up within 10 minutes. I don't really know "how often" this happens, but it happens from time to time. I am doing fine most of the time obviously because I avoid my allergen, but I do get unavoidable reactions sometimes. These are not "daily" reactions because obviously I avoid wheat!

what the doctor said was this if it got bad: stab the anapen, then take cortisone followed by an antihistamine. what he said was - call 911 and tell them the situation, but he seemed to think the paramedics don't always come if the symptoms clear up after the first anapen. he said - if you need to use the second one - don't even wait, just go straight to the hospital.


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PostPosted: Fri Feb 27, 2009 7:43 am 
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Joined: Tue Mar 22, 2005 11:17 pm
Posts: 6455
Location: Ottawa
We've had this question come up from time to time.
I like to refer people to Allergy Safe Communities
Quote:
The information and most of the resources on this website are taken from Anaphylaxis in Schools & Other Settings, a document developed by the Canadian Society of Allergy and Clinical Immunology (CSACI) in collaboration with patient allergy associations and allied healthcare professionals.
http://www.allergysafecommunities.ca/pa ... p?catid=11
According to the recommendations:
Quote:
While there is no universally accepted definition, anaphylaxis (pronounced anna-fill-axis) can be defined as:

a severe allergic reaction to any stimulus, having sudden onset, involving one or more body systems with multiple symptoms

Quote:
Key recommendations

There are six key recommendations for dealing with anaphylaxis:

1. Epinephrine is the first line medication that should be used in the emergency management of a person having a potentially life-threatening allergic reaction.

In studies of individuals who have died as a result of anaphylaxis, epinephrine was underused, not used at all, or administration was delayed.1-4

The course of an anaphylactic episode cannot be predicted with certainty and may differ from one person to another and from one episode to another in the same person.5

It is recommended that epinephrine be given at the start of any suspected anaphylactic reaction occurring in conjunction with a known or suspected allergy contact.

Epinephrine should be injected in the muscle on the outer side of the thigh.


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2. Antihistamines and asthma medications must not be used as first line treatment for an anaphylactic reaction.

While they will do no harm when given as additional or secondary medication, they have not been proven to stop an anaphylactic reaction.

Epinephrine is the only treatment shown to stop an anaphylactic reaction.

The main benefit of antihistamines is in treating hives or skin symptoms.


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3. All individuals receiving emergency epinephrine must be transported to hospital immediately for evaluation and observation.

While epinephrine is usually effective after one injection, the symptoms may recur and further injections may be required to control the reaction.

Repeat attacks have occurred hours later without additional exposure to the offending allergen6,7, therefore, observation in a hospital setting is necessary.

It is recommended that a patient suffering from an anaphylactic reaction be observed in an emergency facility for an appropriate period (e.g. 4 hours) because of the possibility of a bi-phasic or prolonged reaction8.

This time may vary depending on the judgment of the attending physician who will take into consideration factors such as:

the severity of the reaction
the patient’s response to treatment
previous episodes
distance from the hospital to the patient’s home
Upon discharge, a new epinephrine auto-injector prescription should be obtained and immediately filled.


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4. Additional epinephrine must be available during transport. A second dose may be administered within 10 to 15 minutes, or sooner, after the first dose is given IF symptoms have not improved.8, 9

The second dose should only be given in situations where the allergic reaction is not under adequate control; that is, the reaction is continuing or getting worse.

Signs that the reaction is not under adequate control:

the patient’s breathing becomes more labored; or
there is a decreased level of consciousness
Patients who have been prescribed epinephrine are advised to have at least one epinephrine auto-injector with them at all times.

Optimally, patients should also have access to a back-up auto-injector in case a second dose is required.

It is important for persons at risk of anaphylaxis to take extra precautions when planning trips or camping outdoors. When traveling, they should try to be within a reasonable distance to a medical facility should an emergency occur.


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5. Individuals with anaphylaxis who are feeling faint or dizzy because of impending shock should lie down, unless they are vomiting or experiencing severe respiratory distress.10

To improve blood circulation, caregivers should lift the person’s legs above the level of the heart, keeping the legs raised by putting something (e.g. a pillow) underneath.

Keep the person lying down until emergency responders arrive or until the patient has fully recovered.

If the person feels nauseated or is vomiting, lay them on their side, head down, to prevent aspiration of vomit. (Note: if the person is having difficulty breathing, they should be sitting up.)

It is important that the patient not be made to sit or stand immediately following a reaction as this could result in another drop in blood pressure.10

Individuals at risk should be advised to seek help when experiencing an allergic reaction and to not go off alone (e.g. to the washroom) unaccompanied if they are feeling unwell. If they lose consciousness they will not be able to ask for help.


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6. No person should be expected to be fully responsible for self-administration of an epinephrine auto-injector.

Individuals may not physically be able to self-administer epinephrine when they are suffering from a reaction.

They may be anxious about using a needle, may downplay the seriousness of a reaction, or may not want to draw attention to themselves. They may also be confused.

Assistance from others is crucial in these circumstances.

_________________
Moderator
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: Fri Feb 27, 2009 9:51 am 
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Joined: Mon Oct 06, 2008 5:09 am
Posts: 34
very straightforward. thanks!


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