According to local news reports, Tanner Henstra, who also had asthma, was at a friend’s house last week when he took a pretzel from a bowl and popped it in his mouth, not realizing these pretzels were filled with peanut-butter. His mother, Stacie Henstra, told The Salt Lake Tribune that her son spat out the pretzel as soon as he tasted peanut, but the allergic reaction had begun. His tongue and throat began to swell.

Stacie Henstra said Tanner usually carried an epinephrine auto-injector with him, but he did not have the emergency device with him at his friend’s house. She also said that the boy, who had been diagnosed allergic as an infant, had never needed to use one before.

Tanner did have some other allergy or asthma medicine with him, which he took immediately before calling his mother, who is a nurse, to come pick him up.

“He sounded worried but otherwise OK,” Stacie Henstra told the Tribune. But during the drive home, Tanner began to have trouble breathing. When they got home, about four minutes away, a neighbor came outside and performed CPR on Tanner while his mom ran inside to get the EpiPen.

She gave him the injection, but it had little effect. He was transported to a local hospital in St. George (which is north of Las Vegas), then to a larger hospital in Salt Lake City. After two days in hospital, Tanner was removed from life support.

Young Tanner’s death adds to a tragic and concerning list of children and teens who have experienced fatal anaphylactic reactions this spring. (See our report: Tragic Spring: 3 Food Allergy-Related Deaths)

Allergic Living reminds readers of the need for constant vigilance with food allergies. Most important of all, we remind you that anaphylaxis can progress swiftly and that the drug epinephrine is most effective when used immediately. Please take a moment to review our emergency procedures slideshow – Six That Save Lives.

See also: The Salt Lake Tribune’s full report.

A fund has been established to help Tanner’s family pay for hospital and funeral expenses. Donations can be made here.

posted: April 26, 2013

EpiCenter Medical, Inc was founded by allergist Dr. Mark Greenwald and lawyer Elizabeth Goldenberg

A comprehensive new training course for understanding and managing anaphylactic emergencies has just launched online.

“First Aid For Anaphylaxis: An Allergic Emergency” fills an important educational gap by providing clear instructions for what steps to take if witnessing an anaphylactic reaction. It provides easy-to-follow, standardized information in line with World Allergy Organization (WAO) guidelines.

“We have created this course to protect allergic individuals by ensuring that the first on the scene are trained to recognize an allergic emergency – anaphylaxis – and respond immediately with life-saving first aid,” said Dr. Mark Greenwald, the Toronto allergist who co-created the course with Elizabeth Goldenberg, a lawyer and allergy advocate.

“This medical emergency requires immediate first aid – the individual can’t wait for emergency crews to arrive,” said Greenwald, referring to the need for quick response with emergency epinephrine when an anaphylactic reaction is in progress.

Greenwald and Goldenberg founded EpiCenter Medical Inc., the company that offers this online course, which provides excellent guidance for parents of allergic children, their caregivers and school and daycare staff. But the course is also designed to be used more widely in the community: staff in restaurants, dental offices, airlines, government offices, hotels, and sports venues are among those Greenwald sees benefiting from its emergency training.

“When staff in those locations are called to respond to a reaction on their premises, they will know how to recognize anaphylaxis, to treat anaphylaxis immediately with epinephrine for the best survival rate, and what life-saving steps to take next,” he says.

Anyone with Internet access can take the course, which is divided into modules:

• It begins with definitions of allergy and anaphylaxis, and moves into an explanation of epinephrine and easy instructions on how to use an epinephrine auto-injector. (So far, the course gives details on the widely prescribed EpiPen, but this may be updated soon to include the new Auvi-Q/Allerject injector.)
• As the lessons progress, participants learn how to spot anaphylaxis, and are given clear steps to follow (and remove any lingering doubt) during an anaphylactic emergency.
• As legal questions can arise among would-be good Samaritans, legal consequences are also covered, from injecting the life-saving shot into someone else, to the ramifications of deciding not to do so.

To confirm the participant’s comprehension (and keep the user engaged), quizzes are taken throughout to test knowledge. Users cannot move on to the next section until they have passed the previous one.

Allergic Living was glad to see that EpiCenter Medical’s course stresses that it’s always better to give the shot, and immediately, in the case of a suspected anaphylactic reaction. Delay can reduce the chance of epinephrine being effective, and there are no harmful effects associated with giving the shot to a healthy person who doesn’t require it.

Those who complete the online course are able to print out a personal certificate stating that they are S.A.V.E. certified – which stands for Save Anaphylaxis Victims in an Emergency.

EpiCenter Medical also offers sale of an ‘Epi-Kit’, which is a case of multiple EpiPens designed to be placed in public locations, in a manner similar to automated external defibrillators. The idea is that an Epi-Kit should always be available within 60 seconds of an anaphylactic emergency.

In summary: This course provides highly valuable information and life-saving instructions. It is excellent as a standalone course, and could also be integrated into CPR courses, so that any first responder in an anaphylactic emergency will know what steps to take to save a life.

The course is available at epipentraining.com
Cost for an individual: $29.95
Discounted group rates available for groups larger than 10

Job:

Allergic Living’s Gwen Smith: Julie, how did you first become aware of your child’s food allergies?

Julie Bowen: I was at work on Boston Legal and my husband was at home. He sent me a text saying, ‘I think we have a problem with our son and peanut butter.’ I said, ‘but he’s had it before,’ and then he said – ‘and he got stung by a bee’. And I was thinking, ‘What is going on over there?’

AL: You mean he was stung at the very same time he was reacting to peanut butter?

JB: Well, it is California and our doors are open all the time. So he [her son Oliver] had wandered out eating peanut butter and was stung by a bee. I was one to think this was no big deal until my husband sent me a picture of our son’s face, which was clearly in distress. It was swollen and disfigured.

My husband rushed him off to the emergency room and he was treated with epinephrine, and after that we learned that Oliver had allergies to all sorts of nuts and peanuts and probably also to stinging insects – but that’s a different series of tests.

After the anaphylactic reaction, I know that my job is to be aware and to be prepared for the next reaction – whenever that may be.

AL: These days you’re a big TV star, you’ve won a second Emmy and the show is a huge hit. But facing anaphylaxis, is that the great leveler?

JB: You know, I think being a parent is the great leveler. People often ask me how my life has changed since Modern Family. And I say, ‘Having three kids in three years was a much bigger change than having a lovely, lovely job.’

AL: What ages are your kids?

JB: Oliver is the older boy and we have twin 3-year-old boys. [So far, no life-threatening allergies have been diagnosed with the twins.]

Next: Bowen’s decision to get involved in the “Get Schooled in Anaphylaxis” campaign.

Dr. Sharma:  The ability of epinephrine to treat the many signs of anaphylaxis is rather amazing.

It acts on a number of receptors in the body to exert its effects. First, it causes constriction, or tightening, of the blood vessels, which decreases swelling and also helps to increase blood pressure.

It also increases the heart’s contraction and heart rate, which can help to prevent or reverse cardiovascular collapse. Epinephrine relaxes the muscles around the airways in the lungs, helping the airways to open up.

Finally, it prevents the release of additional allergic chemicals, which aids in stopping further progression of the reaction. No other medicine acts on so many body systems, which is why epinephrine is the drug of choice for anaphylaxis.

Dr. Sharma is an allergist, clinical researcher and Assistant Professor of Pediatrics. He is Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington D.C. and Director of the Food Allergy Program. He co-authors “The Food Allergy Experts” column in the American Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.

On April 7, 2013, Adrian Gutierrez, an 8-year-old boy from Monmouth County, New Jersey, experienced a severe reaction and died in hospital. The reaction came over the boy on his family’s drive home from church, following a visit to a coffee shop. The boy’s mother suspects that Adrian, who was allergic to dairy and peanuts, may have accidentally sipped from his brother’s hot chocolate with milk. (Adrian had ordered a hot chocolate with  soy milk.)

One news report stated that an epinephrine auto-injector was administered to the boy. However, it is not clear whether the shot was given immediately after the reaction began, or  whether there was a significant delay. In the case of a severe allergic reaction, epinephrine should always be administered right away, as the drug can be less effective if a reaction has progressed.

On March 13, 2013, Maia Santarelli-Gallo, a 12-year-old girl from Burlington, Ontario (in Canada), appears to have experienced anaphylaxis during an outing to a shopping mall with her father and older sister. Local news reports suggest Maia had reacted to dairy and egg in the past, but her parents had been told she was intolerant rather than allergic, and she had never been prescribed an auto-injector. At this point, it is not definitively known what caused the reaction, but milk is suspected – since the last thing Maia ate was an ice cream cone.

Asked to comment on the girl’s fatal reaction, allergist Dr. Susan Waserman expressed profound concern to the local press. “It speaks to the need for proper diagnoses, proper education, how the family was told to handle this supposed food intolerance,” she said, adding that better support for the family would have led the girl to have an auto-injector. “The whole community feels terrible when we feel something like this,” she said.

On March 8, 2013, Cameron Groezinger-Fitzpatrick, a 19-year-old from Plymouth, Massachusetts, died from his peanut allergy while home from university for spring break. His family has said that a friend had offered him a cookie, which was supposed to be peanut-free but turned out to contain peanut butter.

According to ABC News, Cameron’s mother was told over the phone by a 911 operator not to administer an expired EpiPen which was in a nearby cupboard. Cameron’s current auto-injector couldn’t be found in time, as he had not finished unpacking for his visit.

“I didn’t know you can die from nut allergies. I feel foolish,” Robin Fitzpatrick, Cameron’s mother, told ABC News.

These tragic events reinforce the need for allergy education and having epinephrine always ready to access for those with food (and sting) allergies.

In more positive news, several states are beginning to see the importance of readily available epinephrine and are passing bills that allow doctors to prescribe “stock” auto-injectors to schools. These devices can used in emergencies for students who don’t have an auto-injector on school premises (in some cases, it may be a first allergic reaction).

Kentucky, Nevada, Oregon, Georgia and Tennessee have all seen recent progress in such bills in their state legislatures. In fact, Kentucky Governor Steve Beshear will be holding a formal ceremony to sign that state’ stock epinephrine bill into law on April 22, 2013.

• Intentional Food Allergy Exposures: Researchers have revealed the reasons that a concerning number of parents are knowingly giving their allergic children food that they are allergic to.
• Pollution Changing Genes: Researchers found that a certain type of air-pollution may be causing a DNA change which results in worsened asthma symptoms, and potentially even new cases of asthma.
• Milk Therapy Lacks Staying Power: Editor Gwen Smith on the study that showed a surprising reversal among patients who had been successfully treated for milk allergy.
• Alcohol, Asthma and Aspirin: A group of people with asthma are experiencing respiratory reactions when drinking alcohol. But how does Aspirin fit into the equation?
• Allergic Children Underweight: Children with multiple food allergies or milk allergy appear to be underweight when compared with their non-allergic peers.
• A New Spot for the Shot: Investigators discovered that there may be a more effective location for an epinephrine shot in obese patients.

Epinephrine works best when injected directly into muscle, as opposed to fat, as it absorbs into the bloodstream faster this way. Using ultrasound results, researchers from the U.K. measured the distance between the surface of the thigh and the inner muscle of 93 children. It was discovered that this distance was greater than the length of the auto-injector’s needle in 82 percent of the obese children studied.

At three-quarters down the thigh, the distance was reduced so that only 17 percent still had their muscle out of reach.  This suggests that the lower thigh could be a more effective location for giving an epinephrine shot to any obese individual.

Heights, weights, waistline measurements and body mass index data were gathered in order to determine which children would be considered obese.

See more news from the AAAAI 2013 conference here.

The following article is from the Winter 2013 of Allergic Living magazine.

Michael Saffioti’s mom Rose thought her 22-year-old son was doing the right thing by turning himself into police after a missed court date last July. But for the Washington state man, who had a life-threatening allergy to dairy, one night in jail turned into a death sentence.

The young man had landed in the court system on a misdemeanor marijuana possession charge – he spoke of using pot to curb crippling anxiety about his food allergy and asthma – and then a legal technicality led to him spending a night in the county prison.

Under normal circumstances, he would have gone before a judge then been released, but Saffioti never made it past breakfast. According to witness testimony from fellow inmates, the young man was given a meal that included a pancake and oatmeal, and when he reminded staff of his dairy allergy, they removed the pancake and told him the oatmeal was safe.

After a few spoonfuls, Saffioti began having difficulty breathing and asked for his asthma medication. Soon after, the prisoners were locked into their cells and the guards changed shifts. Saffioti’s reaction continued to worsen. According to Anne Bremner, the Seattle lawyer representing the family, Saffioti pressed his emergency button and called for medical help, but his emergency light got turned off; as his breathing grew more labored, Saffioti pleaded for someone to call 911.

Other inmates say they began pressing their emergency buttons and yelling for help, making clear that this guy was not faking. Their calls were ignored.

Saffioti was supposed to be housed in the prison’s medical ward, and his mother had made sure that corrections staff had his asthma medication, EpiPen auto-injector and medical records, and yet no help came for at least 20 minutes. A prison trustee (an inmate who has work privileges) said he watched in horror as Saffioti finally collapsed in his cell. By the time paramedics arrived, it was too late.

“The trustee is a tough guy, but he said it’s the worst thing he’s ever seen,” says Bremner. “They let this guy die, and he was begging for help.”

Next: Mother’s Actions

If necessary, the counselors may put the auto-injector in the child’s hand and “guide” it.

Jean-Pierre Ménard, a Quebec lawyer who specializes in medical rights, told Le Journal de Québec newspaper that the rule – intended to protect the counselors against liability – contravenes Canada’s Charter of Rights and Freedoms, since the Charter says that every human being whose life is in danger has the right to be saved. In addition, he says this “incomprehensible” rule should instead have the City of Quebec worried about prosecution for instructing caregivers, in essence, not to save a child’s life.

Similar restrictive camp policies have arisen in some parts of the United States.

Gervais Bélanger, director-general of Asthme & Allergies Québec, says he finds the day camp rules for not administering auto-injectors “inexplicable”and “unjustified” – since this puts the onus on allergic campers between the ages of 4 and 12 to self-inject at a time when they are having an anaphylactic reaction. (Epinephrine is an emergency medication, and it would be rare for a young child to self-inject.)

Bélanger is one of the members of the Coalition for Megann’s Law, which is urging the Quebec government to pass a law on school food allergy accommodations that would include school staff auto-injector training and preparedness to act in an allergy emergency.

On behalf of the coalition, he has written letters to the Quebec camping association and to the president of the Office of Professions of Quebec, the provincial agency that reviews the regulations adopted by various organizations. Bélanger makes these groups aware of a regulation amendment that the Quebec College of Physicians proposed in June to allow non-medical persons to administer epinephrine auto-injectors.

The College of Physicians has a 45-day commenting period on changes, so while its proposed amendment will clarify the rules for non-medical people caring for allergic children and ultimately should have a positive impact on day camp rules, it won’t help parents and campers this summer.

Dr. Scott Sicherer: Being able to recognize the need for epinephrine and to actually self-inject in an emergency are beyond the capability of most children your son’s age. The readiness to self-administer requires the appropriate developmental level, understanding about symptoms of a reaction, and then the willingness to inject the epinephrine.

Before you consider the readiness of your child, speak with your allergist to be sure you are comfortable with recognizing symptoms and understand when and how to inject epinephrine. Since barriers to using the auto-injector include “needle phobia” and unfounded worries about side effects, have a discussion with the allergist about the safety of epinephrine, and perhaps practice with an old injector and an orange. Achieving your own comfort is the first step in preparing the right message to give to a child who will eventually take on this responsibility.

The notion of self-treatment can be taught early on, but granting full independence is a much more gradual process. For all children, I generally instruct that a responsible adult should be available to make treatment decisions and ultimately inject epinephrine. For teenagers, having their friends aware of the food allergy and how to inject epinephrine can add another layer of safety.

Gradually include your child in allergy management, with guidance from your doctor. Having him practice with an epinephrine self-injection trainer is a good first step. The road toward independence also includes having him play a part in reading labels on packaged foods, speaking up about allergy at restaurants, and eventually discussing when epinephrine would be required.

Dr. Sicherer is a practicing allergist, clinical researcher and Professor of Pediatrics. He is Chief of the Division of Allergy and Immunology, Jaffe Food Allergy Institute, at the Mount Sinai Medical School of Medicine in New York. He is also a member of the FAAN medical advisory board. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the American Edition of Allergic Living magazine.

To submit a question, write to ask@allergicliving.com. Write “The Food Allergy Experts” in the subject field, and keep your question brief.