More People Need Training in Lifesaving Epinephrine Use, Advocates Say

THURSDAY, Feb. 9 (HealthDay News) — 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 U.S. Senate in November and
the U.S. 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.

The law is supported by the Food Allergy Anaphylaxis Network.
“Data shows that up to 25 percent 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 U.S. 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 pediatric 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.

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.

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.”

More information

The California Department of Education has more on how to use an epinephrine pen.

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