Life Saving Epinephrine not used in nearly 80% of anaphylactic events

New research presented at the AAP National Conference & Exhibition reveals that many parents of children who require allergy treatment often don’t administer epinephrine.
The researchers said most parents (78.5%) reported that autoinjectors were not used during their child’s allergic reactions.

The most common reason for not using epinephrine was that the reaction did not seem severe enough to warrant epinephrine use (40.3%).
Other reasons included that it was their child’s first allergic reaction and no epinephrine was prescribed at the time.
18.5% of parents reported being too scared or emotional to administer an epinephrine autoinjector at the time.

“Underuse of epinephrine to treat severe allergic reactions continues to be an important area to address with patients and their families,”
Julie Wang, MD, professor of pediatrics in the division of allergy and immunology at the Icahn School of Medicine at Mount Sinai says “Identifying barriers to treating severe allergic reactions will allow targeted education, interventions to optimize management of allergic reactions or both.”

Epinephrine Nasal Spray for Anaphylaxis Gets Fast Tracked by FDA

INSYS Therapeutics, Inc has announced that the (FDA) has granted Fast Track designation to the company’s epinephrine nasal spray as an investigational treatment for anaphylaxis, an acute, life-threatening allergic reaction requiring urgent treatment.

The Company say that preliminary data (n=60) of patients with seasonal allergies showed rapid absorption of intranasal epinephrine.The bioavailability of the novel epinephrine nasal spray also proved similar to that of intramuscular injection with EpiPen 0.3mg injection.

“This is an exciting milestone for people affected by severe allergies who might be seeking an alternative delivery mechanism for epinephrine,” said Saeed Motahari, president and chief executive officer of INSYS Therapeutics.

Food Allergy Market is on the Rise

The global food allergy market is expected to grow at an approximate CAGR of 6.6% during the forecast period of 2018-2023.

The Americas holds the largest share of the global food allergy market owing to the increasing prevalence of food allergy, the presence of a well-developed healthcare sector, and huge health care expenditures within the region.

Europe stands second in the market due to the availability of funds for research followed by a huge patient population and strict food regulation standards. On a regional basis, Europe is segmented into Western Europe and Eastern Europe. Western Europe leads the regional food allergy market while Eastern Europe is estimated to be the fastest growing region.

Asia Pacific stands third in the global food allergy market and is projected to be the fastest growing region. The presence of developing economies, rising patient population, and increasing government efforts for a labeling-compliance drive the market within the region.

The Middle East and Africa holds the least share in the global food allergy market owing to the presence of weak economies, lack of awareness, and poor availability of healthcare services, especially within the African region.

Medical Engineers Have Built A EpiPen Replacement That Costs $16 (USD) A Shot

A South African team has created the ZiBiPen, which delivers a shot of adrenaline from a replaceable, $16 (USD) cartridge.

The reusable pen costs $80 and is intended to last five years.

The standard for treating anaphylaxis, the EpiPen, is single use, must be replaced regularly, and is expensive.

A team of South African biomedical engineers have built a cheap replacement for the EpiPen that could revolutionize the emergency treatment of anaphylaxis, a severe allergic reaction that can be triggered by food or insect bites.

Called the ZiBiPen, it delivers a shot of adrenaline in the form of a replaceable, $16 cartridge.

“The cost of the pen is $80 (USD) and we are testing to make it last up to five years,” said Gokul Nair, who helped develop it alongside fellow University of Cape Town’s Medical Devices Lab alumnus Giancarlo Beukes.

That is a fraction of the cost of the dominant device on the market, the EpiPen, which sells for $600 (USD) in a pack of 2; lasts only up to 18 months; and can only be used once.

“When we originally did research into the cost of the devices on the market, we found that delays in the distribution chain can mean South Africans only receive their devices with six months before expiry, which made it unaffordable for South Africans,” said Nair, who originally designed it for a master’s project at the Division of Asthma and Allergy at the Red Cross Children’s Hospital.

The rising cost of the EpiPen has seen a class action lawsuit against manufacturer Mylan. The lawsuit claims the company is engaged in an illegal scheme to dramatically increase the list price, which ten years ago was $88, reported CNBC.

Adrenaline auto-injectors are inserted in the thigh, through the clothes. The shot slows the allergic reaction, buying precious time to get users to a hospital.

Family Pushes For Epinephrine Auto Injectors On Planes After Mid-Flight Allergy Attack

A family vacation turned into an emergency on the way home when 10-year-old Long Island boy Luca Ingrassi suffered a severe allergic reaction mid-flight.

Luca had no idea he was allergic to tree nuts when he and his family boarded the plane, but 15 minutes after consuming a single cashew, Luca started complaining of stomach and chest pain, and a tickling sensation in his throat. Luca was experiencing anaphylaxis, a severe allergic reaction.

Thanks to quick-thinking passengers and staff on the American Airlines plane, Luca survived.

Now his mother, Francine, is calling for change and has started a petition to make all airlines have two pack Epinephrine Auto Injectors on all flights made available to all passengers who have allergies, and for those who are unaware they have an allergy like Luca.

Here is the link to the petition https://chn.ge/2EGBNqH

New Israeli app geared to help allergy sufferers in medical emergencies

Israeli researchers have teamed up with Magen David Adom (MDA), Israel’s emergency medical service, to create an app that can provide immediate help to patients having an acute allergic reaction.

Aware that many allergy patients find themselves in a medical emergency far from their medication, Bar-Ilan University Professor David G. Schwartz, and doctoral students Michael Khalemsky and Michal Gaziel Yablowitz of the univerity’s School of Business Administration, developed the “EpiMada” app to connect hundreds of high-risk allergy sufferers.

the “EpiMada” connects providers – who might be close enough to arrive significantly faster than an ambulance – with allergy patients. Based largely on the same system as Gett Taxi or Uber, the app could save the sufferer valuable minutes that it would have taken emergency medical personnel to arrive.

Data from University Allergy Clinic Shows Red Meat Allergy May Be a Growing Issue

A study at the 2018 American Academy of Allergy, Asthma & Immunology (AAAAI) and World Allergy Organization (WAO) Joint Congress presented a snapshot from a private, university-affiliated allergy clinic with a large increase of anaphylaxis cases caused by alpha-gal, or red meat, allergy.

The dataset included 222 cases of anaphylaxis dating back to 1993 from the clinic. Forty percent of cases had a definitive trigger, 26% of cases had a probable trigger and the cause was unknown in 34% of the cases.

“Interestingly, among cases of anaphylaxis with a definitive cause, the most common trigger was a reaction to galactose-alpha-1, 3-galactose, better known as alpha-gal. That is the compound that patients with mammalian meat allergy react to after ingesting red meats like beef or pork,” said author Philip L. Lieberman, MD, FAAAAI.

This varies from earlier reports from the clinic, when alpha-gal allergy had not been fully described. In fact, the percentage of cases with an unknown cause dropped from 59% to 34% from the prior report. The scientists believe that the change in percentage could largely be explained by the increase in alpha-gal cases.

“There has been such an influx in anaphylaxis caused by alpha-gal, that the rate of anaphylaxis without a clear cause has dropped 25%,” said Thanai Pongdee, MD, FAAAAI. “The correct diagnosis of anaphylaxis is paramount for patient care, and understanding common causes is vital in this regard.”

The second leading cause was food allergy and the average age of the patients who experienced anaphylaxis was 41 years-old.

 

Urine Test Could Indicate Food Allergies, How Severe They Are

Researchers have discovered that a large amount of identifiable substances are contained in the urine of patients who have food allergies, which could help lead to early diagnosis of allergies through less-invasive testing.

Currently, to check for food allergies, a blood test or skin test, which involves inserting a needle in the skin, is needed. But in a recent study, researchers from the University of Tokyo identified compounds in the urine of mice that can not only indicate whether a food allergy is present, but how severe the symptoms will likely be.

“Urine tests wouldn’t be burdensome even for small children,” said Takahisa Murata, an associate professor at the Faculty of Agriculture at the University of Tokyo specializing in animal radiology, who led the team of researchers. “I want to develop testing methods that are easier to evaluate if there is a food allergy and to what degree the allergy symptom is.”

Many food-induced anaphylaxis cases in children occur under adult supervision

Montreal researchers found that at least a third of childhood severe food allergy reactions occur in kids who are under adult supervision. And, in most cases, those adults are not the child’s parents.

Scientists from the Research Institute of the McGill University Health Centre collected data from four Canadian emergency departments, looking for incidents of pediatric anaphylaxis – severe allergic reactions in kids that required medical attention.

They found that, in 31.5 per cent of the incidents, the children had been under the supervision of adults. Another 20 per cent involved kids who were unsupervised; in the last 50 per cent of cases, it was not known if the children had been supervised.

In those incidents involving supervised children, the supervising adult was not the child’s parent in 65 per cent of the cases.

The study’s lead investigator, Dr. Moshe Ben-Shoshan, says the study also found that the majority of allergic reactions occurred at home,

“It was a little bit surprising because I think that we have that false sense of security that as long as we are at home under adult supervision, with an adult that we know, we’ll be fine. Apparently, that’s not the case,” he said.

The study also looked at the role food labelling played in the accidental allergic reactions. They found that one third of the incidents were attributed to a food labels issue.

“But when we asked specifically what were the issues, apparently it’s not because the food labels were not clear. The majority of reactions were because we don’t read the food labels,” Dr. Ben-Shoshan said.

He said the fact that food labels are being ignored suggested supervising adults are not being properly instructed on the need for vigilance.

Asthma and food allergies predictable as early as age one

Children at one year old who have eczema or atopic dermatitis (AD) and are sensitized to an allergen are seven times more likely than other infants to develop asthma, and significantly more likely to have a food allergy by age three.

This new finding from the Canadian CHILD Study will help doctors better predict which children will develop asthma and allergies, according to a paper published by the Journal of Allergy and Clinical Immunology.

It has long been known that infants with eczema or atopic dermatitis (AD) are more likely to develop asthma and allergic rhinitis in later childhood, a progression known as “the atopic march.” But predicting precisely which children with AD will go on to develop these conditions has been difficult.

The CHILD researchers did find that having AD alone, without sensitization to an allergen, did not significantly increase children’s risk of developing asthma.

“Over the years, the clinical community has struggled to explain the atopic march,” said Dr. Malcolm Sears, founding director of the CHILD Study, a professor of medicine at McMaster University and a researcher at the Firestone Institute for Respiratory Health at St. Joseph’s Healthcare Hamilton.

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