Tag: Epi-Pen

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Wow. A study finds that only 54% of patients experiencing an anaphylactic episode requiring an ER visit or hospitalization get an epinephrine prescription within a year, and only 22% visit an allergist or immunologist in that time. (via this week’s FARE newsletter)

The article treats this as an education/compliance issue, but I have two big questions:

  1. How many of these patients discussed the incident with their regular doctor? It’s possible that more than 22% followed up with a doctor, just not with a specialist.
  2. How does insurance coverage correlate? If you don’t have insurance, it’s expensive to see a specialist, and expensive to get an Epi-pen (though there are generics now that are a bit cheaper)…especially after you’ve just received a bill for thousands of dollars for the emergency room.

Regarding #2, the study looked at “healthcare claims,” so if I’m reading that correctly, they may have only looked at people who do have insurance. If that’s the case, I wonder if it would be possible to break it down by type of insurance: HMO vs. PPO, do they charge a higher co-pay for specialists, etc. Our current system could do a lot more to encourage preventative care.

For the record: The first thing I did when I got home from that San Diego trip was to order a replacement Epi-Pen, and Monday morning, I called up my allergist to schedule an appointment. But then, I already had an allergist, a prescription, and insurance.

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I’ve been attending San Diego Comic-Con for more than 20 years, but this was the first time I left the con in an ambulance.

I’m OK now. Though I might not be when I see the bill.

It started at lunchtime. We went to New Break, an independent coffee shop near Ralphs, which we’d been to before. They were offering samples of a blended peanut butter banana coffee drink, and while I really wanted to try their blended mint mocha, it was safer to skip something made on the same equipment.

What I decided on was a Mexican Mocha. Generally, these add cinnamon, maybe nutmeg or chili powder. I’ve had drinks with that and similar names, and Mexican hot chocolate, plenty of times. I didn’t ask what was in it, but I had just told them I was allergic to peanuts when I decided to skip the blended drink.

I considered getting it iced, but there was some confusion as to what was included in the lunch deal, so I got it hot instead. That turned out to be a wise decision, since I probably would have started out chugging a few ounces of a cold drink.

Two sips in, the back of my throat and my lips started tingling — a bad sign. I stopped, flagged over one of the baristas, and asked whether there were any nuts in the drink. She didn’t think so, but said she’d check.

I pulled out my emergency kit, took my Benadryl and Pepcid, and set my Epi-Pen on the table in case it progressed. I probably should have just taken it right then, but who wants to spend the afternoon in the emergency room instead of Comic-Con?

Meanwhile, the coffee shop staff had been unable to find ingredients for the mix, and had to call the owner to confirm that yes, there were peanuts in it.

Great.

Over the next hour, it felt like the reaction was under control, so I figured we could return to the convention center. Unfortunately, anaphylaxis can take several hours to run its course, and medication can wear off before it does. Continue reading →

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Allergic Living reports on a peanut allergy treatment study that shows a great deal of promise. Called sublingual immunotherapy, or SLIT, it’s surprisingly simple: Introduce a small amount of peanut protein in drops beneath the tongue each day, slowly ramping it up over time.

After 44 weeks of the daily doses, 70 percent of those getting the peanut powder could tolerate at least 10 times more peanut in an oral food challenge before showing symptoms than they could have at the outset of the study. In a follow-up challenge at 68 weeks, they could tolerate about twice as much again.

It’s a similar premise to allergy shots, which work well for airborne allergens but not for food. And while I’m creeped out by the idea of deliberately ingesting something that I’m used to avoiding because it could kill me (this has to be done under medical supervision!), like so many other things it’s all about dosage. It makes sense that it could work.

The main drawback is that 30% of the participants didn’t show improvement, though the people running the study suspect that it’s a matter of finding the right dosage for each patient.

The article mentions another problem being that the amount tolerated is relatively small: they could eat the equivalent of two peanuts before experiencing allergy symptoms.

I say: Two peanuts? Are you kidding me? I would LOVE to be able to safely eat that much!

So it’s not enough to eat Thai food or PBJ. It would mean I can stop worrying so much about cross-contamination! I’d still carry my epi-pen around, but I’d feel a lot safer about, say, drinking a milkshake at a restaurant that also serves peanut butter shakes, or eating an eggroll at a place that also has kung pao, or eating a chocolate chip cookie that’s been stored on the same shelf as the peanut butter cookies.

One question I do have is how effective it is at reducing sensitivity to similar allergens. Would taking the peanut treatment help someone tolerate legumes better, or are they different enough to require a separate course of treatment?

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Allergies to nuts, grains, vegetables, seafood and milk are common. Allergies to meat? Much less so. But that’s starting to change.

A few months ago I read about adults (author John Grisham in particular) developing an allergy to red meat after being bitten by ticks.* And not just a low-level allergy like your face turning red — we’re talking full-on hives and anaphylactic** shock, the kind of thing that requires you to carry an Epi-Pen to make sure you keep breathing long enough to reach the emergency room.

Researchers have determined that the lone star tick’s bite can cause the body to produce an IgE antibody for a sugar called alphagal, which is found in mammal meat.

The result: from then on, you’re allergic to meat.

CNN calls it mysterious. Allergic Living calls it baffling. It’s certainly weird compared to “usual” allergies, and the fact that the reaction is usually delayed by a few hours makes it hard to diagnose, but we’re ahead of the game in understanding it: Unlike most allergies, we know what causes this one.***

With most allergies, we know the process, but we don’t know what gets the ball rolling to begin with. We know that in people who are allergic to a food, exposure to it causes an IgE antibody reaction that triggers a massive release of histamines that sends the body into some level of shock, but we don’t know why some people have that reaction and others don’t.

There are a lot of ideas being investigated, with varying amounts of supporting evidence, but there’s still nothing we can point to and say: “This caused you to be allergic to nuts” or “That caused you to be allergic to milk.” Advice to parents concerned about keeping their child from developing allergies is all over the map.

That’s why Katie and I are walking in this year’s Walk For Food Allergy. The event raises money for the Food Allergy and Anaphylaxis Network’s mission to support allergy research, spread awareness (you’d be amazed at how many people dismiss allergies as inconsequential or even bogus), provide education and advocacy for people living with food allergies.

Walks are being held across the country over the year. We’ll be walking in the Los Angeles event in October. If you’d like to help, you can donate or join our team here: [Edit: link removed since the event is over.]

Thank you!

*Naturally, this was a few days after I hiked a severely overgrown trail without taking precautions against ticks, so I freaked out a bit, but I also hadn’t found any ticks when I got home from the hike.

**Fun fact: Chrome’s spell-checker doesn’t know “anaphylactic,” and suggested such helpful alternatives as “intergalactic” and “anticlimactic.” Not sure about the former, but I get the impression a lot of viewers suffered “anticlimactic shock” when watching the Lost finale.

***Or at least we know what primes it. There’s still the question of why only some people who are bitten by the lone star tick go on to develop the allergy.