Refill Those Epinephrine Auto-Injectors!

By Kelley Lindberg

I heard a surprising and disturbing statistic 2 weeks ago when I was at the Mylan Specialty Allergy Bloggers Summit:

Only 5% of allergy patients are still refilling their prescriptions for EpiPens three years after their last reaction.

That’s scary. The speculation is that the farther you get from your last reaction, the less likely you are to think about it, so the less likely you are to take it seriously.

Really? To me, that’s kind of like someone who drives for three years without a traffic accident, so they stop wearing a seatbelt. Then maybe they stop using their turn signals. Then they stop braking at stoplights. I mean, hey – they’ve been just fine for three years, so obviously all those traffic rules and safety precautions were unnecessary, right?

If you’re vigilant for three years and nothing bad happens, does that mean the danger no longer exists? Or that your vigilance kept you safe?

That’s a no-brainer, right? It usually means that your vigilance kept you safe.

Unfortunately, it’s when you stop being vigilante that you discover just how important your vigilance was. And then it’s too late to get it back.

If you haven’t had an allergic reaction in three years, fantastic! That’s great, and it means you’ve been careful – and probably lucky, too. It doesn’t necessarily mean your allergy has vanished, or that anaphylaxis has suddenly disappeared from the planet. (Wouldn’t that be great, though?) It just means that you’ve managed to navigate your way through the minefield of a food-filled world safely for three years. It doesn’t mean that you won’t step on that landmine tomorrow. Or next month. Or three more years from now.

Even if you’re crazy-careful, accidents still happen. You sit down at a table with a peanut-butter smear you didn’t notice. Your favorite brand of cookie suddenly contains egg for the first time EVER, and it was the one time you didn’t think to read the ingredients. The kid at the next table drops his lunch tray and splatters your milk-allergic child with milk. The pasta dish you’ve ordered at your favorite restaurant for years suddenly contains sliced almonds because the chef got an adventurous urge to jazz things up a bit.

And those accidents are why we need to carry our epinephrine auto-injectors every day, everywhere. Yes, be careful. Yes, read labels. Yes, avoid eating risky foods. But don’t assume that will be enough. You can control your own actions, but you can’t control the people around you, and they cause accidents, too. In fact, I’d be willing to bet that at least half of all food allergy reactions are probably caused by the actions of other people (on airplanes, in restaurants, in school cafeterias, at soccer games, etc.).

So refill and carry those epinephrine auto-injectors. Not because you’re careless. But because you’re careful.

To help make it easier to remember to refill that prescription, Mylan has a nifty app for smartphones that helps you track your EpiPens and get reminders when they’re expiring. Called “My EpiPlan,” the app can also show a how-to training video, display tips and articles about managing allergies, and store your allergy profile to show medical professionals. The My EpiPlan app is available on iTunes and Google Play.

Don’t have time to refill your prescription? Remember, it takes less time to get a refill than it does to go to the ER when you’re in anaphylactic shock. I’m just sayin’.

And right now, you can still get your EpiPens for $0 co-pay (up to $100) by going to the EpiPen website, printing the coupon, and taking it to your pharmacy with a valid prescription. Click here for more info: EpiPen® $0 Co-Pay Offer. 

[I disclose in any communication made by me about EpiPen® (epinephrine) Auto-Injector and/or the Mylan Spcialty Blogger Summit that such communication is at my own discretion and based on my own opinion. I also disclose that my travel expenses were compensated by Mylan Specialty in exchange for evaluation and feedback on information presented during the meeting.]

Stock Epinephrine Laws Save at Least 2 Lives So Far

By Kelley Lindberg

Two school students’ lives were saved this month because of the new law in Nevada allowing schools to keep stock EpiPens on hand. An 8th grader suffered their first allergic reaction during a cooking class, and a school nurse grabbed an EpiPen and administered it while others called 911. Then, two days later, a 9th grader suffered anaphylactic symptoms during lunch, and the school staff administered an EpiPen while 911 was called. (See "EpiPens Saving Lives on School Campuses.")

So far, 27 states have made it legal for schools to keep “stock” epinephrine auto-injectors on hand to use on students who don’t have their own prescriptions. A surprising number of the allergic reactions that happen at school are first-time reactions in students who didn’t previously have an allergy. (You can develop a food allergy at any age, often to foods you’ve eaten without any problems for years.) Since those kids obviously won’t have their own prescriptions, it’s essential for schools to have their own supply on hand.

On November 13, 2013, President Obama signed into law the School Access to Emergency Epinephrine Act, which encourages states to pass laws allowing schools to stock epinephrine and treat students who don’t have a prescription for it. The law enables states that pass such laws to be eligible for grants that will allow them to stock their schools with epinephrine auto-injectors. Fortunately, Utah is one of the 27 states that allow stock epinephrine in schools.

In addition, Mylan Specialty, the company that manufactures EpiPens, has a program called EpiPen4Schools that provides free EpiPens to schools to improve the access to epinephrine for students who have reactions while at school.

The following is the list of the 27 states that allow schools to stock epinephrine auto-injectors as of October of last year (2013). Additional states may be considering similar legislation this year. If your state is on this list, call your local school to make sure they have EpiPens or other auto-injectors on hand. If they don’t, let them know about Mylan’s generous and life-saving EpiPen4Schools program.

• Arizona
• Arkansas
• California
• Colorado
• Florida
• Georgia
• Illinois
• Kansas
• Kentucky
• Louisiana
• Maryland
• Massachusetts
• Minnesota
• Missouri
• Montana
• Nebraska
• Nevada
• North Dakota
• Oklahoma
• Oregon
• South Carolina
• Tennessee
• Utah
• Vermont
• Virginia
• Washington
• West Virginia

It’s a Law! The School Access to Emergency Epinephrine Act Is Official

By Kelley Lindberg

This Thanksgiving, we have another reason to be grateful: on November 13, 2013, President Obama signed into law the School Access to Emergency Epinephrine Act. This law is important because it recommends that states pass their own laws requiring schools to stock epinephrine auto-injectors. Read FARE’s announcement and watch a video of the President signing the bill here: “School Access to Epinephrine.” 

Why is it important to ask schools to stock their own epinephrine? A big reason is because studies show that 20 – 25% of all of the epinephrine injections administered in schools are given to students or adult staff WHO DIDN’T KNOW THEY HAD AN ALLERGY, and who therefore didn’t have their own medication. All too frequently we read about another child who died from a food allergy reaction because they didn’t have immediate access to epinephrine. This law will encourage schools to make sure that scenario never happens to one of their students.

Anyone can develop a food allergy at any time in their lives, often to foods they’ve been eating uneventfully for years. I developed allergies to avocado and brewer’s yeast in my 20s and to barley in my 30s. Then I developed a contact allergy to aluminum and other metals in my 40s. Just because a student hasn’t even shown signs of a food allergy doesn’t mean they won’t develop one. And if it happens at school, the consequences can be tragic.

This new law doesn’t, in and of itself, require schools to stock epinephrine. Instead, it encourages states to pass their own laws requiring stock epinephrine auto-injectors, and it provides incentives for states to do that. It raises the priority level of dealing with food allergies across the nation, pointing a spotlight at this very serious problem and illuminating a very simple way to deal with it – consistent and effective school policies that require epinephrine autoinjectors be added to each school’s medical first aid kits.

Mylan, the pharmaceutical company that makes EpiPen auto-injectors, is supporting this effort with a program called EpiPen4Schools, which allows eligible schools to receive up to 4 EpiPen or EpiPen Jr. auto-injectors at no cost. With this program, any school, no matter how tight their budget, can make sure they have the medication on hand to save lives.

So as you celebrate Thanksgiving this year, remember to offer a word of thanks for the tireless advocates and legislators who worked hard over the last couple of years to make this Act into a Law. And many thanks to President Obama and his peanut-allergic daughter Malia, who recognized the importance of this law and its potential to save lives.

Flying Safely with Food Allergies

By Kelley Lindberg


This week, I’m a guest blogger for Living Without magazine, a magazine about gluten-free and allergy-free living that’s been a great resource for several years. So click on over to their blog to read my new article called “10 Tips for Flying Safely with Food Allergies,” where I share survival tips for airline travel.

While you’re clicking, you might want to read an excellent opinion piece that was published on the New York Time’s website this week, called “EpiPens for All.” Curtis Sittenfeld writes about the need for the national School Access to Emergency Epinephrine Act, which will allow schools to stock ephiphrine autoinjectors that can be used for anyone in an emergency, whether or not they have a prescription. Not sure why that's so important? Sittenfeld explains it well.

See you back here next Monday!

Choosing an Epinephrine Auto-Injector for Your Food Allergies

by Kelley Lindberg

If you have the potential to experience an anaphylactic reaction to an allergen (whether it’s to food, medication, insect venom, or something else), you need to carry at least one (preferably two) epinephrine auto-injectors. So let’s talk about epinephrine choices on the market today.

Epinephrine is a form of adrenaline that is injected into the outer thigh during a severe reaction. The sooner you administer it, the more likely it is that the allergic reaction will be controlled and the patient will survive. The later you administer it, the longer the reaction has to take hold, and the harder it may be to control. It’s practically a miracle drug – it can stop an allergic reaction in its tracks, or at the very least slow it down. It’s been around for decades, and it used to be the only medicine available for asthma attacks.

Physicians are now saying that epinephrine should be considered the first line of defense, rather than an antihistamine like Benadryl, if the reaction appears to be severe. There are no situations where doctors say you should NOT give epinephrine if the patient is experiencing a severe allergic reaction.

A dose of epinephrine may only last about 20 minutes, and a reaction can last much longer, so that’s why you should have two injectors, and why you should always call 911 when you’ve administered one. And the allergic person should be monitored for at least 24 hours after injections, in case a secondary reaction occurs.

There are now four choices of epinephrine auto-injectors, since a generic version has come onto the market:

• EpiPen: For years, the EpiPen has been the gold standard of epinephrine auto-injectors for treating anaphylactic allergic reactions. See www.epipen.com for more information and for a video on how to use one correctly. Your doctor or pharmacist can show you how to use one, using a trainer (which has no needle or medicine in it).
• Auvi-Q: The new Auvi-Q auto-injector is making a big splash lately, because of its new size and shape (rectangular and flat – smaller than a cell phone, so that it fits in a pocket) as well as its audio instructions. Yes, it talks you through the injection process using a small computer chip in the case. See www.auvi-q.com for info and a training video.
• Adrenaclick: Similar to an EpiPen, the Adrenaclick doesn’t require you to jab your thigh – you put it against your thigh and then press firmly. See www.adrenaclick.com for more information and for a training video.
• Generic: A generic version of the Adrenaclick auto-injector is now available. Because it is a generic, some pharmacies and health insurance companies may automatically substitute it for the auto-injector you thought you were getting, so be sure you know exactly which auto-injector you’re getting, and be sure you’re trained to use whatever you get. Apparently this generic is causing some confusion when patients are trained on the EpiPen and then receive a generic auto-injector at the pharmacy, for example. Here is the website for more info: www.epinephrineautoinject.com.

 

Food Allergy Emergencies on Planes are Rare

By Kelley Lindberg


Flying somewhere this summer? Great! A new study, just published in the New England Journal of Medicine, says the odds of having an in-flight medical emergency are rare. (“Outcomes of Medical Emergencies on Commercial Airline Flights,” New England Journal of Medicine, May 30, 3013.)

According to the study, 2.75 billion passengers fly worldwide every year. The authors of the study analyzed records from all calls to a medical communications center from five large domestic and international airlines, which together represent about 10% of global flight passengers. After analyzing the data from more than 7 million flights, they categorized the number and the type of medical emergencies as well as their outcomes (whether or not the passenger had to go to the hospital after landing, whether they were admitted, etc.).

The study shows good news. Medical emergencies are rare, occurring on only 1 out of every 604 flights, affecting only 16 out of every 1 million passengers. According to the authors, “the most common medical problems were syncope [fainting] or presyncope (37.4%), respiratory symptoms (12.1%), and nausea or vomiting (9.5%).”

Allergic reactions were about half-way down the list, lower than cardiac symptoms and seizures. Allergic reactions accounted for only 2.2% of the medical emergencies – that’s just 2.2% of the 16 out of a million passengers. So out of the estimated 744 million airline passengers analyzed during the study period, there were a total of 11,920 medical emergencies reported, and only 265 of them were an allergic reaction. (It doesn’t break down “allergic reactions” into causes, so we don’t know how many were caused by food allergies, environmental allergies, or other.)

And of those 265 allergic reactions, only 12 required the aircraft to be diverted, 40 required transport to a hospital, and only 8 were actually admitted to the hospital. Here’s the best part: there were zero (0) deaths caused by an allergic reaction on the plane.

Remember, that’s out of 744 MILLION total passengers studied during that time frame.

So… airplanes are scary. Peanuts on airplanes are even scarier. But if you consider how many people with food allergies fly every year (and we’re one of those families), these numbers were actually really surprising to me – I thought they would be a lot higher. I actually have an adult friend who had a food allergy reaction on a plane once, so I know it happens. But I’m surprised at how seldom it happens, according to this study. (And my friend knew nuts didn’t agree with her, but had never had a serious reaction before the airplane incident, so she wasn’t as prepared as she might have been had she known.)

What I would love to see now is a study that is more specific to food allergic passengers. I'd like to see how many food-allergic people have flown on airplanes during a particular time period, and then see the percentage of THOSE people who had reactions on airplanes. That would really show us some concrete information. So if there are any researchers out there looking for a good topic... have I got an idea for you!

Please understand, I’m not trivializing the risks of food allergies on airplanes. The risk is DEFINITELY still there. Here is a story of a woman who is severely allergic to peanut allergy who reacts to airborne particles (which may be more severe than some allergic individuals), and her bad reaction on a recent United flight: "Peanut Allergy Causes Emergency Landing, Airline Sued," USAToday.com. As we plan our vacations, we need to remember to be vigilant – take HandiWipes to wipe down the seat tray, seat belt, and arm rests; notify the flight attendant of your allergies (especially if you are traveling alone); keep your antihistamine and epinephrine auto-injectors handy; and pack your own food or snacks for the flight if at all possible.

By staying vigilant and being careful, we can reduce those numbers of medical emergencies even more.

And, if the unthinkable happens and you DO suffer an allergic reaction on the plane, there’s more good news. The FAA mandates that every commercial airline keep an emergency medical kit onboard, and epinephrine is a required medication in that kit. In addition, the study also showed that when the flight attendants asked for medical help over the PA system, physicians were on board 48% of the time, and professional nurses or emergency medical technicians (EMTs) were on board another 25% of the time. So chances are very good that there will be professional medical help on your flight should you need it.

So if travel is in your future, plan ahead and stay vigilant, but rest a little easier knowing that the odds appear to be good that you’ll have a great time.

 

Epinephrine Auto-Injector Carriers

by Kelley Lindberg


When our food-allergic children are young, carrying their epinephrine auto-injectors is easy. We throw them in our diaper bag or purse, and off we go. Our kids are always with us, so it’s easy to keep their medications within reach – our reach.

As they get older, however, there comes a time when we have to transition to having them carry their own EpiPens or Auvi-Q injectors. Whether they’re headed off to soccer games or dance practice, or going to school, birthday parties, or the mall, they need to have their epinephrine with them at all times. For girls, carrying their pens is still pretty simple: girls can carry purses, of which there are about a million cute varieties.

For boys, however, it becomes more problematic. Boys don’t carry purses, or anything remotely resembling a purse. So the question of how to get boys to carry (and keep up with) their meds is a perennial question. Over the years, my own son has changed how he carries his, depending on his age and his current definition of “cool.” He is now 14, which means I expect the next few years to become more challenging as his concept of cool begins to change at light-speed.

Anyway, here are some ideas for carrying EpiPens and Auvi-Q injectors that I’ve found so far. If you have ideas, please share!

Clear plastic case: I keep my son’s EpiPens, Benadryl, and written information about what to do in an emergency in a clear zippered case. That way anyone looking for it can see instantly what’s inside and what to do with it. The cases I use are small makeup bags from Walmart, but a pencil case from office supply stores would work the same way. The case slips easily into things like a backpack, soccer gear bag, or my purse, and it’s just big enough for 2 EpiPens, a small bottle of Benadryl, and his inhaler.

Allergy Apparel EpiBelt: The Allergy Apparel website has a good-looking belt option for carrying EpiPens or Auvi-Q injectors. I think this would be ideal for young kids.

Allergy Apparel Pouches: The Allergy Apparel website also offers several carrying cases for your EpiPens or Auvi-Q injectors, but I especially like the autoinjector pouches that have a clip so you can clip it to a backpack, cooler, belt loop, or lunch box. It comes in a variety of designs, from camo to superheroes. The pouches for the Auvi-Q injector include these with sport designs on them: Sport It Ject Pouch Combo

AllerMates EpiPen Pouch: This pouch from AllerMates has Velcro straps that can loop around a belt or backpack, and it has a strap to hold an inhaler if needed.

RescueShot Epi Case: This case from RescueShot is rugged, made from padded alistic nylon, and can clip to a belt or use your own carabineer clip to secure it to a backpack.

WaistPal and LegBuddy: These unique EpiPen carriers from OmaxCare may be just the solution for your fashion-conscious teen. The WaistPal is a narrow neoprene belt that fits around your waist with one pen in back and one in front, and it is easily hidden under a shirt. The LegBuddy fits around your calf like a holster, hidden under your pant leg.

KozyEpi has a variety of neoprene carriers in different sizes, designs, and shapes for EpiPens and Auvi-Qs.

Fanny pack: My son carried his meds case in a regular fanny pack when he was much smaller, but now that he’s a teenager, he wouldn’t be caught with one. But it was a good option for a while.

String bag: These lightweight bags are handy, and right now they’re the carrying option of choice for my son. Easy to sling over a shoulder, not bulky, and you can toss in a water bottle, snack, or other essentials.

Epi-Essentials Handbags: I’ve focused on boys, since they’re harder to please, but I haven’t forgotten teen girls and women! These Epi-Essentials clutches keep all your medications handy, while doubling as a stylish purse. They’re a little on the expensive side, but might be just what you’re looking for.

Those are just some ideas I’ve found. If you have a favorite option, be sure to share it with us!

UPDATE 4/8/13: Readers have added some great tips:

Alert Wear lets you design your own EpiPen case: Find Alert Wear on Etsy or Alert Wear on Facebook.

Neoprene camera or glasses cases work well too for about 1/3 the cost! You can find many different designs, also.

One reader recommended MediPouch, but their website doesn't appear to be working for me, so let me know if you can find them. www.medipouch.com

 

 

Peanut-Allergic Teen Dies in Massachusetts

by Kelley Lindberg


A couple of times a year, I seem to find myself reporting on another teenager who died after eating a food they were allergic to. Unfortunately, it has happened again: “Allergic Teen Dies After Eating Cookie.”

Cameron Groezinger-Fitzpatrick was a 19-year-old college student, who had come home to Massachusetts for spring break. He’d only been home for 2 hours.

According to the news report, he and his friend went out driving and bought some cookies. The friend tried a cookie, said he didn’t taste any peanuts, and then young Cameron ate one, saying “Ah, the hell with it, I’m sure it’s fine,” according to the friend. He didn’t have his EpiPens with him.

There are the first 3 problems: 1) Cameron was out of the house without his EpiPens. 2) The cookie didn’t have a label, but Cameron risked it anyway. And 3) his friend tried to predict the ingredients by tasting the cookie. (You can’t always taste allergens in a food product. The taste test is NEVER a reliable test, and should never, ever be used to determine the safety of a food. If a food doesn’t have an ingredients label, avoid it. Period.)

Then even more problems occurred: 4) The friend apparently drove Cameron home, instead of to the ER. 5) Cameron hadn’t unpacked his suitcases yet, so his mother couldn’t find his EpiPen. 6) She had one in her cabinet, but it had expired 2 months earlier, so first responders told her not to use it. (Seriously?) A neighbor brought one over and used it, but by then it was too late.

The mother was later told by a doctor that she could have used the expired one, but no one knows if it would have made a difference at that point.

In any crisis, problems and mistakes can stack up in a heartbeat. In this case, all of those problems and mistakes created an unthinkable disaster for this family.

As my friend Suzanne said when she told me about this story, “I don't know what is scarier, the fact that the teen willingly ate something that he had no label for or the mom being quoted to say, ‘I didn't know you could die from nut allergies.’”

So if we can learn anything from this awful experience, it’s that we need to remind our kids (and ourselves) that food-allergic people simply cannot let our guards down, even for a minute. We must stay vigilant, keep our medications with us, read ingredients labels each and every time, and never rely on blind luck. It isn’t really all that difficult to do. But convincing teens to do it seems to be a challenge sometimes.

Once again, I feel compelled to remind us all that most food-allergy deaths occur to teen boys who don’t have their epinephrine auto-injectors with them. Now that my son is a teenager and running with a very social group of friends, I worry more about making sure he has his epinephrine with him. I also remind him about food every time he leaves the house. I know he’s probably tired of hearing me nag him, but I know he needs constant reminders even if they are annoying. Much as we love ‘em, teen boys just aren’t universally known for their common sense and perfect memories.

So I remind him, and make sure he has his meds, and show him articles like this one that really hit home. My heart goes out to Cameron’s family and friends. And I hope that his experience will help reinforce our own children’s commitment to staying safe.

Auvi-Q Epinephrine Injector

by Kelley Lindberg


There’s a new sheriff in Allergy Town.  He’s packing epinephrine, and he’s not afraid to talk about it.

And that’s what makes him cool.

Auvi-Q is a new epinephrine auto-injector from Sanofi. It’s about the size and shape of a smartphone (so it can slide easily into a pocket), but what really sets it apart is that fact that it has a voice. It will literally talk you through the process of administering the epinephrine. When you take it out of its plastic case, the voice guide automatically begins to tell you what to do (remove the red plastic guard, place against outer thigh, press and hold for 5 seconds).

The Auvi-Q also has visual cues, like lights that point you in the right direction and let you know when the injection is finished. And the instructions are also printed on the case, for people who are hearing impaired or if you’re somewhere too noisy to hear the audio instructions, like a night club or concert.

The FDA approved the Auvi-Q in August 2012, and it’s now available in U.S. retail pharmacies across the country. You need a valid prescription from your healthcare provider to obtain one. They are sold 2 to a package, and each pair comes with a non-active demo unit that you can use to practice with or train other caregivers with. The Auvi-Q also comes in 2 dosages: 0.15mg for patients who weigh 33 – 66 pounds, and the adult version of 0.3mg for people who weigh 66 pounds or more. It hasn’t been studied in children smaller than 33 pounds.

Check out the Avui-Q website for more information about Auvi-Q, and be sure to watch the Auvi-Q demo video. While you’re there, you can also sign up for their Let’s Talk Auvi-Q Support Program, which includes savings offers that they say will make it so that “most patients will pay no more than $25 for an Auvi-Q prescription.”

Here is a link to the Sanofi press release describing Auvi-Q.

I haven’t seen one in person yet, so leave a comment if you have one and what you think about it.

And I welcome this new sheriff to town. We can never have too many good guys on our side in the battle against food allergies.

 

Another Heartbreaking Food Allergy Death of a Teen

by Kelley Lindberg


It’s a tragic way to start a new year. The Daily Mail website reports that William Luckett, a 15-year-old boy in Great Britain, died on December 29 after eating two bites of take-out food from a Chinese restaurant. He ordered spare ribs that were cooked in a peanut sauce. He did not have his EpiPen with him. (See “Nut Allergy Teenager, 15, Dies After Two Bites of Chinese Takeaway Spare Ribs Marinated in Peanut Sauce.”)

The family says he had ordered them before without problems, and that they didn’t know the ribs were cooked in peanut sauce. The restaurant says they were clearly labeled on the menu as having nuts. The restaurant owner even added, 'If a customer has allergies then they have to tell us and we are very careful not to include what they are allergic to in the dish. I know how important it is because my son has allergies.”

How awful for the boy’s family. And how awful for the restaurant owner, cook, and servers.

The Daily Mail also reports that another U.K. teen, 18-year-old Emma Egerton died after eating Indian food cooked in nut oil and containing ground almonds in December. And another student, 22-year-old Preethi Koshy, spent three days on a life-support machine last year after eating a “nut-free” cake that actually contained 55% peanuts. (Fortunately, Koshy recovered.)

These deaths and near-deaths are tragic, and I hope that someday, with new advances in food allergy treatment and cures, these stories will stop. In the meantime, if there is anything we can learn from them, it must be to:

1. Never assume, and always check! (Even if you’ve eaten that food before.)

2. Always carry your EpiPen.

We’re often told the most common victims of anaphylactic death from food allergy are teenagers who aren’t carrying EpiPens. If you know any teens who are food allergic, please show them this article. Carrying an EpiPen may not be “cool” and it might be a little inconvenient, but it’s not nearly as inconvenient as dying. Please don't leave your friends and family mourning a promising life cut short.

The hearts and prayers of the entire food allergy community go out to the families of these unfortunate young people.

Getting Rid of Expired EpiPens

by Kelley Lindberg


Have you checked your EpiPens lately to see if they’ve expired? It’s important to replace EpiPens promptly when they expire, so that the potency of the medicine isn’t compromised.

But now that you’ve replaced your EpiPens with new ones, what should you do with the expired ones? Those sharp needles and medication can be dangerous if they fall into unsuspecting hands, so it’s important to get rid of them safely.

The best way to dispose of expired or used EpiPens varies, depending on where you live. In general, there are a few options. You will probably need to call around to see what works best in your area. If one of the options you try charges a fee, try another option first. And in many cases, even if the place you call won’t take them, they can probably refer you to someplace that does, so ask.

Here are some places to try:

• The pharmacy where you got the EpiPen.
• Your allergist’s or doctor’s office.
• The local hospital or urgent care facility.
• A local medical lab.
• The police or fire department. In Layton, Utah, the police department has a large white box near the north doors where you can deposit medications to be disposed of safely. Medication disposal is becoming a big enough problem these days that many police departments are starting to take a proactive role in helping dispose of medications safely.
• Grocery stores or pharmacies sometimes host “Clean Out Your Medicine Cabinet” drives where they collect old meds. Call your local stores to see if they are planning this kind of drive anytime soon.

In all cases, try to put the EpiPen back in its original plastic case to prevent the needle from sticking you or anyone else.

If you’re out of options and can’t find someplace to dispose of the medication safely, you can put it in household garbage. But experts recommend that you drop the EpiPen in a plastic bottle (like a juice or soda bottle), tape the lid securely on, and label the bottle with a permanent marker saying “Sharps.” Then dispose of the EpiPen out of reach of children.

Here’s another helpful idea I got from a friend: before she throws away her expired EpiPens, she gets an orange and “practices” injecting the EpiPen into the orange. Of course, if you do this, be incredibly careful so that no one gets stuck, and throw the orange away immediately so that no one accidentally eats it!

If you know of someplace in your area that takes expired or used EpiPens, use the Comments to let us know about it!

Back to School Shopping List for Allergies

by Kelley Lindberg


It’s amazing how much power and emotion are packed into those magical “three little words”:

“Back to school.”

Some folks (mostly parental-type folks) are giddy with happiness. Others (mostly kid-type persons) are less enthusiastic. Still others (my son) become overwhelmed with despair and gloom.

Like it or not, the stores are packed with Back-to-School supplies now, and it’s time to stock up.

Of course, those of us with food-allergic kids have to add a few extra items to our back-to-school shopping lists. So if you, too, are preparing a back-to-school shopping list for the food-allergic student in your life, don’t forget these essentials:

• Epinephrine Injectors – Have yours expired? It may be time to get new ones. I get a pair to leave at the school’s office, and a pair for him to carry in his lunch box (along with instructions). Be sure you check the expiration dates on the new ones to make sure they’ll last through the school year.
• Antihistamine (Benadryl, Zyrtec, Claritin, Allegra, etc.) – Like with the EpiPens, I put some in the office, and some in his lunch box. Again, check the expiration dates.
• Lunch Box – He always takes a home lunch and sits with his food-allergic buddy.
• Thermos for hot foods – He lives on noodles, but these are great for safe soups, chili, and casseroles, too.
• Food Containers – Invest in a few plastic containers that will fit inside the lunch box for things like salads, dressings, sandwiches, fruit, etc. They’re more economical, more ecological, and far less “squishable” than plastic baggies.
• Beverage Thermos or water bottle
• Handi-Wipes – I always put a couple of individually wrapped Handi-Wipes in his lunch box so he can clean off the table if he needs to.
• Food Allergy Action Plan – Make an appointment with your child’s allergist or pediatrician now, and have them fill out a Food Allergy Action Plan to give to your school. I attach a current photo of my son, and then I make a few color copies of it. I give one to the school office, one to each of his teachers for them to hang in their classroom, and one to the school cafeteria manager for her to hang in the kitchen, so that the lunch workers will know him and recognize him if he has a reaction. If your doctor doesn’t have their own form, use this Food Allergy Action Plan from FAAN (Food Allergy and Anaphylaxis Network). It’s probably the most widely used form in the U.S., and most doctors recognize and use it.
• Medical ID Bracelet or Necklace – If your child will wear one of these, it’s a great idea. It is a visual reminder for teachers of your child’s allergies, and it’s an instant help for EMTs who might be summoned if your child has a reaction.
• Clean-up Wipes – I always take a couple of tubs of wipes to his teacher, for cleaning desks. (I usually take tubs to the teacher throughout the year, too, since they often go through them quickly.)

Do you have any other great suggestions for allergy-aware back-to-school supplies? Be sure to share them with us!

Happy shopping!

Make a Call, Save a Life (Support Senate bill “S. 1884”)

by Kelley Lindberg


It’s scary to think your child could have an anaphylactic reaction to food when you’re with him or her. It’s even scarier to consider what might happen if they have an anaphylactic reaction at school. Will anyone be able to find and administer the epinephrine that can save your child’s life?

Last January, Amarria Johnson, a first-grader in Virginia, died from a peanut reaction at school. The school had told her mother she had to keep her EpiPen at home, so none were available at the school to save little Amarria’s life. This tragedy could have been easily prevented.

U.S. Senate bill 1884, the School Access to Emergency Epinephrine Act, is life-saving legislation that can help prevent more food allergy tragedies at school. This bill would encourage states to ensure that epinephrine is available in schools and that school personnel are trained to administer it in an emergency.

This is even more important for kids that may have a food allergy reaction for the first time – since allergies can develop at any time during an individual’s life, you may not know your child is allergic until they’re having a deadly reaction. In those cases, their life may depend on the school having its own epinephrine auto-injector available.

The state of Virginia has already enacted its own law consistent with S. 1884. But we don’t want other states to wait until they lose one of their own students before they recognize the importance of asking schools to stock their own epinephrine. That’s why the Food Allergy and Anaphylaxis Network (FAAN) has been working with several Senators to build support for S. 1884. So far, about 35 Senators, both Republican and Democrat, have signed on as co-sponsors of this important bill. And the following organizations have all joined FAAN in endorsing S. 1884:

• The American Academy of Allergy, Asthma and Immunology 
• The American Academy of Emergency Medicine 
• The American Academy of Pediatrics 
• The American College of Allergy, Asthma and Immunology 
• The National Association of Elementary School Principals
• The National Association of School Nurses 
• The Utah Food Allergy Network (UFAN)

We in the food allergy community can help this bill become a law by letting our Senators know how important we think it is. All it takes is a one-minute phone call.

In Utah, UFAN is targeting Senator Hatch, who is not yet a co-sponsor. But he has two staff members responsible for recommending whether he should co-sponsor the legislation: Hayden Rhudy and Karen LaMontagne. After several of us called Hatch’s office this morning, his assistants have directed us to contact one of these two staff members directly so that they can see how important this legislation is to Utah children.

So take a quick minute and call one of these staff members. It’s easy:

1. Call 202-224-5251 and ask for Hayden first. If she’s not available, ask for Karen.
2. Just say you’re a Utah voter and that you’re calling to ask Senator Hatch to strongly support S. 1884, the School Access to Emergency Epinephrine. That’s all you have to do!
3. If you leave a voicemail, you can send a quick email follow-up, too:

        Hayden_Rhudy@hatch.senate.gov
        Karen_LaMontagne@hatch.senate.gov

When I called Hatch’s office earlier this morning, the assistant who answered said that Hatch isn’t necessarily opposed to it, but that he might prefer that it be a state law instead of a federal law, so he wondered if that’s why Hatch hasn’t signed on as a co-sponsor.  But I reminded him that it’s not really an education issue but a health issue, and that I really hope Hatch doesn’t oppose it when it goes to a vote. I also reminded him that statistically Utah is up to 1 food allergic kid in every classroom. The assistant seemed understanding and supportive, and he suggested I also contact my Utah legislators.

If you can, call as soon as possible so that they receive a significant number of calls. A few UFAN members have already called this morning, and we’ve been told by Hatch’s assistants that the more calls they receive, the better it is for our cause – it lets the Senator see just how important his constituents believe this bill is. We’d love to have at least 50 calls, and 100 would be even better!

So take just a minute out of your busy schedule and make a fast phone call.

Then tonight when your spouse or a friend asks “What did you do today?” you can honestly answer:

“I helped save a child’s life.”

Two Food Allergy Deaths in Atlanta

by Kelley Lindberg


Last month, in two separate incidents, two different teenage boys in Atlanta died from apparent allergic reactions to food.

This is the type of news parents everywhere dread.

The first boy was a 15-year-old who was shopping with his aunt. While she shopped, he went out to her car to grab a chocolate chip cookie. He didn’t realize there were traces of peanuts in the cookie. After eating the cookie and realizing what it contained, he ran to a nearby McDonalds to rinse out his mouth, then took an over-the-counter medicine. Neither did enough to stop the reaction. By the time he was transported to a medical center, then flown to a hospital, it was too late. He didn’t carry an EpiPen even though he knew about his allergy, because he thought he was cautious enough. (“Teen Dies After Eating Cookie Containing Peanut”)

The second boy was a college student at Kennesaw State University, who apparently had a reaction to something he ate at the school’s Commons Student Culinary Center. He ate a meal there, then left. Then he returned to the Commons “in distress” and called 911. By the time he got to the hospital, he was dead. According to people who knew him, he was aware of his allergies and had used EpiPens “often.” But no one knows why he didn’t have one with him at the cafeteria that day. (“KSU Student Dies After Apparent Allergic Reaction”)

My heart bleeds for those parents, families, and friends. I can’t imagine anything worse.

Members of the American Academy of Allergy, Asthma & Immunology and the Food Allergy and Anaphylaxis Network (FAAN) maintain a registry of fatalities from food allergy reactions so that they can try to identify patterns in these deaths, such as the type of food, where it was consumed, and the age and gender of the affected individual. The registry isn’t a systematic or complete record of all fatal food-induced allergic reactions in this country, but it helps show where more education is needed to help prevent these fatalities.

One of the patterns they’ve noted multiple times is that the largest percentage of fatalities is usually teenage boys who were allergic to peanuts or tree nuts, who consumed food away from home and didn’t have their epinephrine with them at the time.

Neither of the boys in Atlanta had an EpiPen.

As my own son enters his teenage years, I worry about him more and more. He’s forgetful. He’s image conscious. He’s always in a hurry. He doesn’t want to be bothered by having to carry things, keep up with things, or wear something bulky on his belt.

He’s a typical teenage boy.

That’s bad enough, by itself. But when a teenage boy has a severe health issue that he has to maintain, whether it’s food allergies, diabetes, epilepsy, or any other disease, it gets that much worse.

The only thing I can do is keep educating him, keep reminding him of the severe consequences of not taking his EpiPen with him everywhere he goes, show him stories like these, and engage him in finding his own solutions to the problem of how to carry those EpiPens, how to ask about ingredients, how to say no. I have to do everything I can to prepare him and educate him, and then trust him to make the right decisions even if I’m not there.

But I still hug him tighter every day.

Back to School Food Allergy Shopping List

by Kelley Lindberg


Don’t ask me where the summer has flown to, but it’s already back-to-school shopping time! This does NOT make my son happy. The mere sight of all those brightly colored school supplies lined up on the shelves of all the local department stores sends him into a deep blue funk. But whether he likes it or not, school is just around the corner, and I’m stocking up on paper and pens.

Of course, I also have to stock up on a few extra items because of his food allergies. So if you, too, are preparing a back-to-school shopping list for the food-allergic student in your life, don’t forget these essentials:

• Epinephrine Injectors – Have yours expired since last year? It may be time to get new ones. I get a pair to leave at the school’s office, and a pair for him to carry in his lunch box (along with instructions). (EpiPens and Twinject are the two brands used in the U.S.) Be sure you check the expiration dates on the new ones to make sure they’ll last through the school year.
• Antihistamine (Benadryl, Zyrtec, Claritin, Allegra, etc.) – Like with the EpiPens, I put some in the office, and some in his lunch box. Again, check the expiration dates.
• Lunch Box – He always takes a home lunch and sits with his food-allergic buddy.
• Thermos for hot foods – He lives on noodles, but these are great for safe soups, chili, and casseroles, too.
• Food Containers – Invest in a few plastic containers that will fit inside the lunch box for things like salads, dressings, sandwiches, fruit, etc. They’re more economical, more ecological, and far less “squishable” than plastic baggies.
• Beverage Thermos or water bottle
• Handi-Wipes – I always put a couple of individually wrapped Handi-Wipes in his lunch box so he can clean off the table if he needs to.
• Food Allergy Action Plan – Make an appointment with your child’s allergist or pediatrician now, and have them fill out a Food Allergy Action Plan to give to your school. I attach a current photo of my son, and then I make a few color copies of it. I give one to the school office, one to each of his teachers for them to hang in their classroom, and one to the school cafeteria manager for her to hang in the kitchen, so that the lunch workers will know him and recognize him if he has a reaction. If your doctor doesn’t have their own form, use this Food Allergy Action Plan from FAAN (Food Allergy and Anaphylaxis Network). It’s probably the most widely used form in the U.S., and most doctors recognize and use it.
• Medical ID Bracelet or Necklace – If your child will wear one of these, it’s a great idea. It is a visual reminder for teachers of your child’s allergies, and it’s an instant help for EMTs who might be summoned if your child has a reaction.
• Clean-up Wipes – I always take a couple of tubs of wipes to his teacher, for cleaning desks. (I usually take tubs to the teacher throughout the year, too, since they often go through them quickly.)

Do you have any other great suggestions for allergy-aware back-to-school supplies? Be sure to share them with us!

Happy shopping!

Emergency Kits and Food Allergies

by Kelley Lindberg


It’s been a bad year for natural disasters. Earthquakes, tsunamis, volcanoes, tornadoes, wildfires, flooding… and we’re just barely starting hurricane season.

Until we’ve lived through one, it’s hard to imagine what we’d do in a natural disaster. But it’s safe to say that thinking calmly and rationally might not be our first reaction – at least for most of us! (Okay, at least for me.) What if you only had a few minutes to throw things into a suitcase and escape? What if you don’t even have that much time?

Every time I see a news report talking about people being evacuated to a shelter, I worry about the people arriving who have food allergies. I doubt the shelters are equipped to handle people with food allergies – especially multiple food allergies. Perhaps they are – maybe they have meals set aside for people allergic to gluten, milk, eggs, and nuts, for example. But more likely, they’re making do with whatever they have on hand, and the cross-contamination alone must be a constant threat.

That’s why experts say it’s important to prepare an emergency evacuation kit before there’s a natural disaster, so that you don’t forget something vital, like medications, phone numbers, safe food, and cash.

There are lots of websites you can visit to find recommendations on how to pack an emergency kit, such as:

• http://www.nationalterroralert.com/72hourkit/
• http://bereadyutah.gov/family/documents/72-hourchecklistpdf.pdf

But one thing these sites might not mention is to pack essentials for your food allergic family member. So when you’re assembling an emergency kit, remember to pack:

• EpiPens (or TwinJect)
• Antihistamine (Benadryl, Claritin, Zyrtec, Allegra, etc.)
• Safe food (Sunbutter, gluten-free crackers, beef jerky, or whatever will sustain you for 3 days)
• Copy of your medical insurance card
• Phone numbers of important people, including relatives and doctors

If you’ve got these things with you, at least you’ll have one less thing to worry about. One emergency at a time is enough.

Signs of a Food Allergy Reaction

by Kelley Lindberg


How do you know if someone is having an allergic reaction to a food?

Knowing the most common signs of a reaction can help you identify it correctly. Here are the most common symptoms to look for in a food allergy reaction, according to the Food Allergy and Anaphylaxis Network (FAAN):

• A tingling sensation in the mouth
• Swelling of the tongue and the throat
• Difficulty breathing
• Hives
• Vomiting
• Abdominal cramps
• Diarrhea
• Drop in blood pressure
• Loss of consciousness

Typically, symptoms appear within minutes of eating the food, but sometimes it can take up to two hours for symptoms to appear.

Don’t expect to see all of those reactions at the same time. Many reactions may only display one or two of those symptoms. If you spend a lot of time with someone who has food allergies (such as a student in your class, a co-worker, or a scout in your troop), ask what their most common symptoms are and watch for those. But beware – allergic symptoms can vary from episode to episode, so try to be familiar with all the symptoms and watch for them.

Parents are usually the best at reading the early signs of a reaction, of course. For example, my son’s friend often gets itchy spots on the back of his neck as the first sign of an allergic reaction. That’s the kind of thing a stranger probably wouldn’t notice, but his mother can see that little tell-tale before anyone else can. But her son’s reaction can rapidly progress to include cramping, a rash near his mouth, welts if there was skin contact, or vomiting. All of these are signs I know to watch for if he’s staying at our house. They’re also signs I watch for in any child, now that I know they are common food allergy symptoms. Even if you don’t know someone well, being familiar with all the signs of an allergic reaction can help you identify what might be happening.

Now that you know what to look for, what do you do if you suspect someone is having a reaction? It’s pretty simple:

1. Administer the person’s medication immediately. Usually you give them an antihistamine first (Benadryl, Allegra, Zyrtec, Claratin, etc.). If the symptoms get worse, administer the person’s epinephrine injection (EpiPen, Twinject, or Adrenaclick). Don’t worry, The instructions are usually printed right on the injector.
2. Call 911 or a doctor and tell them you believe the victim is having an allergic reaction to food. Tell them what medicine you gave them.
3. Get the person to medical help, and stay with them and watch them for 24 hours (even if they’re sent home). As the medication wears off, the reaction can come back, so it’s important to watch them for recurrences.

With some extremely sensitive people, it’s critical to immediately administer epinephrine without waiting to see if an antihistamine works. If the victim tells you to use the epinephrine right away, don’t hesitate.

Remember, I’m not a medical professional, so don’t take this information as medical advice – I’m just giving you some tips. Talk to your own allergist or medical provider for information specific to your own condition. And for more information about food allergies, their symptoms, their treatment, and other aspects, see FAAN’s website, http://www.foodallergy.org/. For information on epinephrine injectors, see http://www.epipen.com/, http://www.twinject.com/, or http://www.adrenaclick.com/.

Back-to-School Shopping List for Food Allergies

by Kelley Lindberg


It’s official – it’s back-to-school shopping time! My son cringes every time we walk past a back-to-school display or see a back-to-school ad. He nearly went into hysterics when the Land’s End Back-To-School catalog showed up in our mailbox a couple of weeks ago. He’s watching the days on the calendar count down like a condemned man choosing his last dinner from a menu.

Despite his protests and heartfelt denials, school is still coming, and we still have to stock up on those supplies. Of course his back-to-school list includes a few extra items because of his food allergies. So if you are preparing a shopping list for a food-allergic student, don’t forget these essentials:

• Epinephrine Injectors – I get a pair to leave at the school’s office, and a pair for him to carry in his lunch box. (EpiPens, Twinject, and Adrenaclick are the three brands used in the U.S.) Be sure you check the expiration dates to make sure they’ll last through the school year.
• Benadryl – Like with the EpiPens, I put some in the office, and some in his lunch box. Again, check the expiration dates.
• Lunch Box – He always takes a home lunch and sits with his food-allergic buddy.
• Thermos for hot foods – he lives on noodles, but these are great for safe soups, chili, and casseroles, too.
• Beverage Thermos or water bottle
• Handi-Wipes – I always put a couple of individually wrapped Handi-Wipes in his lunch box so he can clean off the table if he needs to.
• Food Allergy Action Plan – Make an appointment with your child’s allergist or pediatrician now, and have them fill out a Food Allergy Action Plan to give to your school. I attach a current photo of my son, and then I make a few color copies of it. I give one to the school office, one to each of his teachers for them to hang in their classroom, and one to the school cafeteria manager for her to hang in the kitchen, so that the lunch workers will know him and recognize him if he has a reaction. If your doctor doesn’t have their own form, use this Food Allergy Action Plan from FAAN (Food Allergy and Anaphylaxis Network). It’s probably the most widely used form in the U.S., and most doctors recognize and use it.
• Medical ID Bracelet or Necklace – if your child will wear one of these, it’s a great idea. It is a visual reminder for teachers of your child’s allergies, and it’s an instant help for EMTs who might be summoned if your child has a reaction. Try American Medical ID (my son likes their sports band bracelets) or Sticky J Jewelry (some amazingly cute childrens' bracelets, including leather and hemp, beaded, etc.), but there are several online vendors who make these types of medical ID bracelets.

Do you have any other great suggestions for allergy-aware back-to-school supplies? Be sure to share them with us!

Happy shopping!