All posts by admin

Penicillin Allergy in Children Substantially Overreported

Most children with parent-reported symptoms of penicillin allergy have negative results for a true allergic reaction to the drug, a new study shows.

“Our results showed that the majority of children had rash and itching as their primary reported symptom of allergy,” the authors write. “Consistent with our hypothesis, all children with symptoms deemed to be low risk for true [immunoglobulin E (IgE)]-mediated drug hypersensitivity ultimately had negative results for true penicillin allergy after the standard 3-tier testing process.”

 Penicillin allergy is the most frequently reported drug allergy, and its reporting affects how clinicians treat affected patients.

According to the authors, although many children present to the pediatric ED with parent-reported symptoms of penicillin allergy, most of these symptoms are low risk for true reaction.

However, because clinicians in the pediatric ED cannot safely and quickly diagnose true penicillin allergy, they avoid giving penicillin to children with a reported penicillin allergy. Thus, many children are not receiving optimal antibiotic treatment because of penicillin allergy misdiagnosis.

The gold standard for diagnosing penicillin allergy comprises a three-tier testing process, in which a percutaneous skin test is followed by more sensitive intracutaneous testing and an oral drug challenge.

More

Half of kids who needed epinephrine didn’t get it before trip to the emergency room

Anyone suffering a severe allergic reaction (anaphylaxis) should receive epinephrine as quickly as possible. A new study showed that even kids who were prescribed an epinephrine auto injector didn’t receive the life-saving medication when they needed it.

The study in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI) examined 408 patient records for children seen in an emergency department (ED) or urgent care (UC) setting for anaphylaxis. The records showed fewer than half the children received epinephrine prior to arriving at the ED or UC even though approximately 65 percent had a known history of anaphylaxis, and 47 percent had been prescribed epinephrine.

“We found kids who had a reaction at home were less likely to receive epinephrine than kids who had a reaction at school,” says allergist Melissa Robinson, DO, ACAAI member and lead author of the study. “Treatment with epinephrine is often delayed or avoided by parents and caregivers. And sometimes antihistamines are used even though they are not an appropriate treatment.”

“Allergists want parents, caregivers and emergency responders to know epinephrine should always be the first line of defense when treating anaphylaxis,” says allergist David Stukus, member of the ACAAI Public Relations Committee and co-author of the study. “Our study found that only two-thirds of those who had an epinephrine prescription had their auto injector available at the time of their allergic reaction. It’s vital to keep your epinephrine with you if you suffer from any sort of severe allergy. Anaphylaxis symptoms occur suddenly and can progress quickly.  Always have a second dose with you and, when in doubt, administer it too.  Anaphylaxis can be deadly if left untreated.”

Anyone seen for anaphylaxis in the ED/UC needs to be referred to an allergist for a follow up visit. Allergists provide the most comprehensive follow-up care and guidance for severe allergic reactions.

More

CHRONIC COUGH

Cough is usually described as chronic if it is present for eight weeks or more. The most common causes of chronic cough are postnasal drainage, asthma and gastroesophageal reflux disease (GERD), or heartburn. Any or all of these may be the cause of chronic cough, in addition to a number of other less common causes. An allergist can help diagnose the cause(s) of your chronic cough.

Allergists have particular expertise in allergic rhinitis (or hay fever) and sinus infections, which may contribute to postnasal drainage, a common cause of chronic cough. Allergists are also experts at diagnosing and treating asthma, which may be present in 25% of patients with chronic cough. Cough from asthma may be associated with wheeze, shortness of breath or chest tightness and may be worsened by colds, exercise, smoke exposure and laughter, among other things. In addition, allergists are experienced in dealing with GERD, or heartburn, which may produce cough.

When to see an allergist:
• If you have a cough that lasts more than eight weeks.
• If your cough is associated with symptoms of asthma.
• If your cough is associated with nasal symptoms or tobacco use.
• If your cough is severe and affecting your quality of life.

More

FDA Approves New Epinephrine Prefilled Syringe

The US Food and Drug Administration (FDA) has approved an epinephrine prefilled syringe (Symjepi, Adamis Pharmaceuticals) for the emergency treatment of allergic reactions (type I), including anaphylaxis, the company has announced.

“Symjepi provides two single dose syringes of epinephrine (adrenaline), which is considered the drug of choice for immediate administration in acute anaphylactic reactions to insect stings or bites, allergic reaction to foods (such as nuts), drugs and other allergens, as well as idiopathic or exercise-induced anaphylaxis,” the company said in a news release.

Each Symjepi prefilled syringe contains 0.3 mg epinephrine.

“With an anticipated lower cost, small size and user-friendly design, we believe Symjepi could be an attractive option for a significant portion of both the retail (patient) and non-retail (professional) sectors of the epinephrine market,” Dennis Carlo, president and CEO of Adamis, said in the release.

“We are currently in the process of exploring all of our commercialization options and in discussions with potential partners in order to facilitate broad patient access to this new epinephrine treatment option and to maximize the value of our important asset. In the interim, we expect to build inventory levels in preparation for an anticipated launch in the second half of this year,” he added.

The company said it is also preparing to submit a second new drug application to the FDA for a junior version of Symjepi.

More

Body weight and Asthma

When you are overweight or obese, most excess weight is usually in the central area of the body, or the midsection. This can reduce your lung volume, making you not able to breathe as well.

Also, the foods you put in your body are an important factor. With obesity, there’s often a pro-inflammatory diet that includes sugary, starchy foods. This can cause your body to release inflammatory hormones, such as leptin, that increase inflammation in the lungs and can lead to asthma symptoms.

Diseases that often occur with obesity, such as gastroesophageal reflux disease (GERD), diabetes and hypertension, have also been found to worsen asthma. So losing weight can also help you reduce the risk of developing these conditions.

Losing 10 pounds can make a huge difference in a person’s asthma symptoms. And as an added benefit, weight loss allows patients to be better able to exercise – obviously the less weight you have, the easier it is to move around. Regular exercise has been shown to improve not only asthma symptoms but also asthma outcomes.

More

Asthma and Obstructive Sleep Apnea

A recent study demonstrates that asthmatic patients with obstructive sleep apnea (OSA) have a greater decline in lung function (FEV1) over time than those without OSA. The natural history of FEV1 decline in asthmatic patients has been reported to be about 40 ml/year, twice the normal age-related decline. Factors associated with the decline in pulmonary function are age, sex, smoking, acute exacerbations, and obesity.

This is also the first study reporting more exacerbations in asthmatic patients with OSA than in patients without OSA. CPAP treatment, however,  can reduce exacerbations in asthmatic patients with OSA. Such exacerbations are also associated with the decline in pulmonary function among asthmatic patients with OSA.

Finally, CPAP treatment was found to alleviate the accelerated decline in FEV1 in asthmatic patients with severe OSA.

 

 

More

Do You Really Have Asthma?

 

Shortness of breath. Wheezing. Coughing. Chest tightness. If you had asthma, you’d know it, right? It turns out that it’s not always that simple, and even your doctor can get it wrong. When Canadian researchers studied more than 700 people who had been diagnosed with asthma in the past five years, they determined that one-third of them didn’t have asthma after all. Their study, published in JAMA, suggests that you might very well be treating a condition you don’t even have—while simultaneously neglecting your real issue.

How could this happen? Lead study author Shawn Aaron, MD, a senior scientist at the Ottawa Hospital Research Institute, suspects that doctors are often relying on symptoms to make a diagnosis, but “asthma” symptoms can overlap with those caused by other health problems. He says that physicians ought to be conducting an objective spirometry test, but some are skipping this step.

The test is simple—you blow into a tube, and the doctor measures how quickly you blow the air out—but only half of the patients in Aaron’s study were given one. “We think that doctors are taking shortcuts,” he says. “Although we can’t say exactly how many were misdiagnosed initially verses how many went into remission, we think a sizable proportion were misdiagnosed from the beginning.”

If you’ve been told you have asthma but haven’t had a spirometry test, see an asthma/immunology specialist to get tested now. “You wouldn’t let a physician give you insulin to treat diabetes without testing your blood sugar,” says Aaron. “Patients are accepting inhalers for asthma all the time without getting appropriate testing to confirm.”

 

More

Epi-pen Recall

The United States has joined the list of countries covered by a voluntary recall of EpiPen auto-injectors for anaphylactic shock on account of a defective part that may result in the device failing to inject a potentially life-saving dose of epinephrine, the US Food and Drug Administration (FDA) announced today.

Mylan, the company that markets the device, announced earlier this month that it was recalling one lot of roughly 80,000 EpiPens in Australia, Europe, Japan, and New Zealand. It reported two instances of the device failing to deliver its dose. The patients in question, however, were treated successfully with backup, functioning EpiPens.

Pressing the EpiPen into a person’s thigh — the prescribed area for administration — causes a needle to penetrate skin and inject epinephrine into muscle. The defective part may require a person to use increased force to activate the needle, or it may prevent the EpiPen from working at all, according to Mylan.

The company announced today that it was expanding the recall not only to the United States, but also other markets in North America and South America.

In the United States, the recall applies to 13 lots of both EpiPen and EpiPen Jr. auto-injectors distributed between December 17, 2015, and July 1, 2016. Patients can receive another EpiPen or an authorized generic version at their pharmacy, Mylan said. In the meantime, they should continue to carry and use their current EpiPen until they acquire a replacement.

Product/Dosage

NDC Number

Lot Number

Expiration Date

EpiPen Jr Auto-Injector, 0.15 mg

49502-501-02

5GN767

April 2017

EpiPen Jr Auto-Injector, 0.15 mg

49502-501-02

5GN773

April 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

5GM631

April 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

5GM640

May 2017

EpiPen Jr Auto-Injector, 0.15 mg

49502-501-02

6GN215

September 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

6GM082

September 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

6GM072

September 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

6GM081

September 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

6GM088

October 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

6GM199

October 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

6GM091

October 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

6GM198

October 2017

EpiPen Auto-Injector, 0.3 mg

49502-500-02

6GM087

October 2017

 

More

Allergy Shots Fast-Track Relief

Conventional allergy immunotherapy requires a considerable time commitment since an allergy shot is given once or twice a week for about five months. The amount of allergen is gradually increased until a maintenance dose is reached, so there is no longer a reaction to the allergen. Research presented by allergist Richard Weber, MD, ACAAI vice president, shows allergists who use accelerated schedules known as cluster and rush immunotherapy find patients experience benefits faster and reach their maintenance dose sooner.

You shouldn t have to put your life on hold to treat your allergies, said Dr. Weber. Accelerated schedules offer patients more flexibility, faster results and a treatment plan they are more likely to follow because it reflects their needs and busy lifestyle.

Rush immunotherapy typically involves a patient getting multiple injections two or three days in a row, but schedules may be varied either shorter or longer to suit circumstances.

Cluster immunotherapy aims to help patients reach a point where they no longer react to the allergen in a few weeks by giving two to four injections 30 minutes apart for one day each week for three weeks.

Research shows accelerated schedules are safe and effective options, and they appeal to patients who do not want to commit to weekly allergy shots for five or six months, said Dr. Weber.

More