This post has an Australian flavour, but hopefully there may be some useful tips for those living in other countries.
Wiki Commons
Anaphylaxis is a dramatic rapidly-evolving allergic reaction. It can become incapacitating in seconds to minutes. Itch, rash, swelling of the lips, tongue or throat, shortness or breath, vomiting and diarrhoea, and fainting or collapse are the hallmarks. Usually there is a combination of these symptoms. Here is a good summary of the effects on the body and the common causes.
The emergency treatment is adrenaline. This substance is called epinephrine in the USA because Parke-Davis Co patented adrenaline in 1900 and registered the name Adrenalin, so the generic name epinephrine was, and still is, used in North America.
Adrenaline is a natural product made in the adrenal glands, but high doses by injection are needed to reverse anaphylaxis.
We often teach medical students that the first three steps in the treatment of anaphylaxis are adrenaline, adrenaline, then adrenaline. Of course, usually one dose only is needed, and maybe 15% need a second dose, but we make the point that adrenaline rapidly reverses the symptoms of anaphylaxis. Antihistamines and steroids are often given also, but when anaphylaxis is diagnosed, it is adrenaline that is effective. More on the action of adrenaline can be read from point 1.6 to 1.11 in this pamphlet.
So, we need adrenaline, and it needs to be injected. A person at risk of anaphylaxis has to CARRY ADRENALINE in an easy to administer form, and know HOW to use it, and WHEN to use it.
A number of devices are available in the world to make it easy to carry adrenaline, either for yourself or for a child. In Australia, the two devices are called EpiPen (by far the most popular), and AnaPen. I will just use the word EpiPen from now on, but the same principles apply for AnaPen.
You do NOT NEED A PRESCRIPTION to buy an EpiPen in Australia. They are a so-called S3 item. The pharmacist can dispense the device with instructions. But buying it this way will be expensive, of the order $100 to $150. The Australian Government subsidises EpiPen if if the first prescription is made by a hospital emergency department, or by an allergist, clinical immunologist, respiratory physician or paediatrician. The cost then drops to $4 for health Card or $35 for non-pensioner. You can only qualify for the subsidised rate if anaphylaxis has occurred. For example, hives and welts all over your body alone, with no other symptoms, does not qualify. Here is a very detailed review of anaphylaxis. Look at Figure 3, this pictorial shows you how anaphylaxis is diagnosed.
To obtain the cheaper prescription the specialist needs to obtain an authority number by phone. Once the initial subsidised prescription is allowed, any doctor in Australia can prescribe repeats further down the track, if they are used, damaged or expired. But the doctor still needs to ring for another authority number.
Now, HOW to use it. Nothing replaces practising with a training device (no needle). Your specialist, GP. or allergy nurse educator can show you. But here are a couple of videos, for EpiPen , and for AnaPen.
Finally WHEN to use it. This is spelt out in your Anaphylaxis Action Plan. You or your child should have one. Here are examples.
There’s more. Lots of information. Here is is very good summary of FAQs about these devices, often called autoinjectors.
If needed, the EpiPen is injected, then you must call the ambulance. clearly, this is 000 in Australia, but you know the emergency number where you live. And remember, if you have a mobile (cellphone) in a foreign country, 112 anywhere will get you to the emergency service. Tell the emergency service “I (or the patient) have (has) used an EpiPen” They then know exactly what the problem is, but will of course ask you lots of questions.
If the anaphylaxis fails to improve after 15 minutes, or there is a relapse later, and you have a second EpiPen, use it.
So, you are now resuscitated in the emergency department, observed say 4 hours, about to be discharged. Is that the end?
No. Make sure you get a replacement EpiPen. Make sure you get referred to a hospital allergy clinic or an allergist for follow-up.
There are other matters. There are psycho-social problems with children. Bullying. Dares (“go on, I dare you, eat it”) As a parent or guardian, these matters are addressed by education, communication, and rapid involvement of teachers if needed.
Then there are more difficult teenage issues. Here is the best summary on this problem I have read. Look through it carefully.
Do you want more training on this subject. ASCIA Australia offers an on-line course. It is excellent.
What about travelling with allergies. Try here for general advice, and here for a written travel plan.
Don’t forget to monitor food alerts in Australia. Here is the best way.
Whew! Anything else. Look, there are a zillion good places on the net for advice. Mayo Clinic and AAAAI in USA, Anaphylaxis Canada with their excellent ‘First Kiss’ video, and the Anaphylaxis Campaign in the UK. Ves Dimov MD has a wealth of information on his blog.
Once you have check the material in this blog, maybe you might have the time to read these Aussie sites carefully
