It might be the result of a bee sting or the ingestion of a peanut, but whatever the cause, when anaphylaxis occurs it can be life-threatening.
Anaphylaxis is an acute allergic reaction to a specific antigen (food, pollen, drugs, etc.); it’s the immune system’s whole-body response to the presence of an allergen it perceives as a threat. Symptoms generally occur immediately after exposure and might include respiratory distress, swelling of the lips, eyes and throat, rash, low blood pressure, bleeding and/or vomiting. It can result in cardiac arrest.
Parents of children with known allergies should ensure that their child’s school authorities are aware of the allergy and have a prescription on file for epinephrine in case of emergency. (Epinephrine is the hormone adrenaline and is the primary treatment for anaphylaxis.)
Epinephrine is generally safe, with few adverse effects, if given even when it is not needed.
But according to a recent story in the New York Times, school nurses can find themselves in a horrifying position if a child without such a prescription develops a sudden reaction to an undiagnosed allergy. If they inject epinephrine, they risk losing their nursing license for dispensing it without a prescription. Their only other option is to call 911 and hope the paramedics arrive in time.
Some states have passed laws to enable school caregivers to have epinephrine injectors on hand and to give a shot to any child with an emergency. Mylan, which markets Pfizer’s EpiPen, the most commonly used injector, is lobbying for such federal legislation. The company has lobbied individual state legislatures and has distributed free EpiPens this year to schools.
Sure, it’s a naked grab for market share, but it also makes medical sense.
As The Times reports, Mylan has spent millions on consumer advertising and has hired scores of sales representatives to help promote the product. It’s estimated that EpiPen sales will total $640 million this year, a 76 percent increase over last year, according to one analyst.
A study last year in the journal Pediatrics found that about 1 in 13 children had a food allergy, and nearly 40 percent of those with allergies had severe reactions.
Efforts to make epinephrine more widely available, The Times says, are an acknowledgment of the rising rates of food allergies among children and the handful of deaths from allergies across the country. Some children with known allergies carry their own epinephrine injectors to use themselves, if they’re old enough, or the devices are kept in their school nurse’s office.
It’s unclear why the rate of food allergies among children appears to be increasing. “I don’t think it’s overdiagnosis,” Dr. Scott H. Sicherer, a researcher at the Jaffe Food Allergy Institute at Mount Sinai Medical Center in Manhattan, told The Times.
A Mylan executive said schools were just the first place to make emergency epinephrine injectors more widely available. The company would like to see them as available as defibrillators—in restaurants, airplanes and other public places.
The Food Allergy and Anaphylaxis Network (FAAN) has not taken a position on placing injectors in public places other than schools, and Sicherer wondered about their suitability in settings such as restaurants, where staff might not be able to tell the difference among choking, a heart attack or anaphylaxis.
Next month, Sanofi plans to introduce a rival epinephrine delivery device, and in 2015, Teva may win approval of a less expensive generic version of the EpiPen, according to The Times. Sanofi’s Auvi-Q features voice instructions and Teva’s product, if approved by the FDA would closely mimic the EpiPen design and, like a generic drug, could be substituted by pharmacists even if doctors prescribed the EpiPen.
To learn about the latest developments in food allergies, visit the NAAN site. To learn about the widespread practice of bogus testing, see our blog about free allergy tests. To learn about the early signs of allergy, see our blog here.