Standard Protocol for "Asthma Action Plans"

[LinksEtc]

"Interview with Dr. Hemant Sharma"
http://home.allergicchild.com/interview-with-dr-hemant-sharma/

Prior studies suggest that more than a third of children with food allergies also have asthma, and up to 8% of asthmatic children have a food allergy.

Asthma is another risk factor for fatal food allergy reactions.  This might be explained by delayed use of epinephrine since people with asthma might often reach first for their inhaler when they are experiencing breathing difficulty, and overlook other signs of anaphylaxis.

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"Shortness of Breath or Wheezing After Eating"
http://foodallergies.about.com/od/foodallergysymptoms/a/Shortness-Of-Breath-Or-Wheezing-After-Eating.htm

If you recently ate, have known food allergies, and are feeling like you are having a severe asthma attack, use your epinephrine auto-injector (Epi-Pen or Twinject). You may or may not be experiencing anaphylaxis –- but your auto-injector will stop both anaphylaxis and an asthma attack. Your inhaler will not help if the problem is anaphylaxis.

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"Teen Food Allergy Deaths: Lessons from Tragedy"
http://allergicliving.com/index.php/2010/07/02/food-allergy-teen-tragedies/

While Chantelle's death is considered the more evident case of anaphylaxis (to peanut or nut in the square she ate), each girl assumed she was having an asthma attack. In the panic of breathing distress, both Chantelle and Christina reached for a puffer, but neither administered an epinephrine auto-injector, which would have been effective in an anaphylactic episode and also in severe asthma.

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[LinksEtc]

"Taking Asthma Care To School"
http://www.k12.wa.us/healthservices/pubdocs/AsthmaManual.pdf

appropriate asthma management plans (both ECP and IHP/ 504) will be developed by the school nurse.

The written asthma management plan developed by the school nurse should include:

Co-morbidities that may affect asthma management (i.e. anaphylaxis and need for emergency epinephrine in acute unresponsive asthma treatment)

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"Foods That Trigger Asthma"
http://www.asthmaallergieschildren.com/2013/12/13/foods-that-trigger-asthma/

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http://www.allergyhome.org/handbook/table-of-contents/food-allergy-at-risk-groups/asthma/

If your child has difficulty breathing during an allergic reaction, give the auto-injector before giving asthma medication.  Keep in mind that epinephrine will treat severe asthmatic symptoms as well as anaphylaxis.

[LinksEtc]

See, this must be my problem in getting this idea "heard" 

"Inside the Box: People don't actually like creativity."
http://tinyurl.com/mtukm3m


Just kidding, sort of.

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Also, the whole "patient finding info on the internet thing" is problematic.

Docs helping patients to surf the internet

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Tweeted by @helenbevan

"Culture Eats Strategy – Innovation Psychology Explored"
http://linkis.com/com/MFlmK

Deep knowledge of a subject is of course crucial, but emergent innovation usually comes from the integration of ideas from different areas.  This is where T-shaped innovators, or expert generalists become crucial to the process.

[LinksEtc]

Reminder time ... this thread is not medical advice.  If you have questions about stuff in this thread, talk to your own doctor(s)!!!  Follow the allergy and asthma plans your docs give you!  I'm no expert, only a mom.

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"Asthma Tragedy At School Reveals Flawed Board Policy, Ryan's Law Proposed"
http://blog.onespotallergy.com/2013/12/asthma-tragedy-at-school-reveals-flawed-board-policy-ryans-law-proposed/

expanding labeling indicates use of an EpiPen for temporary emergency treatment of severe life-threatening asthma attacks. That is, when the puffer isn't providing relief or can't be administered (for example with an unconscious patient), injecting the patient with an EpiPen is the treatment to provide.

[LinksEtc]

Study re: pre-hospital use of Epi in anaphylaxis cases

"Prehospital Management of Pediatric Anaphylaxis"
http://www.jems.com/article/patient-care/prehospital-management-pediatric-anaphyl

Not every anaphylaxis patient presents the same. Patients often present with respiratory distress alone, which is common to many childhood illnesses. The study states that a larger percentage of the patients had a history of asthma. With this pertinent information, the procedures of albuterol nebulizers and oxygen would be the protocol followed.

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"Respiratory Manifestations of Food Allergy"
http://pediatrics.aappublications.org/content/111/Supplement_3/1625.full.pdf

A recent investigation summarized data from a voluntary registry of 5149 individuals, mostly children, with peanut and/or tree nut allergy.¹² Respiratory reactions, including trouble breathing, wheezing, throat tightness, and nasal congestion, were reported in 42% and 56% of respondents as part of their initial reactions to peanuts and tree nuts, respectively. One half of the reactions involved >1 organ system, and registrants with asthma were significantly more likely than those without asthma to have severe reactions (33% vs 21%; P < .0001).

[LinksEtc]

I tried to resist, really I did.  I brought no printouts to the pulmonary appointment, I was going to be the good mom and just talk about dd.

Fate.  The doc starts complaining how he doesn't like the changes made to their asthma action plans ... the hospital didn't consult their expert pulmos to the extent that they should have in his opinion  .  We get on the subject ... carefully watching my approach so as not to offend or look like google-mom ... we had a good-natured, albeit short, conversation on this topic (I drew a beautiful 10 second sketch).

This is a famous place for pulmo.  He didn't seem to knock it on theory, but it just didn't seem to have a lot of relevance to him because he estimated only about 2% of his patients had both FA (with epi rx) & asthma.  I didn't push it, but interesting to hear some of his perspective on changing asthma plan formats.

[LinksEtc]

http://blawged.blogspot.com/2013/01/10-things-i-learnt-about-preventing.html?spref=tw&m=1

At the end of the lesson, Raymond got up and left the building. At the bottom of the stairs he collapsed. The trained first aid officer was on the scene very quickly and fetched asthma medication. Raymond said "EpiPen, EpiPen".

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"2 MORE DEATHS LINKED TO SULFITE IN FOOD ARE UNDER SCRUTINY"
http://www.nytimes.com/1985/09/05/us/2-more-deaths-linked-to-sulfite-in-food-are-under-scrutiny.html

If sulfites are fully established as the cause of the asthmatic attacks, the two cases will bring to 15 the number of confirmed deaths associated with the preservative since 1983.

[LinksEtc]

Latex-Fruit Syndrome

Strange Symptom Last Night

[LinksEtc]

http://www.amazingandatopic.com/2012/09/anaphylaxis-posing-as-asthma.html

I was just standing there, looking at her chest suck inward, perplexed, not knowing what to do.  The problem was, we were looking at this from purely a breathing/asthma perspective and forgetting that we are assessing an allergic child, here.  We were missing the bigger picture.

[LinksEtc]

"Auntie, I've taken my asthma puffer, but I still can't breathe and I'm scared"
http://www.allergynet.com.au/auntie-ive-taken-my-asthma-puffer-but-i-still-cant-breathe-and-im-scared/

If Billy had a known severe food allergy and carried an EpiPen, and got sudden life-threatening asthma as described above, even without other features of anaphylaxis, you should inject him with the EpiPen, give him the First Aid Plan for asthma, and call the ambulance.

[LinksEtc]

http://www.ottawaasg.com/OASG2006/Downloads/QCMay06.pdf

In his report, Dr. Miron also emphasized the complexity of treating a severe asthma crisis in a person with life-threatening allergies. Should a person experiencing severe bronchospasm use the epinephrine auto- injector first and then the bronchodilator, or vice-versa?

evaluate the pertinence of using the epinephrine auto-injector as the first-line medication for severe brochospasm that could lead to death in those with asthma and food allergies

[LinksEtc]

http://cornwalls.com.au/sharing-knowledge/legal-updates/a-venture-into-dangerous-territory-an-overview-of-the-responsibilities-of-schools-and-teachers-in-off-campus-care-for-students-with-serious-medical-conditions-such-as-anaphylaxis-.aspx

they both made their way to the camp headquarters by which stage Nathan was finding it harder to breathe and puffed on his asthma puffer. The student placed the EpiPen on top of the first aid kit at the headquarters and alerted others to Nathan's situation. Two teachers were present at the headquarters. Neither administered Nathan's EpiPen.

[LinksEtc]

http://www.allergy.org.au/about-ascia/media/558-jan-28-2014-ascia-anaphylaxis-training-and-action-plan-updates

Many individuals with severe allergies, who are at risk of anaphylaxis, also have asthma and sometimes it can be difficult to differentiate between anaphylaxis and asthma symptoms.

To help address this issue the Australasian Society of Clinical Immunology and Allergy (ASCIA), the peak medical society for immunology and allergy in Australia and New Zealand, has recently included a new "Asthma and Anaphylaxis" module into its updated versions of ASCIA anaphylaxis e-training for schools, childcare services and the community.

Revised wording regarding asthma – by stating "If uncertain whether it is asthma or anaphylaxis, give adrenaline autoinjector first, then asthma reliever medication." and inclusion of a tick box in the personal (red and green) versions to indicate if the person has asthma.

http://www.allergy.org.au/images/stories/mediareleases/ASCIA_media_release_Jan_2014.pdf


http://www.allergy.org.au


http://www.allergy.org.au/patients/anaphylaxis-e-training-schools-and-childcare

[LinksEtc]

"Safety Of Pediatric Peanut Oral Immunotherapy Is Complicated By High Adverse Event Rates"
Yamini Virkud, MD, MA, , , ,
https://aaaai.confex.com/aaaai/2014/webprogram/Paper11185.html

Symptom diaries showed 54% of subjects received treatment at home for likely related events at some point during OIT, 53% with antihistamines, 18% with albuterol, 9% with epinephrine, and 15% had an emergency room visit.  Over the course of OIT, 37% of subjects should have received epinephrine based on symptom severity yet were not given any.

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Tweeted by @IgECPD

'A few peanuts killed my Sarah, but her death has saved thousands'
http://www.dailymail.co.uk/health/article-1325192/A-peanuts-killed-Sarah-death-saved-thousands.html

The paramedics on the scene concluded that her death was caused by an asthma attack and the doctors at the hospital agreed, but Sylvia questioned the diagnosis.

A GP friend used a phrase I'd never heard, anaphylactic shock

[LinksEtc]

Re: How epinephrine works to stop Anaphylaxis