Standard Protocol for "Asthma Action Plans"

[LinksEtc]

http://www.foodallergy.org/treating-an-allergic-reaction

Short-acting bronchodilators (known as "rescue" inhalers), such as albuterol (Alupent®, Proventil®, Ventolin®), may be used to help relieve breathing problems once epinephrine has been given, particularly if you are experiencing asthma symptoms. They should not be depended upon to treat the breathing problems that can occur during anaphylaxis—use the epinephrine.

--------------------------------------------------------


Tweeted by @Aller_MD

"Epinephrine autoinjectors for asthmatics"
http://www.aaaai.org/ask-the-expert/Epinephrine-autoinjectors-for-asthmatics.aspx?utm_content=buffer43748&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Is there a guideline as per AAAAI on prescribing Epi Pens in asthmatic patients for use in case of experiencing immediate hypersensivity reactions to food (no prior Hx of food allergies).

Your question is a philosophical one in that there is risk with anaphylaxis in all subjects with asthma, as anaphylaxis is likely to be more severe and life threatening with preexisting asthma. However, there is risk and cost in prescribing this therapy.

--------------------------------------------------------


7 yo possible anaphylaxis death

https://www.facebook.com/lillith72/posts/402139973273576?pnref=story

His father did his very best, he placed him on the machine at first assuming to asthma, grandma god bless her made him give benadryl regardless but once he noticed it was more and got the epi pen it set in.

[LinksEtc]

"HALTON ASTHMA PROTOCOL"
http://www.hdsb.ca/ParentInfo/Health%20Protocols/AsthmaProtocol.pdf

In cases where an anaphylactic reaction is suspected, but there is uncertainty whether or not the person is experiencing an asthma attack, epinephrine should be used first. Epinephrine can be used to treat life-threatening asthma attacks as well as anaphylactic reactions.

------------------------


"Misdiagnosis: is it what doctors think, or HOW they think?"
http://myheartsisters.org/2014/05/25/diagnostic-errors/

some conditions (such as ureteral colic and dissecting abdominal aneurysm, or subarachnoid hemorrhage and migraine) may show complete overlap in their symptomatic presentation."

Dr. Croskerry adds that in these latter examples, the probability of correctly diagnosing the disease on the basis of clinical presentation may be no better than chance because noise may completely overlap the signal.

------------------------


Re: Think it's "just asthma?" THINK AGAIN-- could be peanuts.

I think sometimes people like to divide asthma & FA with a big line ... but I think the reality might be more complicated ... a more integrated approach might work better ... & it will benefit patients if allergists & pulmos can work together & coordinate patient care.



^WORD.   

IMO-- this is no time for a turf war, guys.  There's enough trouble here for two groups of specialists.

Thanks,

~The patients and parents who live with this kind of reality.

[LinksEtc]

"Part 2: Pertinent Food Allergy Education in a Pediatric Ambulatory Care Setting with a Focus on Anaphylaxis"

http://jaa.sagepub.com/content/3/4/162.full.pdf

Page 163

patients could also benefit from a greater understanding of risk recognition and learning to differentiate between symptoms/treatment related to asthma versus a food-induced allergic reaction.

Page 169

More than 75% of the parents were able to identify most laryngeal or respiratory symptoms of anaphylaxis, although less than 50% cited hoarseness or repetitive cough as symptoms.

------------------------------------------------------------



Tweeted by @hhask

"Why Bad Doctors Are Like Bad Writers: The Curse Of Knowledge"
http://www.forbes.com/sites/larryhusten/2014/09/27/why-bad-doctors-are-like-bad-writers-the-curse-of-knowledge/

When the host interrupted and asked him to explain the work more clearly, he seemed genuinely surprised and not a little annoyed. This is the kind of stupidity I am talking about.

Call it the Curse of Knowledge: a difficulty in imagining what it is like for someone else not to know something that you know.

---

FARE webinar - "Your Questions Answered: Anaphylaxis"
Dr. Robert A. Wood
http://blog.foodallergy.org/2013/11/15/your-questions-answered-anaphylaxis/

How can you distinguish between symptoms of anaphylaxis and other illnesses? (e.g., asthma attack, random hives, stomach cramps, or anxiety attack)

The symptoms can be identical. What we want to do is interpret the symptoms in the context of the overall situation and the chance that there's been a food exposure.

The curse of knowledge  ... most patients just don't think this way ... not being a doctor or scientist, I do not have this particular curse.   

Just talking about the general concept here ... of course, Dr. Wood is one of the most  in the FA community.

[LinksEtc]

really sad, another UK death from nuts in a curry.


"Stanhope gardener died from nut allergy after eating curry"
http://tinyurl.com/kyffg7z

after just a few mouthfuls of his chicken tikka, he started coughing violently and his lips turned blue.

The 32-year-old initially thought he was suffering an asthma attack, but after his inhaler failed to work, he told friend Stephanie Hodgson: "S***, I'm allergic to nuts".

 


--------------------------



'I had an asthma attack because of a slice of lemon': Food allergy epidemic that experts fear may be caused by pollen and modern diet
http://www.dailymail.co.uk/health/article-2875028/Food-allergy-epidemic-experts-fear-caused-pollen-modern-diet.html

As the waiter approached his table, Ben Abbott knew he was in for a difficult meal.
For the waiter was carrying a jug of water with a slice of lemon in, which Ben is allergic to.

'Within seconds, my face went red and blotchy, I lost my voice and had an asthma attack.'
Luckily, Ben was carrying antihistamine tablets and his asthma inhaler, so he was able to recover quickly.

--------------------------



"A Young Girl's Tragic Death Saved the Lives of Four Others"
http://www.redbookmag.com/life/charity/news/a39048/girl-dies-asthma-saves-lives-of-four-donate-organs/

Rhiannon Westerhold was a spunky and kind-hearted girl.

Her mom, Roseanne, says that Rhiannon was enjoying dinner at her grandma's house with her father and siblings when suddenly she started having trouble breathing.

"Rhiannon's father, Steve, then gave Rhiannon her puffer and when he realized it was getting worse, he drove her and her siblings to the nearest ambulance,"

[LinksEtc]

"Schoolboy, 12, died of severe allergic reaction to curry containing peanuts after takeaway staff assured his family it was nut-free"
http://www.dailymail.co.uk/news/article-2588674/Schoolboy-12-died-severe-allergic-reaction-curry-containing-peanuts-takeaway-staff-assured-family-nut-free.html

'I got his inhaler and he took ten breaths from it. The inhaler had no effect and I could tell it wasn't going well so I straight away rang 999.

-------------------------



"Victorian Karting Association apologises in court for nut allergy death of boy, 15"
http://www.theage.com.au/victoria/victorian-karting-association-apologises-in-court-for-nut-allergy-death-of-boy-15-20140217-32vdl.html

Jack ate a cookie thinking they only contained white chocolate and had an allergic reaction within half an hour, the court heard.
The boy's father, Robert, gave ventolin and then administered CPR when his son collapsed

---

Re: Association apologises in court for nut allergy death of boy, 15

Teenagers with asthma at increased risk of life-threatening anaphylaxis
https://www.mcri.edu.au/news/teenagers-asthma-increased-risk-life-threatening-anaphylaxis

According to Professor Katie Allen, the concern is that for these teens, an anaphylactic reaction may be more likely to be mistaken for an asthma attack, resulting in delayed administration of an adrenaline (epinephrine) autoinjector and increasing the risk of fatal attacks.

15-year-old Jack Irvine

Jack inadvertently ate a biscuit containing macadamia nuts while attending a catered go-karting camp

Jack had a delay in onset of symptoms and when they appeared they were interpreted as asthma. It was not until an ambulance arrived that Jack's father realised the reaction was anaphylaxis.

---


"Teenagers with asthma have increased risk of anaphylaxis, study finds"
http://www.smh.com.au/business/consumer-affairs/teenagers-with-asthma-have-increased-risk-of-anaphylaxis-study-finds-20160515-govmnj.html

The link between asthma and anaphylaxis was made from the results of a study of 10,000 adolescents (aged 10-14) in metropolitan Melbourne.

The link has prompted concerns among health professionals, that a teenager's anaphylactic reaction could be mistaken for an asthma attack, leading to a delay in the administration of a life-saving adrenaline auto injector.

[LinksEtc]

"They keep smiling for Abbie Benford"

http://www.bostonglobe.com/lifestyle/2014/08/22/they-keep-smiling-for-abbie-benford/IaGrzgrFlOWQGfCqJ4HrUN/story.html

"I heard her wheeze and I grabbed the nebulizer," says Benford. Then he called 911. Amy Benford injected her daughter with an EpiPen, and then another, but Abbie had lost consciousness and was in cardiac arrest.

The problem is sometimes the [anaphylaxis] symptoms can be something else. Abbie's system shut down before we even had a chance to assess and treat her.

-----------------------------------------------------


Re: You've done the right thing by coming here today

The one time my ds went to the ER by ambulance they didn't even believe it was a reaction because he had no hives. I was arguing with the Dr that it wasn't an asthma attack and then the emt who is my neighbor, jumped in and said based on what he saw when he arrived it wasn't asthma. Luckily about ten minutes later his entire body was covered and I made the nurse get the Dr immediately to see them.

-----------------------------------------------------


Re: Connecting "FA Action Plan" with "Asthma Action Plan"

I think this points to some serious issues getting OTHERS to even follow an anaphylaxis treatment plan when they think that they are dealing with "just asthma."

[LinksEtc]

"May is National Asthma and Allergy Awareness Month!"
http://www.aafa.org/display.cfm?id=10&sub=99&cont=457

Each year, the Asthma and Allergy Foundation of America (AAFA) declares May to be "National Asthma and Allergy Awareness Month.

Seemed like a good time to bump this thread.

------------------------------------------


Sooooo, I think that I've finally said most of what I want to say on this topic ... it's only taken me a few years ... not too bad  .

One thing that I  about FAS is that it is a safe environment to push boundaries on things, to really explore issues deeply.  There is a unique mix of people here with different experiences and educational backgrounds ... but we all deal with FA and can communicate with each other on that level ... there's a synergy.

My feeling is that sometimes patient perspective & ideas can be difficult to communicate to others. 

I hope that if any of my current docs stumble across this thread, they will understand that the ideas in this thread are really a heart & soul passion of mine that I wasn't ready to let go of.  I know that I can ask them any question regarding dd's health and I have so much trust in their ability to care for dd  .

From past experience, though, I've learned that discussing general ideas (not directly related to dd) is something different ... being too open or being too passionate can have negative consequences ... maybe it crosses some line of proper doctor-patient etiquette ... I don't know.  It seems that my IRL mom & online id's have started to merge a bit and I guess that I have to find the right balance.

Which brings me back to FAS - this is my safe place to push limits. 

------------------------------------------

Whether anything will come of this thread - that's for others to decide, I'm not a medical professional ... but I've said what I wanted to say.

I do think that these issues are important for those dealing with FA to be aware of.  I find that newbies especially could benefit from more education on these topics.  I would suggest that people discuss with their docs any questions that they have regarding their specific allergy and/or asthma plans.  This is something that you want to have an understanding of before an emergency occurs.

------------------------------------------

I'll save a couple of spaces for later, but like I said, I think that I'm mostly done with this.

[LinksEtc]

Related topic:

If you were an allergy researcher ...

Tweeted by @Aller_MD

------------------------------


"A brave new world – 'research with' not 'research on' patients"
http://blogs.biomedcentral.com/bmcblog/2014/05/20/international-clinical-trials-day-2014/?utm_content=buffer0e6f1&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Since the recognition and acceptance of patient and public involvement, there has been a rapid accumulation of evidence regarding its worth and it has been implemented in many health-care systems across the globe.

I found this interesting:

http://susannahfox.com/2014/05/17/false-boundaries-in-health-care/

Why shouldn't research questions be generated by people with the disease being studied? Why shouldn't research teams make sure there's a seat at the table — more than one! — for people most affected by their work?

[LinksEtc]

Tweeted by @sarahjchapman


"Salhouse boy died from allergic reaction, inquest told"
http://www.edp24.co.uk/news/salhouse_boy_died_from_allergic_reaction_inquest_told_1_3604602

Edward Debbage, who died on February 10

range of food allergies and also suffered from asthma

suspected asthma attack

----------------------------------------------------------------------


I saw this mentioned at KFA


"Man died an hour after being treated for peanut allergy"
http://www.independent.ie/irish-news/courts/man-died-an-hour-after-being-treated-for-peanut-allergy-26531233.html

Mr Schatten, who suffered from asthma, said he had a bit of a cough and that his chest was tight and indicated he wanted to go home to get his medication for asthma.

A post mortem found he had died of an acute hypersensitivity reaction or anaphylactic reaction to peanut.

----------------------------------------------------------------------

[LinksEtc]

Re: If you were an allergy researcher ...

Tweeted by @Richard56

"Richard Smith: Why scientists should be held to a higher standard of honesty than the average person"
http://blogs.bmj.com/bmj/2014/09/02/richard-smith-why-scientists-should-be-held-to-a-higher-standard-of-honesty-than-the-average-person/

The true scientist (if there is such a person) will be delighted when his or her favourite hypothesis is slayed by data.

Um-- well.


"Delighted" might be overstating things just slightly.   

  "Intrigued and excited" though-- that much I buy.   

I'm ok with this idea getting slayed if I know that it has really been heard ... I didn't know how to ask more as "mom" without offending & I was afraid of getting a second confirming opinion of me as PITA google-mom which I couldn't risk doing at the time.

Anyway ... I'm fine leaving things as is or I'm fine talking about it more ... I don't need an answer ... but I needed to finish my thoughts / my questions here.

[LinksEtc]

Tweeted by @MayContainNut


"Schoolboy treated for asthma died of anaphylactic reaction prompts calls for allergy rethink"
http://www.smh.com.au/nsw/schoolboy-treated-for-asthma-died-of-anaphylactic-reaction-prompts-calls-for-rethink-20150826-gj88jh.html

Marcus had been struggling for breath after playing after-school sport. The Ventolin wasn't working. He had gone to the office and said: "It's my asthma."

The focus was always on the asthma. Somewhere along the line someone should have joined the dots.

------------------------------



Re: Social Media

I'd be lying if I said that I was satisfied leaving this thread as is ...
Standard Protocol for "Asthma Action Plans"

I think we as a community can do better ... I'd like to see some big fat discussions on this topic with allergists, pulmos, FASers (& others would also be welcome like KFA), etc.  This topic still bugs me, this is my main loose end.  I'd like to see us all go at it ... talk back to each other ... communicate & see if we can't better address the problem of ana being mistaken for asthma.

[LinksEtc]

I'm sorry guys ... I don't want to annoy anybody here by bumping this again ... if admins really want me to quit this, I will ... my stubborn side can be both a strength & a weakness ... I've been doing my best to try and let this thing go ... really ... but when I hear about another death. 

I just feel so strongly about this issue and nobody has convinced me that this asthma plan idea does not have the potential to save lives ...

To be clear, I'm not expecting our doc to answer this for me ... this is a Links thing, not a Mom thing ... the possibility of me "agreeing to disagree" with Yoda ... chutzpah?, foolishness?, something.



Anyway, I'm going to save a few spots ...

[LinksEtc]

Re: In Memory:  Remembering those who've had fatal food reactions


"Student's puffer had expired, coroner finds"
http://www.lfpress.com/2016/04/12/students-puffer-had-expired-coroner-finds

It was either an allergic reaction or asthma

Either way, Avina did not get all the care that might have saved him, the coroner disclosed

That EpiPen, whose needle delivers a precise dose of epinephrine, would have caused no harm if it was asthma rather than an allergic reaction

------------------------------------------




Ok ... the writer of this blog is not a doc & I am not a doc ... again, don't consider this medical advice, but ... please, discuss these issues with your own allergist and/or pulmo if you have both asthma & FA.


"Tragic Death of Javier Avina Teaches Hard Lessons To Us All"
http://blog.onespotallergy.com/2016/04/tragic-death-of-javier-avina-teaches-hard-lessons-to-us-all/

Before "puffers" were invented sixty years ago, epinephrine was always the emergency rescue treatment for asthma.

To help avoid any confusion when asthma alone is suspected, I suggest that every Emergency Action Plan for children with asthma state that "If rescue inhaler does not provide significant relief, use EpiPen immediately, then call 911".

------------------------------------------




Since I have pretty much been outing myself like crazy these days ... why not continue the trend?  Our pulmo wouldn't put epi in dd's asthma plan red zone ... maybe a tad radical for him  ... but he did put this wording in the comment section of our asthma plan:

In the event that severe symptoms suddenly develop following a meal or snack, please utilize Food Allergy Action Plan.  Consider EpiPen admin during Red Zone treatment plan if asthma symptoms do not promptly improve.

Our school nurse always highlights this wording and it gives her the authority and flexibility to use epi even if she's not sure if asthma or ana.  An interesting thing she told me this year was that the asthma plan of another child (she didn't name names of course) at the school had epi in asthma red zone and she thought of me.      She's a great school nurse.   

[LinksEtc]

Re: In Memory:  Remembering those who've had fatal food reactions


"Parents Of Allergy Victim Press For Broader Warnings"
http://minnesota.cbslocal.com/2016/01/22/ramsey-man-22-dies-of-reaction-to-peanuts/

Brian and Beth Kelly's son, Bruce, died

"When he got to my house, out of the truck, he was already gasping for air. He thought it was his asthma, and so he asked for his inhaler," Brian said.

Brian and his other son, Ryan, administered epinephrine, but Bruce had already gone into cardiac arrest.

-----------------------------


Tweeted by @kfatweets

http://www.aafa.org/page/anaphylaxis-severe-allergic-reaction.aspx#.Vx0TzT9VU8g.twitter

How Can I Tell the Difference Between Anaphylaxis and Asthma?

If you are unsure if it is anaphylaxis or asthma:

Use your epinephrine auto-injector first (it treats both anaphylaxis and asthma).
Then use your asthma relief inhaler (e.g. albuterol).
Call 911 and go to the hospital by ambulance.

-----------------------------



"Farm family reeling after sudden death of teenager"
http://www.americanfarm.com/publications/the-new-jersey-farmer/2745-farm-family-reeling-after-sudden-death-of-teenager

Katherine Cassidy Schaefer, 18, died after a severe asthma attack on Dec. 30

lifelong allergy to milk products

She said normally if Kaycee had a reaction it would be immediate, but this time it was about 40 minutes later when she felt the tingling sensation that she knew preceded an allergic reaction. She reached for her inhaler and her friend went for some Benedryl, and he quickly called 911.

[LinksEtc]

Educational info at places like AAFA & FARE are good, but this has to be addressed by a doc for every patient having both asthma & LTFA during the medical appointment imo ... every patient with asthma & LTFA needs education on this issue imo ... formally having FA instructions (ex - indicating when patient should be following their food allergy plan instead of just giving asthma meds) in the asthma plan of those with FA would likely reinforce this education & help the patient to educate others from places like schools & camps imo.