Allergy Shmallergy

Simplifying life for families with food allergies.

EpiPen Shortage: What You Need to Know Now August 27, 2018

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You’ve likely heard that there’s a shortage on EpiPens through the United States, Canada, United Kingdom and Australia.  What began as spot shortages throughout Australia and North America has escalated into a worldwide panic.  Let’s separate fact from fiction to better understand this ongoing problem and talk about interim solutions.

 

1. There is NO epinephrine shortage.  The life-saving drug epinephrine, also known as adrenaline, is in full supply.

 

2. The shortage refers to pharmacy stock of Mylan’s EpiPen , EpiPen Jr. as well as its authorized generics in North America and the UK and only EpiPen 0.3 (300 mcg) in Australia.  According to Mylan, this shortage is due to manufacturing delays by their partner Pfizer/Meridian.

 

3.  There had been a shortage of Impax Laboratories’ Adrenaclick, but that appears to have been resolved.

 

4.  Some pharmacies in the United States (including Kaiser) are reportedly rationing out only ONE pen to customers.  This is not recommended.  Customers should always carry two auto-injectors in case one pen malfunctions or two doses of epinephrine is required while waiting for emergency services.

 

5.  There IS NO SHORTAGE of Auvi-Q – the innovative epinephrine auto-injector that talks you through how to administer a shot and has a retractable needle to prevent accidental injury.

 

While this problem affects everyone trying to refill a prescription at this time, I am particularly concerned with those trying to fill a prescription for the first time.  Those patients and families who are just getting a diagnosis and hoping to find a little security in the sometimes overwhelming world of food allergies may find themselves unprepared or totally confused by the process.  I’m also worried for schools and daycares, whose stock epinephrine program saves lives.

 

What can you do while you’re waiting for the EpiPen supplies to increase?

 

1. The U.S. Food and Drug Administration has extended the expiration date of Mylan’s EpiPens by 4 months.  There is a list of which batches are affected and their extended expiration dates listed on FDA’s site – be sure to check your boxes.

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2. Should you need a set of epinephrine auto-injectors now, there ARE alternatives to EpiPens:

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  • In the United States, Auvi-Q is in full supply.  Please visit Auvi-Q’s website for instructions on how to arrange direct delivery.
  • Adrenaclick is also in stock in the United States.  Talk to your doctor and pharmacist about getting this filled in EpiPen’s place.  Be reminded, you’ll need to order a free trainer from Impax Laboratories to practice on this device.  It’s smaller than an EpiPen but operates just a little differently.  You may call Impax Laboratories at 1-855-EPINEPH to order them directly.
  • In the UK, both Jext and Emerade are available epinephrine auto-injectors.

 

3.  Should you prefer to wait for EpiPen to become available: 

  • Check the expiration date on your auto-injectors.  As long as they are stored at room temperature (and not, for example, in the car in the heat), you should be fine to use them past their expiration date according to the FDA.  According to Dr. Baker (formerly director of FARE), EpiPens can be used up to 6 months past their expiration date.
  • Check the epinephrine in your EpiPen.  If you look through the window of your EpiPen and see that the epinephrine is discolored or cloudy, it is no longer good.
  • Be sure to speak with your child’s school about the expiration date extension so that you will be allowed to store that set of EpiPens there.
    • Make a plan (and put it on the calendar!) to replace the EpiPens and deliver a fresh set to school when they become available;
    • Discuss if and how procedures will change with an expired EpiPen.  Will the school use that auto-injector or will they choose to use stock epinephrine instead?  Does that effect the timing of a call to emergency services? What is YOUR preference?
  • As always, store your epinephrine properly.  That means keeping them at room temperature as much as possible.
  • Be careful about accepting a refill from a pharmacy that wants to give you only one auto-injector, splitting up a set.  Heads up: We have heard reports of pharmacies charging a regular co-pay for even just ONE pen.  And, again, patients at risk for anaphylaxis must ALWAYS CARRY TWO auto-injectors at all times.
  • The beginning of a school year is the perfect time to review food allergy safety with your children (wash hands with soap and water before eating, no sharing food, symptoms of a reaction, what to do and who to tell).  Here are some great books to use as a jumping off point for your conversations.

 

If you’re new to the food allergy world and getting an epinephrine auto-injector for the first time, consider one of the available auto-injectors on the market if possible.  They are all equally effective and potent.  You may even find that they fit your needs and lifestyle Discuss with your doctor which one may be most appropriate for you based on your age, capabilities and lifestyle.

 

For more information, please read WebMD’s article “EpiPen Shortage Causing Concern as School Starts”.

 

Food Allergy Policies at School – Considerations and Perspective August 14, 2018

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As the school year beings for some and approaches for others, now is an excellent time to reflect on the food allergy policies and procedures at your school. As research and information about best practices emerge, schools should know that small changes can have a big impact.  Camps may also wish to track these same kind of policy shifts to keep campers safe while in their care next summer.

 

Why do schools need a food allergy policy?

 

Schools must create a safe environment for students with life threatening food allergies. Administrators should begin by creating a comprehensive food allergy policy for the entire school or school district.  Policies may vary from school to school depending on their experiences and limitations.  In fact, allergists are hesitant to suggest blanket recommendations for that reason.  Whatever each school decides, the policy and procedures set regarding food allergies need to be

1.  widely communicated;

2.  easily accessible; and

3.  consistently applied and protected.

These policies serve as a baseline for food allergic families to make decisions about additional measures they may need to take in order to keep their child safe.

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Where do schools begin and what factors should they consider in regards to their food allergy policies and procedures?  

When formulating food allergy policies and procedures, schools should consider some of the following factors:

  1.  Age of students and their cognitive and physical development:  Schools may have different policies for students of different ages.  For example, elementary schools may forbid a child from carrying his/her own epinephrine auto-injector while a middle and high school may allow that.
  2. Common risks facing the age group of their students:  Are the students allowed to share food without permission?  What are the school’s thoughts on classroom parties and celebrations? Do your students commonly face peer pressure or bullying? Are they allowed to snack/eat independently (away from a cafeteria or not during a traditional lunch time)?
  3. Stock/unassigned epinephrine: In many states, schools are either required or allowed to keep unassigned (or stock) epinephrine on-hand in case of an anaphylactic reaction.  That means that if a student, staff, or faculty member has a reaction and does not already have epinephrine prescribed to them and stored at school, the unassigned epinephrine may be used.  Consider whether your school should carry this useful medication and who should be in charge of administering it.
  4. Nursing schedule and availability:  Does your school have a full-time nurse?  How many students is he or she responsible for looking after?
  5. How and where to store epinephrine: Is the nurse’s office centrally located or would it be wise to store epinephrine with a trained administrator closer to a lunchroom or classrooms?
  6. Hand washing: Hand sanitizer does not remove the proteins that can cause a food allergic reaction.  Only a scrub with soap and water can do that. Are the students required to wash hands at any point in the day?
  7. Communication with parents:  This piece may not make it into policy, but it should be discussed.  Advanced communication with parents regarding upcoming class parties, school celebrations involving food, field trips, and other food-related events allows parents and teachers to make appropriate accommodations to keep their food allergic student safe.
  8. The classroom versus the lunchroom: How will food allergy policies differ by location within the school?  Rules in the classroom regarding food may be very different from rules in the cafeteria.  Who will be responsible in which location?
  9. Field trips: Each school should consider who is responsible for carrying and administering epinephrine when students are away from school.  Go over a plan should someone have a severe allergic reaction.  Be reminded that epinephrine must be kept at room temperature, so if you are spending time outside in hot or cold weather, epinephrine will need to be temperature controlled.  Communicate this plan to teachers and parents so that everyone is on the same page.
  10. Faculty and staff education:  Faculty and staff should be educated and RE-educated about food allergies each year.  They must learn to recognize the signs of severe allergic reactions (called anaphylaxis) and what those symptoms might sound like in the words of a young child.  [See The Language of Food Allergies for the symptoms and language students may use to describe an allergic reaction.]  They need to learn how to respond to an allergic reaction.  Understanding the basics of cross-contamination and ingredient label reading, among other lessons, will help protect food allergic students in their classrooms.

 

Food allergies are often misunderstood.  Not only can they cause severe allergic reactions that can be fatal, but they cause a great amount of time, preparation, and anxiety for students and parents alike.  This anxiety can hamper a student’s ability to learn. Therefore, it is imperative that schools make every effort to provide a safe environment for learning both academically and socially.  With two students in every classroom suffering from food allergies, it is critically important that schools consider how they can best prepare families and teachers to protect these students.

 

Prep Your Meds for School: Refill Options July 28, 2017

Time to get your emergency medications ready for school.  Don’t worry:  there’s still lots of summer fun to be had!  But to maximize summer fun over back-to-school frenzy, there are a few things you can do.

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  1. Check the Date:  Check the expiration dates on your epinephrine auto-injectors.  If they are due to expire between now and December, it may be a good time to consider refilling your prescription.
  2. Know Your Options:
    • There are several choices of epinephrine auto-injectors these days and they all efficiently deliver the same life-saving drug (epinephrine) in different ways.  I’ll outline those different auto-injectors below.
    • Talk to your doctor and consider your lifestyle when choosing your auto-injector.
    • Be sure you, your school nurse, caretaker, and child are all familiar with how to operate the auto-injector(s) you choose to stock at home, school and elsewhere.
  3. Update Your Emergency Action Plan:  Your doctor may have provided you with one or you can take Allergy Shmallergy’s Emergency Action Plan to your doctor on your next appointment.  Make a copy for home, your car, on-the-go, and school.
  4. Ask Directly:  You may need to ask your doctor specifically for the auto-injector you wish to use.  Some doctors prescribe only one without discussion, but are certainly willing to write a prescription for the auto-injector that works best for you.

 

What ARE the options for epinephrine auto-injector:

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Auvi-Q:

Yes, it’s back on the market and better than ever.  Auvi-Q delivers epinephrine via a compact package that speaks to you.  You heard that right: it talks you through an injection, even counting down the length of time you are supposed to hold the device in place.  Plus, the needle automatically retracts, reducing the possibility of post-injection injury.  Each Auvi-Q is about the size of a deck of playing cards, easy to carry for everyone (especially teens, young adults and fathers – who can fit them in their pockets).

 

*Auvi-Q automatically ships and delivers their auto-injectors directly to you.  Initiate this process with your doctor.  To read more about their direct delivery service as well as their cost-coverage programs, refer to the Affordability program page.

 

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Adrenaclick:

Adrenaclick has a slimmer profile than the well-know EpiPen, but is about the same length. Adrenaclick is a no frills epinephrine auto-injector, often used as a generic for EpiPen.  In fact, responding to the rising costs of brand name epinephrine auto-injectors, CVS pharmacies (among others) replaced its stock of auto-injectors with Adrenaclick. In their words, “Patients can now purchase the authorized generic for Adrenaclick®… This authorized generic is a Food and Drug Administration (FDA)-approved device with the same active ingredient as other epinephrine auto-injector devices.”

 

*IMPORTANT, Adrenaclick operates differently than EpiPens and they DO NOT come with a trainer.  If you choose to use this useful auto-injector, be sure to also place an order for an Andrenaclick trainer.  And, do your research for best pricing locally.

 

EpiPen:

EpiPens are the most widely used and most familiar of the epinephrine auto-injectors.  In fact, its familiarity is what keeps many customers coming back.  School nurses and even non-allergic individuals may be more accustomed to its look and how to use it.  In addition, EpiPens are substantial – making them easy to find in a backpack or purse.  In 2016 Mylan, the manufacturers of EpiPen, released a generic of its own product in response to public pressure over its pricing.  Both products contain the same medication and use the same or similar injector mechanisms.  EpiPen’s price has not been reduced in any way and is the most expensive auto-injector on the market.  The generic version is less expensive, but still a price worth considering for many.

*Mylan does offer coupons which can be found on their website.

 

Food Allergy Education: Allergy and Asthma Today Spring 2016 March 8, 2016

 

As you all know, I strongly support the need for food allergy education in school.  The non-profit Allergy and Asthma Network (AANMA) recently picked up one of my articles on the subject for their publication, “Asthma and Allergy Today.”

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Here’s a link to my article in their Spring 2016 issue:  Thank You For Being a Friend.

 

Or, read it below. And in the meantime, I’d love to hear from you!  Comment below, on our Facebook page, or email me: erin@allergystrong.com:

  • I’d love to hear your thoughts on:
  • What your school is doing right;
  • Any issues you or your child has faced as a result of insufficient food allergy information/education;
  • Suggestions you have for schools/teachers to create a safer, more inclusive school environment;
  • General comments.

Thank you as always for your support!

 

Thank You For Being a Friend
published in Allergy & Asthma Today – Spring 2016
By Erin Malawer

 

Walking through the halls of an elementary school, you might see inspirational bulletin boards, posters promoting “School Spirit Week,” perhaps a donation box for clothes or backpacks.

 

You would not expect to see a whole walnut rolling around on the floor. That’s what some students at my son’s elementary school found recently. At first they didn’t even know what it was.

 

One of the students bent down to inspect it. “Hey,” he yelled to my 10-year- old son, who is allergic to tree nuts. “Come over here. Is this a walnut?”

Feeling a little nervous, my son backed away, explaining that he, of all people, is not qualified to be a nut inspector. A classmate, a girl also diagnosed with food allergies, stepped in to remind everyone about my son’s allergies. Soon after, the kids began to file into their classroom. Somehow the nut followed them.

 

My son’s deskmate grabbed the walnut and teased him with it, waving the walnut close to his face saying, “Oooooh … A walnut.”

 

My son began to speak up – we had practiced for these types of situations at home. The same girl quickly interjected, “Are you crazy? He’s ALLERGIC to nuts! He could go to the hospital!”

 

My son wasn’t harmed. But he WAS upset when I picked him up from the bus.

 

“Mom,” he said, “I know I seem really tough – like my feelings are as thick as a wall. But inside, they can be as thin as paper.”

 

We discussed what he was feeling, things he would have liked to have said, how thankful he was to have a friend like the girl who stood up for him. He felt sure his classmates acted out of misunderstanding or lack of education, rather than malice.

 

This incident was innocent enough. The first boy was curious; the second boy truly didn’t understand the potential consequences of his actions. He thought my son would join in on the joke because they are friends.

 

I asked the school if I could come into the classroom to teach the kids about food allergies – and they agreed. The students were attentive and engaged, and had intelligent questions. They were very sympathetic to how difficult it is to manage food allergies.

 

Both boys apologized to my son, explaining they had no idea about the severity of allergic reactions.

 

In the end, the incident brought my son and his classmates closer together. Looking back, it’s very easy to imagine a different outcome. But as my husband rightly points out, “Kids WANT to do the right thing and be supportive. Sometimes they don’t have enough facts to know how.”

 

Statistically, there are two students in every classroom with food allergies.  But that number is growing.  We need to teach our kids the facts about this condition, so they can act appropriately. And we need to teach them to be supportive of each other.  A lesson in food allergies is a lesson in empathy – and it just might save a life.

 

If your school doesn’t include food allergy education in their health curriculum, I encourage you to volunteer your time to do it yourself.

 

 

Expired EpiPens? EpiPhany! October 21, 2011

After being inspired to clean out some spaces in my house that haven’t received much attention recently, I amazingly stumbled upon a large stash of expired EpiPens.  I was holding on to them with the thought that they might be useful in some way or in need of special disposal, but instead they simply sat in the back of a closet.

 

Suddenly I had an epiphany (an EpiPhany if you will).   Instead of throwing them out, I brought the EpiPens into our school nurse to help train other teachers, assistants, interns and substitutes on the administration of an EpiPen.  More than 15% of food allergic children experience a food allergy reaction while at school.  Given that statistic, emergency training with real EpiPens is only to everyone’s benefit (not least of which is my own son).

 

So, consider donating your expired EpiPens to your local school, preschool, camp or daycare facility and spread the word to any allergic adults you may know.  Our nurse was excited to use our old EpiPens and to store our old trainers for faculty food allergy training and I felt great putting them all to good use.