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epinephrine

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Emerging Epidemic: Latest Research on Childhood Food Allergies Shows Troubling Trend

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We like to follow research in the food allergy world closely—after all, many of our team members are as personally vested as we are professionally in the advancement of food allergy research! Several of our senior team members either have food allergies or have children with food allergies. 

Last month at FABlogCon, we learned that Dr. Ruchi Gupta and her team at Northwestern University were soon releasing a new study in PediatricsThe Public Health Impact of Parent-Reported Childhood Food Allergies in the United States.

The study was published this month, and we wanted to share some key findings with you: 

  • Food allergies continue to affect a significant number of children in the United States—7.6 percent, or nearly 6 million kids, have a food allergy. Of those, 40 percent report having multiple food allergies.

  • Food allergies have a meaningful impact on families—42 percent reported a severe allergic reaction to their food allergen, and nearly 1 in 5 reported that their child had visited the emergency department for a food-allergic reaction in the past year!

  • Not everyone has emergency medicines at the ready—less than half of parents reported that their child has a current prescription for an epinephrine auto-injector, the only treatment for anaphylaxis. 

This study is a continuation of the work carried out by Dr. Gupta and her team in 2011. Their objective was to better assess the public health impact on childhood food allergies. They surveyed over 40,000 households using advanced statistical modeling to ensure they captured a representative sample of children in the United States. 

One noteworthy feature of this study was a “stringent symptom” methodology, which looked at the frequency, type, and severity of allergy symptoms as part of a diagnosis. This approach helped filter out those who did not likely have a food allergy, as several parents reported a food allergy when the symptoms were more characteristic of a food intolerance or oral allergy syndrome (OAS).

Even after applying the stricter criteria, food allergies are still a significant problem for American children. Today, 1 in 13 kids has a food allergy, which translates to 2 in every classroom. Peanut (2.2%) and milk (1.9%) are the most commonly reported food allergies, affecting 1.6 million and 1.4 million children, respectively. African American children are also more likely to have a food allergy than non-Hispanic white children and are more likely than other children to have multiple food allergies. 

Dr. Gupta (second from the left on the bottom row) and her SOAAR research team (Science and Outcomes of Allergy and Asthma Research) at Northwestern University.

Dr. Gupta (second from the left on the bottom row) and her SOAAR research team (Science and Outcomes of Allergy and Asthma Research) at Northwestern University.

We appreciate the work of Dr. Gupta and her team to increase awareness of the public health implications of food allergies. To quote from the study: “With the growing epidemic and life-threatening nature of food allergies, developing treatments and prevention strategies are critical.” 

We couldn’t agree more!

- Susannah & the Allergy Amulet Team 


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Take Two: The Importance of Carrying Two Epinephrine Auto-injectors

With Halloween around the bend, we wanted to share a quick PSA on the importance of carrying two epinephrine auto-injectors in case of an allergic reaction. 

Why? Let’s look at the facts.

In cases of severe anaphylaxis, one dose of epinephrine is often not enough. Up to 20% of people who receive an initial dose of epinephrine for anaphylaxis require a second injection. This can happen even without further exposure to the allergenic trigger! A second allergic reaction called biphasic anaphylaxis can occur between 1 to 72 hours (typically eight hours) after the initial reaction.

Despite these harrowing stats, most individuals do not carry two auto-injectors.

In a study of roughly 1,000 US patients and caregivers with epinephrine prescriptions, 82% said they do not carry two auto-injectors. Meanwhile, 75% of respondents reported previously administering epinephrine. Of those that sought emergency care, 45% did so because a second dose of epinephrine was unavailable. 

Education and awareness is also lacking. Only a quarter of respondents reported that they were advised to carry two auto-injectors.

But epinephrine is expensive.

We hear you. Epinephrine auto-injectors are not cheap, which can make it difficult to have multiple epinephrine auto-injectors on your person at all times.  

Fortunately, that’s starting to change. Increased market competition and PR scandals like the one that rocked Mylan have helped drive down the price. 

Additionally, below are some cost-saving options worth checking out. 

-      Check for discount codes and savings plans on manufacturer websites. 

-      Purchase generic epinephrine alternatives.

-      Explore mail-order pharmacy options (you may be able to receive a larger supply of medication at a lower co-pay amount if these benefits apply).

-      Price shop between local pharmacies—prices vary, especially between large chains and small pharmacies.

-      Ask your doctor about patient assistance programs. 

-      Switch to your insurance carrier’s “preferred” auto-injector (if applicable).

-      Double check that your pharmacy has applied all possible coupons at check out.

-      Ask your company’s HR department if they offer financial assistance to employees to cover prescriptions.

We hope you all have a SWEET and SAFE Halloween! And don’t forget to TAKE TWO!

-      Meg and the Allergy Amulet Team

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Food Allergies + Natural Disasters… A Different Kind of Storm

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As torrential floods from Hurricane Florence ripped through the Carolinas earlier this month, Madison, Wisconsin—home of the Allergy Amulet headquarters—was still reeling from record rainfall levels and flash floods. 

These events got us thinking: How should the food allergy community prepare for a natural disaster? 

First, there are great emergency kit checklists available through the American Red Cross and FEMA websites, which advise on supplies to have at the ready in case of an emergency. If you or your loved one has a food allergy, however, you have a few extra things to consider.

Tell me more.

At a minimum you should plan to have several days’ worth of allergy-friendly foods on hand that don’t require refrigeration, heating, and that don’t spoil easily. This might include canned vegetables, granola, or dried fruits and meats. Don’t forget several days’ worth of water, too! 

The American Red Cross recommends having a seven-day supply of any necessary medications. For food allergy families this could include your antihistamines as well as epinephrine, or any other doctor-recommended medications (e.g., inhaler). Depending on where you live, and what type of emergencies are most common, you may want to have these items already packed and stored in a convenient location. For example, if you live in an area prone to tornadoes, it’s likely that you have a basement, so you may want to store your emergency supplies down there.  

What if I need to evacuate?

Evacuating in the wake of a natural disaster can present unique challenges for those with food allergies. Shelters may not serve allergy-friendly meals, and even if they do, families may need to manage for cross-contact. Having allergy-friendly foods on hand and disinfectant wipes for hands and surfaces can help mitigate exposure risk. Make sure to also pack emergency action plans for children if you have them, insurance cards, and an emergency contact list with your medical providers!

Check expiration dates!

Don’t forget to review and update your emergency preparedness kit at least once a year, and make sure to check the expiration dates on your epinephrine and antihistamines. Spokin recently offered a feature on its app that helps you to manage epinephrine expiration dates.

We all hope that you never need your emergency supplies, but it’s a good idea to be prepared! 

- Susannah and the Allergy Amulet Team 

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Best Practices for Kids + Epinephrine

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I’m not quite sure how summer passed by so quickly. Is it really back-to-school season already?! As families gear up for the school year ahead, we thought it would be a great time to review current best practices for kids and epinephrine—something every parent should know even if your child has no food allergies! 

Here are a few things to remember as you prepare for your child’s fun (and safe!) return to school.

Educating Your School Tribe

It’s a good idea to get your child’s food allergies on the radar of their school caretakers before the year begins—especially if your child is changing schools. Contact their school nurse and teacher to plan for where the epinephrine will be stored and how it will be used in case of an emergency. You may also want to discuss how snacks and treats are handled in the classroom. Many schools have food allergy policies in place, but some protocols are at the teacher’s discretion. 

It doesn’t hurt to schedule a face-to-face with your child, teachers, and caregivers before school starts to talk through your food allergy game plan. As a bonus, this gives your child an opportunity to meet their teacher before the year begins and help them tackle some of those first-day jitters! 

Epi Dosing Options

There are currently three different epinephrine dosages available. For adults and kids who weigh more than 30 kilograms (~66 pounds), the recommended dose is 0.3 milligrams. For smaller kids weighing between 15 and 30 kilograms (~33-66 pounds), the recommended dose is 0.15 milligrams. Several brands offer both dosing options, including EpiPen, Adrenaclick, and Auvi-Q.  

For infants and toddlers who weigh between 7.5 and 15 kilograms (~16.5-33 pounds), Auvi-Q makes an auto-injector with a lower dosage (0.1 milligrams), which also features a smaller needle. 

Make sure to check with your doctor to determine the best option for your child! 

Safe Storage

Remember that epinephrine is temperature sensitive. The medication should be stored at room temperature and never in extreme hot or cold climates (e.g., car glove compartments). Some brands also recommend that users periodically check to ensure the liquid has not changed color. If the solution assumes a pinkish or brownish hue, this can indicate decreased effectiveness. Epinephrine is light sensitive too—so store your auto-injectors in cases!  

Parents should work with their child’s school or daycare provider to map out a plan for both on-site and off-site storage (e.g., field trips), to ensure availability and maximum effectiveness. 

Using Your Epinephrine

As explained in one of our earlier blog posts, the outer thigh is the best place to administer the injection, even through clothing if necessary. Most manufacturers offer videos on their websites to demonstrate how to use their product. These can be a great resource for new caregivers and anyone that should be prepared for an allergic emergency. Like CPR, administering epinephrine is a good skill for any parent to have in their arsenal.

Replacing Your Supply

Currently, most auto-injectors expire within 12 to 18 months. Make sure to check your epinephrine expiration dates and mark them in your calendar. A good rule of thumb is to always have two auto-injectors in close proximity to any food-allergic child in case one is defunct (and in some cases, two injections may be required!). 

As you replace old auto-injectors, remember that some manufacturers offer coupons or other financial assistance, especially for lower income families.  

While we hope you never have to use an epinephrine auto-injector, we share these reminders to keep all of our children safe as we send them off to the classroom! 

- Susannah and the Allergy Amulet Team  

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Peter Rabbit: A Tale of Teachable Moments

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On February 9th, Sony Pictures released its long-awaited movie that modernizes the classic tale of Peter Rabbit—the mischievous little bunny that chases about the garden of grumpy old Mr. McGregor.

While this contemporary rendition has generated lots of laughter and merriment nationwide, it’s also making headlines for the upheaval it’s unleashed in the food allergy community.

In case this is news to you, here’s what happens. The young bunny family discovers that grouchy Mr. McGregor is allergic to blackberries. In their attempt to keep him from monopolizing the affection of their beloved Miss Bea, they launch blackberries at him, one of which lands squarely in his mouth. Mr. McGregor starts to experience trouble breathing and promptly injects epinephrine into his thigh. He then swiftly recovers and starts chasing the bunnies, as if nothing happened. Peter Rabbit even goes so far as to say: “Allergic to blackberries! Is that even a thing? Everyone is allergic to everything! Stop using it as a crutch!”

When I heard the news of the blackberry scene, I was frustrated. The food allergy community has made considerable progress in education, awareness, and teaching kids to be sensitive to those with food allergies. For a major motion picture that targets children to portray food allergies so carelessly (and epinephrine inaccurately) felt like a major step backward.

HOWEVER…

I believe there are some huge positives that came out of the film.

First, this movie has catapulted food allergies into major national news. This New York Times article came out three days after the movie’s release. Press around this incident reached a wide audience, which hopefully helped move the needle forward on food allergy education within the general population.

Most importantly, I viewed this film as a great opportunity to create a teachable moment with my food-allergic daughter. Before seeing the movie, we chatted about the blackberry scene and what she would see. We talked about what really happens when you experience an allergic reaction, and most importantly, about the importance of having compassion for others that are different. We use food allergies in our house as a platform to show our children that everyone has attributes that make them unique—and that differences are not a bad thing! Some of their friends may have food allergies, others might wear glasses, and some may sit in a wheelchair, and it’s important to treat others with kindness and consideration, no matter their differences.

By managing expectations and framing the movie in this light we were able to enjoy the film, and even have a follow-up conversation about the scene afterward. So all in all, I’m thankful for the teachable moments Peter Rabbit brought to our house.

- Meg and the Allergy Amulet Team  

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Do Waitstaff Create a False Sense of Security?

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I’m often asked whether a consumer device that tests for unwanted ingredients in foods will give those with food allergies a false sense of security when dining out. My response is usually the same: do waitstaff give the food allergic a false sense of security when assuring customers their food is safe?

From personal experience as a waitress, and as someone with food allergies, I can assure you, it happens.

Roughly a decade ago, I waitressed at a restaurant in Midtown Manhattan. It was a fast-paced work environment that demanded recall of dozens of orders and seating positions at any given time. The restaurant was located a few blocks north of Madison Square Garden, so we’d routinely get flooded with hungry patrons before and after performances. During my tenure waiting tables, I grew accustomed to the frequency with which waitstaff made mistakes—and it’s often. A few times a week I would mix up orders, fail to put in special requests, and was once lambasted for accidentally serving a woman regular coke instead of diet. I never made that mistake again.

But there’s a difference between mixing up soft drink orders and forgetting to inform the kitchen of a food allergy. Despite their best efforts and intentions, waitstaff don’t always get it right—even when it comes to food allergies. Many waiters don’t know that pesto usually contains pine nuts, that marzipan is almond paste, or that peanuts and nutmeg are not tree nuts. According to a recent CDC report, restaurants were found responsible for nearly half of all food allergy fatalities over a thirteen-year period. That same report found that less than half of all restaurant managers, and only one third of servers, receive any formal training on food allergies. Legislation is also lagging. Today, only six states (Illinois, Massachusetts, Maryland, Michigan, Rhode Island, and Virginia) and two cities (NYC and St. Paul, MN) have passed laws to increase food allergy safety and awareness in restaurants. We’ve clearly got a long way to go.

I’ve also had my fair share of personal experiences with misinformed waitstaff. This past year alone, waitresses at two different restaurants assured me that my dish was allergen-free when, in fact, it was not. One of the more memorable incidents occurred when I was ten. Our family went to a fancy restaurant near our home for my mom’s 40th birthday. I typically wasn’t allowed desserts at restaurants, but my parents decided to make an exception. We informed the waitress of my food allergies, who then confirmed with the chef that the dessert was safe. After sheepishly taking a small bite, the waitress came barreling out of the kitchen towards the table: there was marzipan in the icing (they hadn’t checked with the pastry chef until after it was delivered to our table). Fortunately, I spit the cake out and the reaction did not rise to the level of anaphylaxis.

Dining out has and will always present challenges for the food allergic, and living in a bubble isn’t a realistic option: I don’t know one adult with food allergies that doesn’t dine out at restaurants or eat foods prepared by others. Right now, the food allergy community relies on the word of the kitchen and waitstaff—the first and only line of defense to prevent a reaction; then there’s epinephrine if things go wrong. Little progress has been made in the way of management tools for preventing allergic reactions in past decades, but fortunately, that’s starting to change. We’re finally seeing a surge of start-up activity in the food allergy space, with different products and apps designed to help the food allergic population better manage their allergies. After all, dining out shouldn’t feel like a game of Russian roulette!

Consumer devices that test foods for unwanted ingredients are intended as a supplement, not a substitute, to the standard precautionary measures those with food allergies would otherwise take when dining out or eating foods prepared by others. For example, I’m still going to tell the waitstaff I have food allergies; I’m still going to take a small bite before diving into my dish; I’m still going to avoid Thai restaurants, desserts, and pesto; and I’ll continue to have my epinephrine on hand. But an additional layer of assurance would be a vast improvement on the status quo.

Having been on both sides of the table, I know this much is true: waitstaff make mistakes, and it only takes one to trigger anaphylaxis. We food allergic folks need all the tools and reassurances we can get.

- Abi and the Allergy Amulet Team

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Why the Thigh?

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Most people that carry epinephrine to treat serious allergic reactions will tell you they were given strict instructions to inject the needle into their outer thigh. They may also tell you that the needle can be injected over clothing, if necessary.

For years I carried epinephrine because I received weekly seasonal allergy injections. Today I carry epinephrine for my food-allergic child. For a long time I didn’t know why I was advised to inject the needle into my thigh. My hunch is that most people don’t know why either.

Several years ago, the Journal of Allergy and Clinical Immunology published a study measuring epinephrine absorption in children with a history of anaphylaxis. The participants were randomly assigned to receive a single injection of epinephrine either subcutaneously (under the skin) or intramuscularly (in muscle).

Among children that received epinephrine subcutaneously, epinephrine absorption was considerably slower than for those that received the injection intramuscularly. 

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A few years later, the same clinical journal published this study. Their goal was to measure epinephrine absorption in adults intramuscularly versus subcutaneously, but also evaluate absorption differences between two different intramuscular sites: the thigh and the upper arm.

The results of this latter study (below) support the recommendation that epinephrine should be administered in the outer thigh. Greater blood flow in the thigh was considered the likely reason why the absorption rate was higher relative to the upper arm. 

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Failure to timely administer epinephrine during an allergic reaction is the leading cause of fatalities among the food allergic, which is why it’s so important to carry epinephrine if you have a food allergy. These findings further underscore the importance of administering the needle into the thigh, as delayed epinephrine absorption could have serious implications during life-threatening episodes of anaphylaxis.

So now you know, folks! Raise your epinephrine high to the sky, then swing it firmly into the thigh!

- Meg and the Allergy Amulet Team 

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How to Save a Life

Abi and Sakura at Middlebury College in 2007.

Abi and Sakura at Middlebury College in 2007.

Have you ever stabbed anyone? I have.

I stabbed my friend and Allergy Amulet Co-Founder Abi Barnes with an EpiPen in the summer of 2007.  

Abi and I spent that summer at Middlebury College, where I had just wrapped up my sophomore year. Alongside roughly 100 others, we immersed ourselves in an intensive Mandarin language program, pledging not to speak English for the program’s nine-week duration. Abi’s dorm was across the hall from mine, and we soon became good friends. We watched movies, went on runs, gossiped and joked, but always in this foreign tongue that consumed every part of our daily lives. We couldn’t even read in English, forcing several of us to secretly pass around an English version of the last Harry Potter book, which had just been released—no one wanted to attempt reading that in Chinese.

One particular summer day, we finished up our morning classes and walked over to the dining hall. We were now several weeks into the program, so I was used to seeing Abi meticulously look for nuts on the ingredients list of every item on the self-service buffet menu. She and I chatted away while she seemingly nonchalantly searched for ingredients that could kill her.

Among the various menu items was a grilled, flaky white fish with a brown sauce that we both opted for that day. Shortly after we sat down and started eating, Abi suddenly froze. “Oh my god,” she said; I was alarmed. Not because she turned pale, or had a look of panic in her eyes, but because she spoke English within earshot of other students and teachers.

《什么?》What?” I said.

“Oh my god.”

Worried about Abi getting in trouble I asked,《你为什么说英文?》“Why are you speaking in English?”

“No seriously, I can feel it. It was the fish sauce. I didn’t check it. I know it. I can feel it. I need my EpiPen,” she said in a panicked manner.

《在哪里?》Where?

“We have to go. It’s in my room.”

Abi grabbed my hand and we ran across campus to our dorm. Once in her room, she tossed me the EpiPen in its original cardboard packaging and said, “Read the instructions.” I learned later that it’s always better to let someone else administer the epinephrine­ needle. I also learned that it’s good to have someone with you—which makes sense, considering that someone having an allergic reaction could pass out.

At this point, we were speaking only in English. I remember my hands shaking while I held the instructions and found myself reading them over and over again. Meanwhile, Abi was popping Benadryl tablets like pink Tic Tacs. She extended her paper-white thigh to me and said, “You’ll need to do it with full force.”

So I took a generous upward swing and stabbed her. Bright red blood trickled down her upper thigh. We then rushed to the hospital.

Many hours later, when the hospital determined she was safe to leave, our friend drove over to pick us up. We got into the car and The Fray’s “How to Save a Life” came on the radio. We laughed and heaved a collective sigh of relief.  

It wasn’t until days later when we went swimming in a nearby lake that I realized the force of stabbing her had left a black and blue bruise bigger than my hand on her thigh. I knew that food allergies were dangerous, but this incident with the fish sauce was a terrifying reminder of that fact. I remember Abi was completely wiped out after the ordeal, and to think that she has to constantly look out for dangers lurking in foods must be exhausting.

Fast forward a decade and I’m currently the Chief Operating Officer of a family-owned Japanese restaurant group in New York City. At each of our 15 locations, our staff is trained to manage food allergies. I’d like to think that we’ve educated our staff about food allergies since opening our first location in 1984, but the reality is that dining out is always a potential minefield for individuals like Abi. It makes sense that she came up with the idea for Allergy Amulet.

Stabbing Abi in the summer of 2007 will forever stay with me as a reminder of the importance of food allergy awareness and education. I also hope that incident will remain my first and last stabbing.

 

Abi’s longtime friend, Sakura Yagi, wrote this post. For additional information on the proper use of epinephrine, please read here

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More Tools, More Problems? Food Allergies Since 1960

This guest post was written by Theresa MacPhail—assistant professor in the Science, Technology, and Society Program at Stevens Institute of Technology. 

Last December, I wrote a blog post about the early history of food allergies from the 1800s through the 1960-70s. In this installment, we’ll examine more recent food allergy chronicles, current treatments, and diagnosis debates. Despite advances in our understanding of the immune system, and promising developments in allergy-related technologies (like the Allergy Amulet), the lack of a cure or effective treatments for food allergies persists.

The Discovery of IgE

Immunotherapy treatments were first tested in animals, and then cautiously applied in clinical settings to treat both respiratory allergies and food allergies beginning in 1911. The risk of an accidental anaphylactic response was, and is, ever present. Much of the early allergy testing and treatment remained unchanged until the mid-1960s, when two separate research teams discovered immunoglobulin E, or IgE—a molecule that naturally forms in human blood.

IgE’s discovery led to a greater understanding of the inflammatory response that follows allergen exposure, sparking more research around the cause of allergic reactions. By 1975, the first commercially available and reliable blood test for IgE became available for clinical use. IgE testing quickly became a significant aid in allergy diagnosis, since an elevated presence of IgE levels in the blood often indicates a food allergy.

IgE has played an enormous role in subsequent allergy research, diagnosis, and treatment. However, while IgE tests provide information as to the likelihood of having a food allergy, 50-60% of IgE blood tests yield a “false positive” result, creating a great deal of uncertainty in diagnosis. IgE as an allergy biomarker is accordingly far from perfect.

Food Allergies - A Rising Prevalence?

If you follow the news or social media, or have a young child in the school system, it certainly seems that food allergies are on the rise. Although food allergy awareness has increased over the last decade and has become a more popular topic of conversation, the food allergy prevalence rate has been difficult to measure with confidence.

Figures on the national and global food allergy population are unsettled. This is largely because the numbers rely on multiple data sets collected across different methods and research groups. Official estimates place the figure at around 15 million. Adding to this confusion is the difficulty in confirming the presence of an allergy with current diagnostic tools (often IgE testing, discussed above). The majority of food allergy and food intolerance cases depend on self-reporting and sometimes self-diagnosis—and those numbers fluctuate greatly. A recent paper looking at multiple different allergy studies found that “[s]elf-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for [other foods].” A 2013 paper further suggested that “at least 1%–2% and up to 10% of the US population suffers from food allergies," which based its findings on "self-report, skin prick test (SPT), serum-specific IgE (sIgE), and oral food challenges (OFC).” These reports show that food allergy populations vary based on allergy type, reported severity, geographic region, study design, and testing method.

In short, with no easy and standardized way to diagnose food allergy cases, it is difficult to confirm and measure the perceived rise in the food allergy population.

The LEAP Study and the Future of Oral Immunotherapy

Perhaps the most significant study on food allergy in the last 50 years is the Learning Early About Peanut Allergy (LEAP) study by the Immune Tolerance Network. In this study, infants at a higher risk of developing a severe allergy to peanuts were randomly assigned to one of two groups: one that would avoid ingesting peanut-containing foods until age 5, and one that would consume a peanut-containing snack (~6 grams of peanut protein) with three or more meals per week until age 5. Of the children who avoided peanut, 17% developed a peanut allergy, compared to only 3% of the children in the control group. In a press release for the study, one of the researchers noted how for decades allergists have recommended that infants avoid consuming allergenic foods, and this study "suggests that this advice was incorrect and may have contributed to the rise in [] peanut and other food allergies.” Indeed, the LEAP study overturned decades of prior advice and shook the allergy research community. The study also gave credence to one of the oldest forms of allergy treatment: immunotherapy. 

After a decade of research, oral immunotherapy is becoming more widely accepted as effective for the most common food allergies (e.g., peanut), but little is known about its long-term effectiveness. If you’re not familiar, oral immunotherapy (OIT) is a method of food desensitization that involves re-introducing the immune system to the allergenic food in gradually increasing amounts over time, with the goal of eventual tolerance. Although researchers are optimistic about its potential, it is not without its drawbacks. You can learn more about OIT in Allergy Amulet’s blog post here.

The Promise and Peril of Epinephrine

Epinephrine (the hormone adrenaline) was first discovered in 1900 and marketed to treat asthma attacks and surgical shock. By 1906, with the development of a synthetic version, the drug was in common use by clinicians to treat severe asthma attacks. Immunologists and allergists experimented with dosages in the decades following, standardizing treatment protocols.

In 1975, a biomechanical engineer developed the first auto-injector syringe for the military, which was then adapted for use with epinephrine. It wasn’t until 1987, however, that the FDA approved the first epinephrine auto-injector for the general public. Epinephrine auto-injectors proved so effective—and the dosage delivered was so consistent—that it became the standard prescription for anyone suffering from a severe allergy. By the 1990s, food allergy patients were advised to carry one at all times for their safety.

In 2016, the mother of a child with a severe food allergy began a campaign against the dramatic rise in price of one of the most popular epinephrine auto-injector brands: EpiPen. The price of EpiPen surged between 2004 and 2016 – increasing from $100 to over $600. With few competitors on the market, Mylan Pharmaceuticals, the manufacturer of the EpiPen, felt no need to lower its prices. The story went viral and sparked debate about pharmaceutical industry pricing policies and access to affordable healthcare. Since the scandal broke, there has been a call to develop alternative and less expensive epinephrine auto-injectors.

The Epi-Pen story—and this post—highlight the urgent need for greater investment in allergy research and innovation. Let’s hope that with new advancements in the coming years, food allergy itself will be history. 

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