Risks of using epinephrine too early

[spacecanada]

An interesting article, considering so many people don't use their autoinjectors often enough. The article makes some good points, but further adds to the blurriest of when exactly to use your autoinjector:

http://www.jaci-inpractice.org/article/S2213-2198(16)30141-6/fulltext

[Puddles]

I've never had a doctor advise we use the auto injector without definite symptoms beyond hives. The onky risk we had considered was, there have been times when we would have been giving it 4+ times per week for what were not anaphylactic reactions. And my doctor and I felt that was not healthy.

Just saying that's our decision. Not disputing that other doctors feel differently.

[CMdeux]

Hourihane's basic angle on epinephrine autoinjectors and patients/parents is that they are a) vastly overprescribed, and b) probably over-utilized, and that c) the greatest ILL in this patient population is anxiety.... which would easily be solved by not telling people that they can die from their food allergies, apparently...

I mean, I jest a bit with that flippant summary of his basic beliefs, but he is the anchoring (sponsoring/corresponding) author on one of these things every 3 or 4 years, at a minimum... ALWAYS the gist of it seems to be that patients shouldn't be given so much of a burden because the odds are actually on their side (the not dying from anaphylaxis bit) and that really, what a waste it is for families to be all in a dither over this day to day anyway...

So yeah.  I'm not saying that WHAT he is saying is necessarily incorrect, so far as that goes... so much as that he's USING it to grind on a favorite axe, and one that I think he is deeply, unfortunately misguided over.  As usual. 

HIS aim, contrary to the stated goal of manufacturers of the devices wanting to sell more of them (something that he claims is driving management plans toward over-use).. is to save the NHS loads of cash... which I'd argue could well be driving things the other direction. 



From a socialized public health stance, I can appreciate his perspective there-- after all, only seldom will anaphylaxis NOT self-resolve, or at least be slow-moving enough to get an ambulance to you in time for additional measures to be undertaken, assuming that someone calls them right away...

but still-- would sure suck to be one of those unfortunate but apparently "rare" outlying folks in his Utopia.   

[gvmom]

I probably shouldn't have read that.

But, who are they and why are they writing that?  Did someone ask them to come up with an opinion, or has there been a bunch of people, with food allergies, with prescriptions from doctors, injecting themselves because they thought they should?

Honestly.  If I could I'd crumple up their whatever that was and toss it back at them.

Has anyone ever really read a persons recounting of an experience like that .... meaning someone retelling their own story, or one of their children's stories...... anywhere..... where it was about how they used their auto injector even though they had no symptoms?  Or, that this is some widespread occurrence or philosophy circulating around in the FA population?

I have to believe that this is a case of more busybody people who have to publish something about something that they don't live with, that ends up becoming nonsense that well meaning friends and family quote to you over the holidays, or clip/print/link to send to you to be helpful.

[name]

That moment of wilting fright when CMdeux is serving some serious truth tea and I want my teddy bear.  It's always the stuff I don't wanna know, but realize not knowing is worse. 

[Macabre]

Yikes this article.

But these doctors are all in England and Ireland, which is enough info for me to put this in perspective. I know that in the U.K. They typically have very different standards than the US has. And I trust what US doctors say about this. I've thought that UK docs are doing harm by their recommendations for using epinephrine. This is not different.

[lakeswimr]

Simply scary.  Epi works best when given early; within 20-30 min max.  Waiting makes it less effective, not more as the author suggests.  I have long felt very frustrated reading stories out of the UK regarding FA fatalities and people who have severe reactions but are not given epi.  The doctors there seem to overall have a very different point of view on ana that I don't believe is supported by research. 

[Nommie]

I've always used Hydrow rower and never had a doctor advise we use the auto injector without definite symptoms beyond hives. The onky risk we had considered was, there have been times when we would have been giving it 4+ times per week for what were not anaphylactic reactions. And my doctor and I felt that was not healthy.

Just saying that's our decision. Not disputing that other doctors feel differently.

Yeah, same here. I don't use it too much because I don't want to build up an immunity to the medicine.

[SilverLining]

I don't think epinephrine is something you can build up an immunity to.

[lakeswimr]

I also don't think you can build up immunity to it.  And if a person is having reactions that frequently they should either look at how this is happening--are they all from food or possibly not food related?  Does the person have MCAS?  Does the person have a yet unidentified food allergy or some cross contamination that they are not realizing is a risk or at the factor level in a food they eat?

[Puddles]

I also don't think you can build up immunity to it.  And if a person is having reactions that frequently they should either look at how this is happening--are they all from food or possibly not food related?  Does the person have MCAS?  Does the person have a yet unidentified food allergy or some cross contamination that they are not realizing is a risk or at the factor level in a food they eat?

f

It took me a while to figure out what I was allergic to, and then how many unlabelled foods were cross contaminated. Since figuring it out, I usually have a reaction about once every 18 months and usually I can figure out to what.

I agree frequent reactions should be looked closer to figure out.

[eragon]

http://onlinelibrary.wiley.com/doi/10.1111/cea.12852/full   


this is the anaphylaxis campaign's response to the BSACI new guidelines.

[spacecanada]

In light of recent events, and how they relate to the initial article, it really emphasizes how bogus some of the recommendations are.  Okay, I agree that Epi without any symptoms might not be warranted for some people (but definitely applicable to some!), and maybe one or two other very minor points made in the article are valid (theoretically, anyway, not necessarily in reality), but giving Epi early can save lives.  Articles like this just cloud the waters and make people more hesitant to Epi.

We really, really, need to make people more aware of that fact: early Epi saves lives.   

[lakeswimr]

In light of recent events, and how they relate to the initial article, it really emphasizes how bogus some of the recommendations are.  Okay, I agree that Epi without any symptoms might not be warranted, and maybe one or two other very minor points made in the article are valid (theoretically, anyway, not necessarily in reality), but giving Epi early can save lives.  Articles like this just cloud the waters and make people more hesitant to Epi.

We really, really, need to make people more aware of that fact: early Epi saves lives.

It is so frustrating to know *doctors* give wrong and bad advice to patients about this.  Waiting doesn't make a person safer.  Waiting makes the epi less effective.  Epi without symptoms is not a standard thing but for some people who have known ingestion and have had ana, their doctors do recommend any future known ingestion = epi.  But waiting and making people scared to use it doesn't make sense to me.  I get it that people can get real anxiety from the fear of reactions but the answer to that shouldn't be bad medical advice about when to epi. 

[Mr. Barlow]

Medicine is an imperfect art to practice subject to wild swings in development.  That I am sympathetic to.  The greater issue is practitioners that refuse to embrace they are always capable individually or in group to develop and disseminate fallible information.  Like the preference to say "old advice" and "new advice" rather than "we were wrong" or "we gave out bad advice" or "we do not always know better than patients."  I'm really not sure what platform we should be giving them because they seem to be saying more to the public who are NOT part of the patient cohort, than the patient cohort itself.