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Inhalers won’t stop anaphylaxis, but epinephrine will
stop either an asthma attack or anaphylaxis. So if in doubt,
use epinephrine and cover your bases.
whether this was a case of food allergy anaphylaxis or asthma or both epinephrine is the best emergency treatment for both kinds of airway constriction, but the double duty makes prompt use even more critical.
Two cases of fatal anaphylaxis are reported who were initially diagnosed as
acute severe asthma, and responded poorly to bronchodilator treatment.
Survivors of “acute asphyxic asthma” should be screened for reactions to
common allergens that provoke anaphylactic reactions. Even if no provoking factor
is identified, the asthma management plan of children who survive an episode of acute
asphyxic asthma should include intramuscular adrenaline (epinephrine) in addition
to conventional bronchodilators.
Severity of future allergic reactions is not accurately predicted by past history.
I wonder if Ryan had an allergic reaction to his morning snack, and this was mistaken for an asthma attack and only treated with asthma medication.
In one case there was documented exposure to nuts prior to death (the patient was known to be nut allergic). Acute severe asthma due to anaphylaxis as a cause of sudden death may be underestimated
In a study that reviewed the death records of individuals considered to have had an apparent fatal asthma attack, autopsy findings revealed that several of these patients had actually died from anaphylaxis.
** Consider administering epinephrine if the student is unable to use SABA because respiratory distress or agitation prevents adequate inhalation from the SABA inhaler device and nebulized albuterol is not available and the exacerbation is life-threatening. Administer epinephrine auto-injector in lateral thigh as per local or state epinephrine protocol. Epinephrine is NOT first line treatment for asthma. Albuterol is the treatment of choice. Administration of epinephrine should be rare and is intended to prevent a death at school from a severe asthma attack. Most school nurses will never need to administer epinephrine.
I'd probably be fine with an asthma plan that called for epi at some interval for non-responsivness to dialator - but wouldn't that likely be on the late end of needing epi if what we really had was a progressing food allergy reaction?
Hope I'm making sense.
I'd like to give a little background on why I started this poll:
1. From the article "When Anaphylaxis Looks Like Asthma" page 11 - 13 of this link
[url]http://www.aanma.org/pdf/AnaphylaxisGuide.pdf[/url]QuoteInhalers won’t stop anaphylaxis, but epinephrine will
stop either an asthma attack or anaphylaxis. So if in doubt,
use epinephrine and cover your bases.
An alarming finding was that 11 of the 37 deaths were probably caused by food allergy and for 8 subjects death was associated with exposure to pet dander. The death certificates were found to contain inaccuracies with 30% of those for whom asthma was reported as the underlying cause having died from other causes.
In a further five children there was evidence of allergen exposure shortly prior to death – in four cases exposure to an animal or pet, and in one case exposure to nuts.
Mike [Andrew's Dad] got his shoes on and started up the truck. But he was afraid to take the nebulizer off Andrew because he was really struggling to breathe and his lips were turning blue.
At first, we though it was just his asthma. They said "no, its anaphylactic shock." It makes me angry more than words can say. We were never told anything like this could happen.
near-fatal asthma (NFA)
What was surprising was that patients with NFA reported more food allergies and onset of their episode following a visit to a bar, party, or restaurant.
Published prevalence of anaphylaxis admissions should be interpreted with caution as an unknown number could be miscoded as severe asthma
As mentioned earlier, patients with asthma, particularly
those with poorly controlled asthma, are at
increased risk of a fatal reaction. In these patients, anaphylaxis
may be mistaken for an asthma exacerbation
and inappropriately treated solely with asthma inhalers.
Therefore, if there are ongoing asthma symptoms in an
individual with known anaphylaxis, epinephrine should
be given [6].
In five of 16 deaths caused by nut allergy, the postmortem cause of death was given as asthma, despite other features of a generalised reaction noted in the clinical record. It is possible that many other acute asthma deaths in those with a history of food allergy might have been reactions to food. A recent study from Sweden has identified soy proteins as a possible cause of such reactions.18 This raises the question of which deaths should be classified as anaphylactic, and which asthmatic.
Because all food-related reactions caused difficulty breathing, the paramedics commonly had difficulty deciding whether to use the protocol for anaphylaxis or for asthma. This led to delayed or inappropriate treatment that may have contributed to the fatality.
I would like to see these standard action plans revised to make it very clear that anaphylaxis can look like an asthma attack. I also would like to see this information part of the "welcome packet" of standard information given to parents of children with both anaphylaxis and asthma.
"The benefits of epinephrine almost always outweigh the risks, but there's a reluctance to use it. Patients get palpitations, they might get a headache, their heart rate goes up, but it's a potentially life-saving treatment."
With a past medical history of asthma, she thought she was having and asthma exacerbation and used her albuterol inhaler multiple times without relief of dyspnea
She was immediately given epinephrine 0.3 mg intramuscularly (into the thigh) and immediately regained consciousness with prompt resolution of dyspnea
Do you think IM or SC epinephrine should be added to school nurse treatment protocols for severe asthma epidoses that are not improving after albuterol administration (in addition to the nurse calling 911).
having epinephrine available as a backup is not a bad idea in case of poor inhalation technique, but it is not necessary to have injected epinephrine available for the treatment of asthma with proper inhaltion technique. Early studies (an example is copied below for your convenience) showed that the injection of epinephrine offered very little in addition to the inhalation of beta-adrenergic agents for the therapy of asthma
Larson’s orders don’t stipulate the EpiPen must be used in an asthma attack, but the family’s attorney, Thaddeus Martin, believes it would have saved her life.
As the four adults tried to get the child to relax, one of them gave Mercedes doses from an inhaler “telling Mercedes to try and hold it in"
The great thing about epi is that if there’s a caregiver present it doesn’t depend on the status of the patient. You deliver the drug to the thigh muscle and the body itself does all the work.
Asthma alone as a manifestation of a food allergy is rare and atypical. Less than 5% of patients experience wheezing without cutaneous or gastrointestinal symptoms during a food challenge.
I’m worried about confusing asthma symptoms with anaphylaxis. What if I give my child the wrong medication?
I wonder if I should ask for some type of inhaler??? Accidental exposure to Sunflower and Sesame bring on the wheezing and feeling like I cant catch my breath big time(obviously other symptoms too) Would that be something to help? Would I use it before or after the epi or in lieu of??? I hate to sound stupid but I would rather ask now and know.
Asthma as anaphylaxis: again, any asthma that doesn't "fit" the usual pattern (for someone like my DD, who has pretty stable asthma) needs to be viewed with deep suspicion, and even moreso if she has been anywhere where there is food within the preceding hour or two. I did laugh and remind him that this means anytime we've left the house.
That's the pattern, basically-- that "regular" asthma responds to rescue meds pretty well, and allergy-driven asthma does not.
My daughter's asthma has shifted slightly (worsened, actually, at least in frequency) in the past year or so. We were aware that this could happen during adolescence, though obviously we aren't pleased about it. She probably uses rescue meds 2-6 times a month even without illness or allergy being in the picture.
We are much better about checking peak flows as a result. That's helpful in some respects, since we know what a 10% or 20% decrease in peak flows looks like, and she knows very well what it feels like.
We also are quite aggressive about pre-medicating in any situation where an impairment is likely-- before exercise, before general anesthesia, etc.
So we have a sort of decision tree-- but not an "action plan" so to speak. Not the way that we do with food allergy.
But I have lot clearer picture of when to transition from the one to the other now, and so I'm happy about that.
Basically, the decision tree re: breathing problems of any kind is:
Possible allergen exposure?
Y/likely? try ONE administration of albuterol-- and if it helps, observe, if not, proceed to allergy action plan-- aggressively. Use Epi.
N/unlikely? try up to TWO administrations of albuterol (5-10 min apart), if impairment isn't significantly better, proceed to allergy action plan and watch carefully. If impairment worsens, use EPI.
Other factors which change things slightly include:
a) ease of access to EMS (the more difficult, the more aggressive we'll want to be)
b) overall 'atopic' context-- that is, how reactive has she been recently, how much allergen load currently, etc.
So we have a sort of decision tree-- but not an "action plan" so to speak. Not the way that we do with food allergy.
But I have lot clearer picture of when to transition from the one to the other now, and so I'm happy about that.
All people with asthma should have an asthma action plan. An asthma action plan (also called a management plan) is a written plan that you develop with your doctor to help control your asthma.
Anaphylaxis is under-reported in emergency settings and the potential for diagnostic confusion with acute asthma has been reported, especially in children who experience predominantly respiratory symptoms.
The results support the conclusion that some cases of anaphylaxis are unidentified and managed as acute asthma in children. The local frequency was estimated at 4.1% of children admitted to PICU but larger prospective multi-centre studies are required to better define the true prevalence nationally.
Project Aim: To determine if intramuscular epinephrine is an effective adjunct to inhaled bronchodilators (β2 agonists) for children with severe asthma exacerbation.
When he was 7, a cheese slice touched his food. He didn’t eat the cheese slice – it just touched his food. Sudden asthma attack. Albuterol and antihistamines barely made a dent this time. We rushed him to the doctor where he was given a shot of epinephrine and steroids. We had an EpiPen with us – we didn’t use it because we were looking for more than asthma. Big mistake. We were lucky his symptoms turned around.
The CSACI says: “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 (e.g. before a puffer). Ephinephrine can be used to treat life-threatening asthma attacks as well as anaphylactic reactions.”
Despite anaphylaxis becoming more common, it is under recognized
The reason is: it’s not so easy to recognize
She notes that breathing problems can cause confusion over whether a person is suffering from anaphylaxis or an asthma attack.
Seven-year-old child with clinical history of milk allergy (hives, vomiting) experiences sudden coughing and wheezing 15 minutes after a presumably milk-free lunch at a friend's house; has no rash or other symptoms.
Pro—inject immediately: safety of lunch uncertain, up to 10% of individuals with anaphylaxis have no skin signs, presentation of anaphylaxis varies from episode to episode in the same individual; treating anaphylaxis only with albuterol could have tragic consequences; low risk of side effects from SIE.
Con—inject immediately: for possible asthma exacerbation, try albuterol MDI first.
Join us with guest speaker David Stukus, MD, a Medical Advisor to KFA. Dr. Stukus is an Assistant Professor of Pediatrics in Allergy/Immunology at Nationwide Children's Hospital in Columbus, Ohio.
Some of the topics that will be covered:
How can you tell asthma from food allergy?
Among all cases, 76 (29%) had a documented non-food allergy and 51 (20%) had a food allergy. Allergic exposure precipitated the admission in 19/102 (19%) of those with known allergies.
At the age of 11 years, despite apparent clinical stability and use of regular controller asthma therapy, she suffered a fatal acute asthma attack that may have been related to acute allergen exposure.
Today my son’s allergist told me that I should use epinephrine ANY time my son starts to show signs of breathing distress after exposure to a known food allergen. And I should use it first, before Benedryl or Ventolin. And if he’s going into an asthma crisis unrelated to food, to go ahead and use epinephrine as well.
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.
If the patient is having a perceived life-threatening event, peripheral or central cyanosis, or worsening symptoms then the epinephrine should be administered and local emergency services contacted immediately.
I authorize administration of an Epinephrine injection for my child if they have a severe asthma episode in which their prescribed asthma medication is not resolving their respiratory distress/failure.
Many parents worry they might mistake anaphylaxis for an asthma attack.
Anaphylaxis may occur in the absence of any skin symptoms such as itching and hives. Fatal anaphylaxis is more common in children who present with respiratory symptoms or GI symptoms such as abdominal pain, nausea or vomiting. In many fatal reactions, the initial symptoms of anaphylaxis were mistaken for asthma or mild GI illness, which resulted in delayed treatment with epinephrine auto-injector.
Fatal anaphylaxis is more common in children with food allergies who are asthmatic, even if the asthma is mild and well controlled.
Yes, yes, yes to what this doc said about needing a holistic approach for treating atopic kids.
Let me count the specialists we've seen for the atopic related stuff: allergist, pulmo, derm, GI, ENT, & ped. These docs often see things from their own corner of the atopic room & sometimes theyfight, ok - let's say disagree, with each other. When that happens, guess who gets to decide - yep, that would be me. It's much nicer when they complement one another & communicate as a team.
My FAS passion these days - having special versions of asthma plans for those having both FA & asthma - in my non-medical opinion - this is the type of specialty crossover that's needed.
Food-induced anaphylaxis often is mistaken for severe status asthmaticus, and laboratory studies aren’t helpful in differentiating the two.
Epinephrine is safe and the alternative is unthinkable. The side effects (e.g. higher heart rate, jitteriness, headache) usually last only minutes and subside with rest.[1] Timing is essential as delayed administration has been associated with fatalities or near-fatalities.
Epinephrine is indicated for various medical emergencies, including cardiac arrest and anaphylaxis, but the dose and route of administration are different for each indication. For anaphylaxis, it is given intramuscularly at a low dose, whereas for cardiac arrest a higher dose is required intravenously. We encountered a patient with suspected anaphylaxis who developed transient severe systolic dysfunction because of inappropriately received cardiac arrest dose, ie, larger dose given as an intravenous push.
The risk of error was amplified by the need for rapid decision making in critically ill anaphylactic patients.
The error rate of epinephrine administration causing potentially fatal adverse reactions in one study was reported to be 2.4%.8 One study suggested that prefilled syringes of 0.3 mg of 1:1000 epinephrine clearly labeled to be given IM for anaphylaxis would decrease the incidence of dosing errors.8
CONCLUSION: Epinephrine by intramuscular injection is a safe therapy for anaphylaxis but training may still be necessary in emergency care settings to minimize drug dosing and administration errors and to allay concerns about its safety.
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.
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.
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.
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)
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.
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.
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.
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.
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).
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".
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.
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.
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.
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
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.
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.
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.
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
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.
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.
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.
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.
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.
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. :yes:
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.
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.
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.
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.
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.
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”.
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.
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,"
'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.
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
Teenagers with asthma at increased risk of life-threatening anaphylaxis
[url]https://www.mcri.edu.au/news/teenagers-asthma-increased-risk-life-threatening-anaphylaxis[/url]QuoteAccording 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.Quote15-year-old Jack IrvineQuoteJack inadvertently ate a biscuit containing macadamia nuts while attending a catered go-karting campQuoteJack 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.
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.
“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.
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.
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."
Each year, the Asthma and Allergy Foundation of America (AAFA) declares May to be "National Asthma and Allergy Awareness Month.
Tweeted by @Aller_MD
------------------------------
"A brave new world – ‘research with’ not ‘research on’ patients"
[url]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[/url]QuoteSince 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:
[url]http://susannahfox.com/2014/05/17/false-boundaries-in-health-care/[/url]QuoteWhy 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?
Edward Debbage, who died on February 10
range of food allergies and also suffered from asthma
suspected asthma attack
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.
Tweeted by @Richard56
"Richard Smith: Why scientists should be held to a higher standard of honesty than the average person"
[url]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/[/url]QuoteThe 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. :yes:
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.
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.
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
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”.
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.
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.
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.
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.