... about food allergies

By Julia Cyboran

A sad irony is that young Sabrina was extremely proactive about her allergies. When she was just 10 she made a CBC radio documentary about living with food allergies called A Nutty Tale. Sabrina always took the necessary precautions to avoid any allergic reactions and on that fateful day she duly asked cafeteria staff if the fries had come in contact with the products that were dangerous to her. She was assured they hadn't.

About a half hour after lunch Sabrina — who was also asthmatic — began wheezing and went to see the school nurse. She believed she was having an asthma attack and left her Epipen behind. Sabrina lost consciousness minutes after reaching the nurse's station. She was rushed to the hospital, but never regained consciousness and died the next morning.

With the new law will also come the need for doctors, parents and anaphylactic patients to get even more informed about how to cut down on the risk of anaphylaxis and what to do if a reaction occurs. Here are some tips on how to talk to your patients about anaphylaxis.

FOOD FOR THOUGHT
Not just peanuts Anaphylaxis is a serious allergic reaction usually caused by food. The most common are peanuts, dairy, soy, sesame and seafood, but insect stings, latex and some medications can also be triggers. "Generally it happens when there is a systemic allergic reaction," says Dr Gordon Sussman, a professor of clinical immunology at the University of Toronto and a physician at St Michael's Hospital. Dr Sussman explains that any allergic reaction is technically an anaphylactic reaction — from breaking out in hives to requiring a dose of epinephrine — but the term anaphylaxis generally refers to the more serious type. Dr Sussman says it's important to educate all patients with anaphylaxis about the signs and symptoms of anaphylactic shock, and what to do to prevent a case like Sabrina Shannon's.

Know the signs Essentially, when a patient is exposed to an allergen it triggers the body to release histamines and other substances into the blood stream. Patients with such allergies must be able to recognize the progression of symptoms that lead to anaphylactic shock. "Initially they will have flushing," says Dr Sussman, "they can have tachycardia [rapid heartbeat], and a headache and feel like something bad is going to happen." He adds that patients may have a strange metallic taste in their mouths, and feel generalized itching that progresses to hives accompanied by shortness of breath and finally cardiac symptoms. Patients can also look out for swelling of the eyes, face, lips, tongue and throat, and difficulty swallowing.

A jab well done When a patient starts feeling these symptoms it's important that they know that time is of the essence. "The treatment is an Epipen," says Dr Sussman firmly, "and it has to be given early." He stresses that there is no harm in administering the Epipen, an epinephrine shot, as soon as they think something's not right. He emphasizes that you have to tell patients to keep their Epipen on them at all times ("There have been deaths reported where people have had their Epipen in a locker or a car," he says) and to head directly to the emergency department once they've taken it. Antihistamines can also be used as an adjunct treatment.

Prevention is the best medicine A key message for patients with severe allergies is to know what to avoid and what precautions to take. Advise your patients to avoid baked goods, says Dr Sussman, since it's impossible to be 100% sure that the product has been contaminated with an allergen, regardless of what the label says. Chocolate is also a common culprit. Dr Sussman says that tests show that nearly 25% of all chocolate has traces of peanut — something that could easily trigger a reaction in those with allergies. Patients should also be told to learn to scrutinize food labels, interrogate restaurant staff and check ingredients carefully.