In late November, Canada was stunned
by the death of a Quebec teen who died after being kissed
by her boyfriend. And no, it's not an urban myth. Christina
Desforges, 15, suffered from peanut allergies and before
their fatal embrace, her boyfriend had eaten some peanut
butter — reportedly some hours earlier. The case
has reignited interest in educating patients about the
safe and proper use of adrenaline in the event of anaphylactic
shock.
USE
IT RIGHT
The onset of symptoms was quick and though Christina
used her EpiPen (an epinephrine shot), it seems she
made a fatal error. In her panic Christina didn't leave
the needle in the skin long enough. She went into respiratory
arrest and died a few days later in hospital. Dr Nina
Verreault, an allergist at the Chicoutimi hospital where
she was treated, emphasized that peanut allergies are
very rarely lethal.
This case does show that patients
don't always know the right way to use their emergency
meds when it counts. Dr Gordon Suss-man, a professor
of clinical immunology at the University of Toronto
and a physician at St Michael's Hospital, told NRM
earlier this year that doctors must make sure their
patients with food allergies know what to do when they
start to go into anaphylactic shock. "Patients have
to take the cap off [the pen device], and push it into
their upper thigh using their wrist," he explained.
"When they do inject it, they have to hold it in place
for five to 10 seconds." This is unfortunately the step
Christina missed. But she's not alone. "A very significant
percentage of people don't carry or know how to use
their EpiPen," Dr Sussman told us. Paladin recently
introduced Twinject, an adrenaline shot that contains
two doses of the medication to aid in treatment. Prompt
and informed patient action remains essential.
Patients often fail to go to emergency
once they've taken their shot — even if the symptoms
are mild or have stopped. It's essential they're observed
for four to six hours to make sure the reaction doesn't
come back.
With peanut allergies on the rise,
it's important to get the message across to patients
to have their emergency meds on them at all times, now
more than ever. "There's no way you can predict in any
individual patient what kind of reaction they'll have,"
stressed Dr Sussman.
For more on what Dr Sussman has
to say about anaphylactic shock see "What
to tell your patients about food allergies" (Vol
2 No 12, June 30, 2005).
CLARIFICATION: "Peanut
butter kiss ends girl's life" (Vol 2, No 21, December
15, 2005, page 11) stated that Christina Desforges had
misused her adrenalin pen during anaphylactic shock.
Conflicting reports have emerged and NRM is unable to
verify the full details of the case, including the cause
of death. The hospital has no immediate plans to release
the autopsy.
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