ASSOCIATION OF
ASTHMA EDUCATORS


News - August 2017

FOOD ALLERGY & ANAPHYLAXIS UPDATE

SEASONAL UPDATES FOR AAE HEALTHCARE PROFESSIONAL MEMBERS
By Anne F. Russell, BSN, RN, AE-C

Physicians, nurses and other members of the clinical team have a critical role in assuring that school entry of children with IgE mediated food allergies includes comprehensive preparation and ongoing communication to promote student safety. Clinical teams can assist families by ensuring back-to-school office visits include completed school health paperwork, school medication forms, anaphylaxis emergency action plans, any needed prescriptions refills, and patient education including use of epinephrine auto-injectors.1,2 It also may be beneficial for the clinical team provider(s) to write a cover letter for the school that clearly delineates recommended case-specific medical accommodations for a patient.2 Schools may be perceived as food allergen ubiquitous settings coupled with varying levels of school staff education on anaphylaxis prevention and preparedness.2 There may also be disparities in school nurse coverage rates between and within states even though the school nurse role includes leading, implementing, and evaluating school health policies, individualized health plans, food allergy/anaphylaxis staff education, and oversight of unlicensed assistive personnel.3,4 Clinical team members may be called upon to assist with food allergy and anaphylaxis education of school staff as well as for input on individualized school health plans.1,2 In your service area, be sure to know school nurse coverage rates, school food allergy policies, any state school food allergy management guidelines, and any state laws regarding self-carry of epinephrine and non-student specific stock epinephrine in your local schools.2 Links to selected resources to assist clinical teams:


KALÉO AUVI-Q® DONATION PROGRAM FOR U.S. PUBLIC ELEMENTARY SCHOOLS 

Kaléo announced their new charitable product donation program to offer AUVI-Q® Auto-injectors free to all U.S. public elementary schools.5 The new Kaléo program, Q Your School, offers up to four AUVI-Q cartons (two epinephrine auto-injectors and a trainer per carton) per school per academic year and access to related educational materials.5 

Kaléo press release about Q Your Schoolhttp://bit.ly/2wAOWhk

Link to application to apply to the program: http://bit.ly/2wXq97E.


NEW AMERICAN ACADEMY OF PEDIATRICS ANAPHYLAXIS EMERGENCY PLAN

In February the American Academy of Pediatrics (AAP) published a new customizable allergy and anaphylaxis emergency plan template which includes clarity on steps to take for mild versus severe reactions and extra space for additional case-specific information.6 Julie Wang, MD and Scott H. Sicherer, MD co-authored an accompanying report for the AAP Section on Allergy & Immunology offering guidance to clinicians on information to include when completing the allergy and anaphylaxis emergency plan.6 Provision of an updated anaphylaxis emergency plan with related patient education is an integral component of a back-to-school office visit.2 Schools may require such documentation for their records and as a guide to school management planning for students at risk of anaphylaxis.

AAP Clinical Report: Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan

AAP template: https://www.aap.org/en-us/Documents/AA-EmergencyPlan.pdf



ORDERING IMPAX EPINEPHRINE AUTO-INJECTOR®PRODUCT TRAINERS

Clinical team members, school nurses, and patients can order Impax Epinephrine Injection Auto-Injector® product trainers which do not contain medication or a needle, online at http://epinephrineautoinject.com or by phone at #855-374-6374.7 An instructional video on how to use the Impax Epinephrine Injection Auto-Injector® can be viewed online at: http://bit.ly/2vbsu1K.7


FDA APPROVES NEW 0.3mg PRE-FILLED SINGLE DOSE EPINEPHRINE INJECTABLE

In June Adamis Pharmaceuticals Corporation announced the U.S. Food and Drug Administration approved Adamis’ EPINEPHRINE INJECTION, USP, 1:1000 (0.3 mg pre-filled single dose syringe) and also approved its trade name of Symjepi™.8 Symjepi provides two single dose syringes of epinephrine.8 Adamis is also preparing a submission for approval of the junior version of Symjepi.8 Press release from Adamis Pharmaceuticals Corporation regarding FDA approval: http://bit.ly/2tpklTc.

 

FDA GRANTS PRIORITY REVIEW FOR EPINEPHRINE AUTO-INJECTOR IN DEVELOPMENT BY KALEO FOR INFANTS AND SMALL CHILDREN

In July Kaléo announced the U.S. Food and Drug Administration granted Priority Review of Kaléo’s supplemental New Drug Application for an AUVI-Q 0.1 mg, an epinephrine auto-injector designed for treating anaphylaxis in infants and small children weighing 16.5 to 33 pounds.9 According to Kaléo, if AUVI-Q 0.1 mg is approved, it is projected to be available on the market in 2018.9 Press release from Kaléo regarding status of AUVI-Q 0.1 mg: http://bit.ly/2w2UfpF.


FOOD ALLERGY BULLYING

Studies have shown bullying among children with IgE mediated food allergy is common, frequent, repetitive and primarily occurs from classmates and school staff.10-12 Physical bullying has included being touched by a known allergen, having an allergen thrown or waved at the food allergic student, and intentional contamination of food with the known allergen.11,12 Because such bullying may negatively impact physical safety, quality of life, and academic performance, clinicians should be aware of forms of bullying, risk factors, and ramifications. Links to selected resources:



CRITICAL ISSUES IN FOOD ALLERGY: A NATIONAL ACADEMIES CONSENSUS REPORT

Scott H. Sicherer et al published an article in Pediatrics summarizing the National Academies of Sciences, Engineering, and Medicine (NASEM) report on “Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy.13 Citation and link: Sicherer SH, Allen K, Lack G, Taylor SL, Donovan SM, & Oria M. Critical Issues in Food Allergy: A National Academies Consensus ReportPediatrics. 2017; 140(2), e20170194.


FACTORS ASSOCIATED WITH PREHOSPITAL MANAGEMENT OF ANAPHYLAXIS IN CHILDREN

Robinson et al published an article in Annals of Allergy, Asthma & Immunology regarding factors related to the delayed administration of epinephrine prehospital.14 Citation and link: Robinson M, Greenhawt M, & Stukus DR. Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency departmentAnnals of Allergy, Asthma & Immunology. 2017; 119(2), 164-169.

RISK TAKING BEHAVIORS AMONG FOOD ALLERGIC TEENS & YOUNG ADULTS

Warren et al published an article in The Journal of Allergy and Clinical Immunology: In Practice investigating the social determinants of health, school food allergy policies, and level of social support which influenced increased risk-taking behaviors among adolescents and young adults with food allergy.15 Citation and link: Warren CM, Dyer AA, Otto AK, Smith BM, Kauke K, Dinakar C, & Gupta RS. Food Allergy–Related Risk-Taking and Management Behaviors Among Adolescents and Young AdultsThe Journal of Allergy and Clinical Immunology: In Practice. 2017; 5(2), 381-390.

CDC MORBIDITY & MORTALITY WEEKLY REPORT ON RESTAURANT FOOD ALLERGY PRACTICES

The Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report for the week of April 21, 2017 included a study about food allergy practices within 278 restaurants in different U.S. cities.16 Less than 50% of restaurant staff surveyed had received food allergy training and few had equipment and/or separate areas designated for allergen-free preparation.16 The CDC report identifies gaps in current restaurant practices among those studied and offers strategies for improving methods to reduce risks of allergic reactions in food allergic consumers.16 Link to CDC report: http://bit.ly/2ij44Ol


REFERENCES

    1. Centers for Disease Control and Prevention. Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs. Washington, DC: US Department of Health and Human Services; 2013.
    2. Russell AF, Huber MM. Food Allergy Management in Elementary School: Collaborating to Maximize Student Safety. Journal of Asthma & Allergy Educators. 2013; 4: 290
    3. National Association of School Nurses. 2011. Healthy children learn better. School nurses make a difference. How does your state measure up? https://www.bcsdk12.net/cms/lib01/GA01000598/Centricity/Domain/4575/Healthy%20Children%20Learn%20Better.pdf. Accessed August 21, 2017.
    4. National Association of School Nurses. Role of the 21st century school nurse.https://schoolnursenet.nasn.org/blogs/nasn-profile/2017/03/13/the-role-of-the-21st-century-school-nurse. Accessed August 21, 2017.
    5. KALÉO. Kaléo Announces AUVI-Q® (epinephrine injection, USP) Charitable Donation Program for All Public Elementary Schools in the United States. https://kaleopharma.com/kaleo-announces-auvi-q-epinephrine-injection-usp-charitable-donation-program-for-all-public-elementary-schools-in-the-united-states. Accessed August 21, 2017.
    6. Wang J, Sicherer SH. Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan. Pediatrics. 2017; Feb 13:e20164005.
    7. Impax Laboratories. How to order product trainers. http://epinephrineautoinject.com/order-product-trainers. Accessed August 21, 2017.
    8. Adamis Pharmaceuticals Corporation. Adamis Pharmaceuticals receives FDA approval for its epinephrine pre-filled syringe. http://ir.adamispharmaceuticals.com/phoenix.zhtml?c=99350&p=irol-newsArticle&ID=2281259. Accessed August 21, 2017.
    9. KALÉO. U.S. FDA grants priority review for an epinephrine auto-injector in development by Kaléo specifically for infants and small children. https://kaleopharma.com/u-s-fda-grants-priority-review-for-an-epinephrine-auto-injector-in-development-by-kaleo-specifically-for-infants-and-small-children. Accessed August 21, 2017.
    10. Bingemann TA. Bullying among pediatric patients with food allergy. Pediatrics. 2011; 1;128(Supplement 3):S113.
    11. Lieberman JA, Weiss C, Furlong TJ, Sicherer M, & Sicherer S. Bullying among pediatric patients with food allergy. Annals of Allergy, Asthma & Immunology. 2010; 105(4), 282-286.
    12. Shemesh E, Annunziato RA, Ambrose MA, Ravid NL, Mullarkey C, Rubes M., ... & Sicherer SH. Child and parental reports of bullying in a consecutive sample of children with food allergy.Pediatrics. 2013; 131(1), e10-e17.
    13. Sicherer SH, Allen K, Lack G, Taylor SL, Donovan SM, & Oria M. Critical Issues in Food Allergy: A National Academies Consensus Report. Pediatrics. 2017; 140(2), e20170194.
    14. Robinson M, Greenhawt M, & Stukus DR. Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department. Annals of Allergy, Asthma & Immunology. 2017; 119(2), 164-169.
    15. Warren CM, Dyer AA, Otto AK, Smith BM, Kauke K, Dinakar C, & Gupta RS. Food Allergy–Related Risk-Taking and Management Behaviors Among Adolescents and Young Adults. The Journal of Allergy and Clinical Immunology: In Practice. 2017; 5(2), 381-390.
    16. Centers for Disease Control and Prevention. Morbidity and mortality weekly report: Restaurant food allergy practices — six selected sites, United States, 2014. Weekly / April 21, 2017.https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a2.htm#contribAff. Accessed August 21, 2017.

    Photo Attributions

    1. Auvi-Q®: https://www.auvi-q.com
    2. Wang J, Sicherer SH. Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan. Pediatrics. 2017; Feb 13:e20164005.
    3. Impax Laboratories: http://epinephrineautoinject.com
    4. Stopbullying.gov
      By Anne F. Russell, BSN, RN, AE-C
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