The Ultimate Guidebook for Teens With Food Allergies - Real Advice, Stories and Tips

Chapter 4

Treatment

Introduction

Many of us have received conflicting information about how to treat allergic reactions. This may be, in part, because of how guidelines have changed over time. Doctors continue to learn more about anaphylaxis as more data on the most effective treatments emerges. You may have also heard about potential “cures” for allergies. While there is a lot of research being done, and there are many interesting ideas out there, there is currently no cure. We will, however, talk a bit about what is being tried and what may work in the future.

In terms of current treatment for anaphylaxis, epinephrine auto-injectors are the way to go. Epinephrine first. Period. There should be no “wait-and-see” approach, no treating with an anti-histamine first, and no chugging of water with the hope that the reaction will subside.

Anaphylaxis happens so quickly. And epinephrine is the only proven way to stop it in its tracks.

Let’s address the elephant in the room—needles. Does an auto-injector hurt? Well, yes. But surprisingly less than you would probably expect if you’ve never used one. It’s a tiny prick. This pales in comparison to how the other symptoms are attacking your body. Often, the more difficult aspect of using an auto-injector is that it makes the entire issue seem more serious. You could be injecting yourself with a needle at the dinner table, for example.

Yes, 9-1-1, or your local emergency service, must be called. You will have to go to the hospital for monitoring. But isn’t it worth it when compared to the alternative? Sure you might be the centre of attention that day and you may feel embarrassed by it. So what? You would be more embarrassed if you tried to ignore the reaction and kept it a secret from others until things were out of control. People will want to help you. They will be there to support you. They will be there for you that much more afterward to help make sure it never happens again.

In Canada, we currently have two auto-injectors available: EpiPen® and Allerject®.

Which one you carry is up to you. Just carry it, okay? Also remember to have two doses with you in case the symptoms are not gone or getting worse. An extra dose also gives you more time to get to a hospital for proper treatment.

It’s very exciting to know that a lot of research is currently being done about treatments for food allergies. Research for treatments such as immunotherapy, among others, is in progress. As mentioned earlier, it’s important to remember that there is currently no cure for food allergies. Below is a list of current research being done. Be sure to ask your allergist if you’re interested in learning more.

Oral Immunotherapy (OIT)4 – A tiny amount of the allergen (for example, peanut flour) is given under close medical supervision. The amount of allergen is increased over time with reactions that are monitored and treated. Studies suggest a definite increase in the amount of allergen a person can tolerate being exposed to with this treatment, but so far, everyone has reactions during the therapy. Research is currently being conducted to see if treatment can result in long-term tolerance rather than just short-term relief (desensitization).

Sublingual Immunotherapy (SLIT)5 - This treatment involves placing a small amount of the allergen, dissolved in a solution, under the tongue for one or two minutes. It is done under close medical supervision. The results show that short-term relief can be achieved. But more studies must be done to assess long-term tolerance.

Epicutaneous Immunotherapy (ET)6 – In a similar approach to the nicotine patch, a small patch is placed on the skin and releases a small quantity of the allergen over time in hopes of building tolerance. There have been promising results with “peanut patches” and more research is being done to include treatment for other allergens, including milk.

Chinese Herbal Medicine7 - Ongoing studies are being conducted regarding the safety and effectiveness of a Chinese herbal formula, FAHF-2, to prevent serious, life-threatening allergic reactions. This herbal formula has been tested in a study involving patients with peanut and tree nut allergies. It was determined to be safe and well-tolerated. Current clinical trials include peanut, tree nut, fish, shellfish, and sesame allergies.

Anti-IgE Therapy8 - A medicine for the treatment of asthma is being studied as a possible short-term relief treatment for food allergies. It consists of anti-IgE molecules that bind to IgE—the antibody involved in allergic reactions. Researchers hope to be able to determine whether this medication could prevent allergic reactions. Current research is focused on combining the treatment with OIT to possibly create long-term tolerance.

Hopefully scientists will soon be able to pinpoint what actually causes allergies, why they are increasing in prevalence, and how they can be cured. In the meantime, it’s important to learn how to avoid and manage your allergies as well as how to use your auto-injector in the case of an emergency.

Quick Tip - There are proven immunotherapy treatments available for some people allergic to things like insect stings, pollen, and pet dander. Immunotherapy for stinging insects in particular is highly effective, and can reduce your risk of anaphylaxis from about 50% down to 3%. Check with your allergist for more information.

What would you say? (Q&A)

Lindsay, Sophia, Sydney P.

Where do you carry your EpiPen® or Allerject®?

Lindsay - If I am at school, my EpiPen® will be in the front pocket of my backpack where it is easily accessible. When I am going out, it will be in a purse or in my pocket.

Sydney P. - It really depends on the season! In the winter, I carry my auto-injector in my jacket pocket. In the summer, I usually carry it in a purse. At all times, I always carry a second auto-injector in a small front pocket on my backpack. And all of my friends know which pocket it is!

What do you do if you forget it?

Lindsay - If I forget my EpiPen®, the majority of the time I will avoid eating anything.

Sophia – Ideally, I would try not to eat anything until I can go home and get it. It’s always better to be safe than sorry!

Sydney P. - The answer to this question would almost always be “turn around and go get it.” However, if I am travelling a long way from home, I always carry an extra prescription just in case!

How many times have you used your auto-injector?

Lindsay - Thankfully I have never had to use it!

Sophia - I have used my auto-injector twice in my life. Both times were in the last couple of years. Once I even used it at my own house!

Sydney P. - I have used my auto-injector 4 times in the past 8 years. But I am currently on a two and a half year reaction–free streak!

At what point during the reaction have you given yourself epinephrine?

Kyle - I’ll admit that I haven’t always given myself epinephrine when I should have. It’s intimidating to use a needle. As you know, once you do, you’ve pressed the “panic button” and you’ll need to go to the hospital. I now know how important it is to use it upon the first signs of anaphylaxis. It’s just not worth waiting to see how far it progresses.

Sophia - I gave myself epinephrine about thirty seconds after I realized something was not right. I was panicking at first. But I came to my senses and knew it I had to do it immediately.

Sydney P. - I usually give myself my auto-injector upon the first signs of an allergic reaction—which, for me, is a tingling on my tongue.

Would you ever be nervous or scared to use your epinephrine? Why?

Lindsay - I think I might be a little nervous because it’s a needle. But I know that this is a life or death situation and I must use my auto-injector to help save my life.

Sophia - I was incredibly nervous the first time I had to use my auto-injector. I was home alone and, even though I was nineteen, I had never imagined what it would be like. It’s not only the feeling of having to inject yourself. It’s the feeling of what’s going to happen after. You know what you have to do even if you are nervous.

Sydney P. - I was very nervous to give myself my auto-injector the first time I had an allergic reaction. I didn’t want to make the trip to the hospital if I wasn’t having a true reaction. That said, I’ve learned that it’s much better to use it than to wait until things have progressed to a dangerous level. It seems to me that the earlier I administer the auto-injector, the less time I have to spend in the hospital!

Does it hurt?

Sophia – As much as I hate needles, I really don’t remember it hurting at all! When you’re in a situation that requires you to use the auto-injector to begin with, the thought of the needle isn’t as terrifying as some might make it out to be.

Sydney P. - To be completely honest, it really doesn’t hurt. I think the flu shot hurts more! Don’t be fooled by the giant shape of the whole device. The needle is actually very tiny. I was very afraid that it would hurt the first time I had a reaction. So I asked someone else to administer my auto-injector for me. But, after realizing how easy it was, I now do it myself!

Summary...