PA Death in Texas

110 replies [Last post]
By PrestonsMom on Tue, 08-09-05, 13:16

According to the ER physician, this man carried an Epi-Pen and DID use it...

Fort Worth Star Telegram, August 9, 2005

GRAPEVINE, TX -- A 23-year-old man died Friday afternoon after possibly consuming
peanut oil at a local restaurant, police said. Matthew Deluce of Toronto was
eating lunch at Big Buck Brewery when he began to have an allergic reaction,
police said. Deluce was assured by restaurant staff that his order would not
contain any trace of peanuts, his companions told police. Deluce was taken to
Baylor Medical Center, where he died just after 3:30 p.m. Employees of the
restaurant were not aware that Deluce had a reaction, said Mark S. Provenzano,
president and chief executive of the restaurant chain, which is based in
Michigan. "Our thoughts and prayers go out to the family," Provenzano said. "We
are conducting an internal investigation." Provenzano said the restaurant is
not aware of any similar food allergy reactions and that few items on the menu
contain traces of peanuts. "We will leave no stone unturned until we find out
what happened," he said.

-- Melissa Sanchez

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By Carefulmom on Tue, 08-09-05, 13:38

How do you know he used an epi? I don`t see that anywhere in the article. Dd`s allergist says that when an epi is used and doesn`t work, it is because it is used too late. That was why both Nathan Walters and Sabrina Shannon died. In both the epi was not used until they had collapsed.

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By PrestonsMom on Tue, 08-09-05, 13:46

The ER physician is a friend of one of the members of our local allergy support group. He told her about the death before the article appeared in today's paper. I don't know at what point the epi-pen was used. The physician's comment was that Mr. Deluce used his epi-pen and that it should have worked.

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By jessyandsophiesmama on Tue, 08-09-05, 14:09

Are they for sure it was from a food allergy? Not a heart attack, etc...???

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By e-mom on Tue, 08-09-05, 14:49

I subscribed--here's the link for the story which doesn't say much.

[url="http://www.dfw.com/mld/dfw/news/local/12338583.htm"]http://www.dfw.com/mld/dfw/news/local/12338583.htm[/url]

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[b]***ADDICTED***[/b]

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By Carefulmom on Tue, 08-09-05, 15:16

I would suspect that the epi didn`t work because it was used too late.

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By Peg541 on Tue, 08-09-05, 15:22

Again another tragedy and again another place for us to remember that "Wait and see" is a dangerous way to go.

Not having the full story I can only speculate that this guy decided to wait and see how he felt and that snowballed to a point where the epi just was not enough.

I have to think that so I can continue to guide my son in what I believe after lots of study is the correct path.

Peggy

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Peggy

Son 22 Allergic to peanuts, tree nuts, tomatoes, soy, milk, oats, fish.

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By erik on Tue, 08-09-05, 16:03

Quote:Originally posted by Carefulmom:
[b]Dd`s allergist says that when an epi is used and doesn`t work, it is because it is used too late. [/b]

Even if an epi is used immediately, I do not believe that there is any guarantee that it will work 100% of the time (I recall reading about a case in Toronto many years ago when the epi did not work).

An epi-pen should buy you additional time to make it to a hospital, but I don't think it is guaranteed to always work even if used immediately (although if used too late, I am sure it often would not work) [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

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By ajgauthier on Tue, 08-09-05, 19:26

...there could also be other circumstances with his death - for instance - was he drinking alcohol and used the epipen? did the alcohol increase the reaction? Also - I have always been told by doctors to go to the ER after using an Epi so they can monitor my heart, as, Epi's can have the side effect of causing a heart attack or other such heart related problems.

AJ

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***retired from pa.com***

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By Peg541 on Tue, 08-09-05, 21:14

The epi is going to buy you 20 minutes but after that who knows? I have seen a secondary reaction after tons of medicine in the ER so even that is not a cure.

Use the epi and call 911. No doubt about it.

Maybe this guys epi was expired?

peg

__________________

Peggy

Son 22 Allergic to peanuts, tree nuts, tomatoes, soy, milk, oats, fish.

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By PeanutAllergySpecialist on Tue, 08-09-05, 21:30

I met Matt Deluce once, and I have several mutual friends who knew him as well. He is originally from Toronto, and was vacationing in Texas at the time. I know very little about this tragedy still, but hopefully more details will emerge soon. I would like to be able to find a lesson here to help prevent similar situations in the future. I have heard that he was in an ambulance only 6 minutes after he first began eating. He was able to get into the ambulance himself, only requiring a bit of help from the people he was with. Apparently he asked that an ambulance be called almost immediately after biting into a sandwich. The medical attention that he received at the hospital was supposedly excellent. I have heard that his heart stopped for a period of several minutes, and then the pulse was regained, only to be lost again. He was extremely vigilant about carrying his epipen and asking about ingredients in restaurants.
I will be attending the funeral later this week, and I hope we will all soon be able to discover what happened exactly.

------------------
The
Peanut Allergy
Specialist

Disclaimer: The information provided in this message is not intended as a substitute for professional and medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this message. I do not recommend or endorse any specific tests, products or procedures, opinions, or other information that may be stated on this message board. Reliance on any information provided within my message history is solely at your own risk. This message is intended for educational and information purposes only.

[This message has been edited by PeanutAllergySpecialist (edited August 15, 2005).]

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By Sandra Y on Wed, 08-10-05, 01:41

That is very sad.

I realize everyone is intensely interested and worried and wants the full story, but I have to say it bothers me a lot when people start speculating publicly about mistakes that might have been made.

It's your right to speculate if you want, but I find it disrespectful and upsetting. If it were my son, I would not appreciate people who don't have the full information starting to speculate.

There's a time and place for everything.

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Sandra

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By Peg541 on Wed, 08-10-05, 03:07

I agree but in this case we need to educate ourselves and speculation does this poor guy no harm. We are not using his name or his information.

I'd rather speculate because someone can still learn.

All in all a terrible tragedy.

peggy

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Peggy

Son 22 Allergic to peanuts, tree nuts, tomatoes, soy, milk, oats, fish.

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By rebekahc on Wed, 08-10-05, 03:34

We had a very bad experience with Baylor Grapevine ER and their treatment of DS when he was having an anaphylactic reaction. DS (age 3 at the time with known ana allergies to peanut and egg) was coughing, wheezing, snot pouring from nose and mouth, very limp and lethargic (like a ragdoll), saying he thought he was going to die, talking in a very high squeaky voice because his vocal chords were so swollen, etc. They never checked his BP and refused to believe it was a reaction because he didn't have hives. They would not allow us to administer his Epi and just left us in a room with no monotoring or anything. Finally they gave him Benadryl and then a steroid. They didn't have a liquid for the steroid, so the doctor offered to crush the pill and give it to DS in a spoonful of PB!! The nurse turned white as a sheet at that point and yelled that DS was allergic. Finally hives started to appear and only then did the ER doctor say to me "Gee, I guess he really is having an allergic reaction." Our allergist was livid when she found out what had happened and called and gave them a piece of her mind. We believe, and our allergist agreed, that possibly DS's own adrenaline kicked in and that's what kept him alive.

Could this man's death partly be due to inadequate treatment in the ER as well? From our experience with the same ER quite possibly.

It's always very sad to hear of PA deaths. I'll be interested to hear more details - what was he eating, were there peanuts on the floor like at many brewery type restaurants, when/if Epi was administered, etc.

So sad [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]
Rebekah

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By on Wed, 08-10-05, 04:53

Is it okay for me to say that I didn't even feel like reading this to-day?

I understand why we question what happened (if Epi-pen was used, etc.), but I do have to agree with Sandra Y. only because to me, it has often sounded like "blame the victim" at a most inappropriate time.

Again, I understand why we do question, so that we, perhaps don't make the same mistakes ourselves (if any were made), but I have never felt comfortable with it.

PeanutAllergySpecialist, welcome! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] What a way to have to join us. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

What a sad and terrible loss. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By Peg541 on Wed, 08-10-05, 05:17

I really was not trying to place blame on the victim. I wanted to use it for a learning experience. I am scared to death that someone will convince my son to wait and see. Right now that will never happen because he's on his own but I was scared all his school years.

I did not mean it to sound like I blamed this poor guy who probably died a horrible death.

Peg

__________________

Peggy

Son 22 Allergic to peanuts, tree nuts, tomatoes, soy, milk, oats, fish.

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By momma2boys on Wed, 08-10-05, 05:20

What a sad story. I understand what you are saying about us questioning, and I would hate for family of someone to come on and think we blamed them.

I have my own theory why we do it. It is fear and insecurity. Maybe denial. We all want to say "Maybe they didn't use the Epi fast enough" because what we are thinking is "I will use the Epi right away, so that will never happen to my child (or myself). It is so scary to read about these deaths and I think we tell ourselves this stuff so we don't have to face that it could happen to us. I don't think anyone means any disrespect, it is just a hard thing to deal with.

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By mommyofmatt on Wed, 08-10-05, 10:17

Yep, Momma2boys, I think you're right. Personally when I read about these deaths, I always look for a "mistake" to learn from, and to comfort myself that this won't happen to us.

Another sad story. Either through here or FAAN's newsletter, I must have heard of 4 allergy related deaths in the past few months [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img] They weren't all peanut, though, 2 were milk caused. Very difficult to read about [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img] Meg

__________________

***[b] ALLERGY ELIMINATOR*** [/b]

Meg, mom to
Matt 3 yrs. PA,MA,EA
Sean 3 yrs. NKA

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By on Wed, 08-10-05, 16:09

Peg, no, I wasn't saying that you were trying to "blame the victim". momma2boys' post was excellent in explaining why I think we all try to figure out what happened and why.

For some reason, I'm finding it harder and harder to read these types of things (I'm fairly clear I know why).

But no, certainly, I understood where everyone was coming from, but I did agree with Sandra Y.

momma2boys' post was great. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By PeanutKate on Wed, 08-10-05, 17:17

This young man's obituary is in the paper today. Anyone interested is asked to make donations to Anaphylaxis Canada or Asthma Canada.

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By Jana R on Wed, 08-10-05, 17:33

[url="http://www.theglobeandmail.com/servlet/ArticleNews/BDAStory/Deaths/20050810/92992921/birthsanddeaths"]http://www.theglobeandmail.com/servlet/ArticleNews/BDAStory/Deaths/20050810/92992921/birthsanddeaths[/url]

MATTHEW JOSEPH DELUCE

MATTHEW JOSEPH DELUCE JULY 12, 1982 - AUGUST 5, 2005 It is with profound sadness that we announce the sudden passing of our beloved son and brother in his 24th year. Matthew was a business student at Seneca College where he excelled. Matthew's passions were his family, friends, and flying. He loved playing cards, all things Irish, and the Maple Leafs. Loving son of Joseph Deluce and Elizabeth O'Connor and stepson of Lisa Deluce. Matthew will be greatly missed by his brother Daniel, his sisters Andrea, Angela, Jasna, and Caroline, and by his grandparents Stanley and Angela Deluce. Beloved nephew of William Deluce (Ann), Robert Deluce (Catherine), Terry Deluce (Holly), Marie Marshall, James Deluce (Sharon), Gwendolyn Deluce (Randall), Br uce Deluce (Flora), Bernard Deluce (Karen), and Joan O'Connor (Tom), David O'Connor (Brenda), Patricia O'Connor, Barbara Dempster (Eric), Peter O'Connor (Beth), Bill O'Connor (Cheryl), Frank O'Connor (Martha), Mar y O'Connor (John), Tom O'Connor (Hilary), Peggy Camire (Norm), and Posie Haight (Scott). His many cousins will miss his everpresent smile. Visitation at R.S. Kane Funeral Home, 6150 Yonge St. (416-221-1159), on Wednesday 2-4 and 7-9 p.m. Funeral at Blessed Trinity Church, 3220 Bayview Ave. (north of Finch on west side), Thursday, August 11, at 11 a.m. He will be laid to rest at Holy Cross Cemetery, joining his sister SarahJane and his maternal grandparents, David and Mary O'Connor. In lieu of flowers, the family requests donations to Anaphylaxis Canada or the Asthma Society of Canada.

------------------
Jana

[url="http://www.seattlefoodallergy.org"]www.seattlefoodallergy.org[/url]

__________________

Jana

[url="http//www.washingtonfoodallergy.org"]www.washingtonfoodallergy.org[/url]

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By Sandra Y on Wed, 08-10-05, 20:09

Peg, I didn't think you were blaming the victim. I know that was not your intention at all. I was just commenting on how the direction of the conversation was making me feel. I was imagining how his family or loved ones might feel if they read it, or how I'd feel if it were my son.

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Sandra

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By ajgauthier on Wed, 08-10-05, 20:30

Just wanted to say that I certainly did not mean for my post to pass judgement on him...my meaning was to say that there are other uncontrollable circumstances at play with a PA reaction sometimes, and, that it's not the fault of the PA allergic person if they have a reaction. I reread my post and saw that it could be construed that he shouldn't be drinking (if he was) or use the epi if he had been. That wasn't the point of my post if anyone read it that way.

Mainly, I wanted to point out that even if you have a reaction and use an epi, one should still call an ambulance and go to the ER for monitoring. As someone else pointed out, the reaction can come back, or as my doctor pointed out...there can be severe heart reactions or other complications.

For those with young ones, teach them what the ER staff should be doing if they go in with a reaction. Benadryl in PB!!! MY GAWD!!! When I was 3 I went into the hospital for pneumonia, above my bed was a very large sign by my mom "allergic to peanuts and nuts" The story goes that a nurse tried to make me eat a PB sandwich one day and I flatly refused and threw a hissy fit and they had to call my mom. WOW! Another story is that in 10th grade I went to the ER and the doctor, who had very broken english, thought I had a peanut stuck in my throat!!

So, educate the young ones. They should know for an adult to call 911, give the epipen, and ask the ambulance ER for benadryl or epi if not already given. Standard procedure and yes, sometimes ERs and doctors screw it up.

Anyway, sympathies go out to the family from me. I hope noone took my own post in any negative way. It's hard with text on discussion boards, you can't tell the tone of the person talking.

Adrienne

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By Cade'smom on Thu, 08-11-05, 02:43

Sad, sad story. DH has actually taken DS there to eat at that very restaurant once before. We live very near there.

------------------
Lynee', mom to:
Cade - PA, seasonal
Carson - NKFA, seasonal
Chase - NKFA

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Lynee', mom to
Cade - PA, seasonal
Carson - NKFA, seasonal
Chase - NKFA

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By pgrubbs on Thu, 08-11-05, 03:35

This is awful
Epis don't work 10% of the time, right?

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By Carefulmom on Thu, 08-11-05, 03:47

According to our allergist, that 10% is when the person waits too long to use it.

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By erik on Thu, 08-11-05, 04:50

Quote:Originally posted by Carefulmom:
[b]According to our allergist, that 10% is when the person waits too long to use it.[/b]

But I have heard of cases where the epi-pen was used right away but the person still died. I was under the impression that an epi-pen was not 100% effective depending on the reaction?

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By on Thu, 08-11-05, 05:12

erik, that's my impression also. I know that I had raised a thread about this (that the Epi-pen won't always work), but I did a search tonight and couldn't find it.

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By Peg541 on Thu, 08-11-05, 05:51

I think that all of us can depend that if we use our epi pens and call 911 our chances are very good to excellent. I'd rather teach this to my son, rather that then him having the angst of is this the time I die?

The epi pen will work. It works, use it immediately, call 911 and stay calm.

Peg

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Peggy

Son 22 Allergic to peanuts, tree nuts, tomatoes, soy, milk, oats, fish.

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By CS on Thu, 08-11-05, 12:01

I had asked Dr. Robert Wood (peanut allergic himself) years ago regarding the effectiveness of the epi-pen, used correctly, etc. He stated it will rescue the person 9 out 10 times. I wish a treatment were available rather than a rescue medication. What a sad story about this young man.

[This message has been edited by CS (edited August 11, 2005).]

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By samirosenjacken on Thu, 08-11-05, 17:18

Erik you are correct. There was an study done published in the new england journal of medicine that stated that 10% of the time epinephrine doesn't work. The article did not clearly state if this was b/c it wasn't given in time or if it was given right away. My guess is that there is a bit of a failure yet with the epi pen.. it's not 100% guaranteed.

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By MommaBear on Thu, 08-11-05, 17:43

I'm confused. Is there an impression that when used correctly, and with no deviations, medical interventions such epinephrine (but not limited to) are a guarantee of successful outcomes [b]100%[/b] of the time? Just because they were performed correctly? Just because follow up care was *excellent*?

[i]That's news to me[/i]. I've seen people who've suffered a physiological insult (and otherwise were in good health) who were given textbook care with *multiple* efforts of herculean proportions still expire. (Not referring specifically to any one adverse condition)

No advice, just happenstance.

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By ElleMo on Fri, 08-12-05, 01:52

I have not read any media stories in the 3 years since my daughter's diagnosis that suggested the epi didn't work. Every story that I have read indicated that it was given too late or proper follow-up care was not given.

The article states that [i]Employees of the restaurant [b]were not aware [/b]that Deluce had a reaction[/i] which suggests to me that he waited too long to give himself the epi or to call an ambulance. This should have been done inside the restaurant.

I am not blaming the victim. But I think we all have enough to worry about & give ourselves enough anxiety without worrying about whether or not the epi will work. I think we should just all assume that the epi, followed by emergency treatment, can save a life. & so that this death is not in vain, we should take it as another reminder of what we need to do to protect ourselves/children.

E

------------------
Ellen
Allergic to Shellfish/ Mom to Jesse 9/01 who has PA

Sometimes I just want to say "blah blah blah blah blah."

[This message has been edited by ElleMo (edited August 11, 2005).]

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Elle
Allergic to Shellfish
Mom to Jesse 2001, allergic to peanuts, legumes, chickpeas

Sometimes I just want to say "blah blah blah blah blah."

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By MommaBear on Fri, 08-12-05, 02:20

wondering: was he taking beta-blockers? how "full" was his vascular compartment after the reaction---was he "third spaced"? what was his cardiac history? health history? [i]was the ambulance that transported him Advanced Cardiac Life Support (ACLS)/Advanced Life Support (ALS), or Basic Life Support[/i]? How much did he weigh? Was he a smoker?

interesting:

[url="http://www.jcaai.org/pp/anaph_3_algo_treat.asp"]http://www.jcaai.org/pp/anaph_3_algo_treat.asp[/url]

Thoughts?

General Disclaimer: I am not offering advice in any manner or form. Just wondering. I do not guarantee the accuracy, currentness, or content of the link in this post.

[This message has been edited by MommaBear (edited August 11, 2005).]

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By synthia on Fri, 08-12-05, 02:47

My heart goes out to the family

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Synthia

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By McCobbre on Fri, 08-12-05, 03:05

Oh, I'm sad. I read this post this morning 5:00ish before going to work. And I've thought about this man and his family all day. And I've thought especially about his mother--and if she had ever experienced any sort of relief that well, he'd come this far with this stupid allergy--only to lose him now.

I only have one thing to add but sadness: in Texas, ambulances are not required by law to carry epinephrine. It's on our allergy action plan to tell them to bring epinephrine. Fortunately, in our community, they do always have it, but it's not so in surrounding communities.

Initially, when I read about Baylor, I was going to post that that's where DS was born, but it's a different Baylor. This is Baylor in Grapevine, not Downtown Dallas, where we did have a good experience.

I think, too, that what hit me about this is that after we ask a few questions, once a restaurant tells us something is safe--if we've done all our homework--we actually believe them. This incident is calling things into question like crazy. Even unrelated things. I was considering letting DS eat at the school cafeteria occasionally (they serve no peanut products). So much is prepackaged, and the research I've done so far suggests that the baked potato on Fridays--served with different veggies on top--would be fine for DS. And now I'm even uncomfortable with that. When we met DS' teachers tonight (he'll be sharing a desk wtih a child while they switch from math to reading throughout the day) and told them our concern about Xcontam on the desks, I did let them know about this death. Not that it had anything to do with DS' school experience. But to remind them that peanut allergy is very, very serious and that our decisions have huge consequences.

Well, I did drone on. But his death has really affected me today. I am so sorry for his parents--and I'm sorry any of us has to worry this might happen to our children.

[This message has been edited by McCobbre (edited August 11, 2005).]

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By on Fri, 08-12-05, 03:18

Oh, Peg541, I definitely agree with you. I would never tell my son that there is a chance that the Epi-pen might not work. Never. I mean it is his only hope.

I think it's just frightening to realize that it is true - it might not work. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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By erik on Fri, 08-12-05, 03:47

Quote:Originally posted by csc:
[b]Oh, Peg541, I definitely agree with you. I would never tell my son that there is a chance that the Epi-pen might not work. Never. I mean it is his only hope.

I think it's just frightening to realize that it is true - it might not work. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img][/b]

I think PA individuals will find out about this themselves through researching their allergy. I agree there's no need to tell children, and as they get older and learn more about their allergy they will find out as I did.

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By McCobbre on Fri, 08-12-05, 10:59

Yes, well, sometimes 7 year old DS asks to read posts here--I guess to learn more. And sometimes I let him. I'm just going to have to remember NOT to let him read this one. And truthfully, this was one I would have kept him from anyway. I was not planning on telling him about this PA death soon, but DH and I had a miscommunication about it and the restaurant. He thought it was the restaurant he and DS were at when I told him. Ah, well . . . .

I really, really hate that this topic came up in this thread because there is a strong degree of uncertainty about this 10%. And someone new to PA coming along might just be blindsided by this thread--when in fact the 10% may be due to timing or user error rather than just not working. We don't know. We need definitive answers. Our doctor said if it's given in time (and assumed correctly), it will always work. Always means 100%.

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By melissa on Fri, 08-12-05, 12:12

I've done a search at pa.com trying to find a link to this article about the 10% so I can take it w/ me to Duke next week to discuss...can't find it...can anyone point me to it?
Thanks,
Melissa

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By erik on Fri, 08-12-05, 13:10

Quote:Originally posted by McCobbre:
[b]Our doctor said if it's given in time (and assumed correctly), it will always work. Always means 100%.[/b]

I don't think anything in this world is a 100% guarantee. Even when I received allergy shots for my hayfever, I was told there was a tiny risk as you can never predict for certainty what will happen as each case is individual and unique.

From MommaBear's link:

[i]Patients experiencing anaphylaxis may not always respond adequately to one injection of epinephrine ..... If subcutaneous epinephrine is not effective, intravenous administration of epinephrine may be required[/i]

Personally, I think it is good for me to know that an epi-pen is not a 100% guarantee. If it was a 100% guarantee, it would be easy to become careless and eat more risky products that may contain traces of peanuts and think "well, the epi-pen will save me 100% of the time so this allergy is not as dangerous as I thought".

By knowing that it is not an absolute guarantee, I must always be extra careful and not rely on the epi-pen as a fail safe method.

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By Carefulmom on Fri, 08-12-05, 18:19

I have the article about the 10%. In that study, the question of whether or not the epi was given quickly was determined by asking surviving family members. The surviving family members were sent questionaires to fill out. These people may not have even been present during the anaphylactic reaction. For example, one of the ones where epi was reportedly given right away, that reaction occurred at a camp and family members were not present. Another was in a college apartment and family members were probably not present. The other two cases were in a restaurant. Those four people are the 10%. Also, in the 10% where the family member stated it was used right away, it was not known if the epi was used correctly.

[This message has been edited by Carefulmom (edited August 12, 2005).]

[This message has been edited by Carefulmom (edited August 12, 2005).]

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By McCobbre on Fri, 08-12-05, 23:51

Quote:Originally posted by erik:
[b] I don't think anything in this world is a 100% guarantee. [omitted stuff]

From MommaBear's link:

[i]Patients experiencing anaphylaxis may not always respond adequately to one injection of epinephrine ..... If subcutaneous epinephrine is not effective, intravenous administration of epinephrine may be required[/i]

Personally, I think it is good for me to know that an epi-pen is not a 100% guarantee. If it was a 100% guarantee, it would be easy to become careless and eat more risky products that may contain traces of peanuts and think "well, the epi-pen will save me 100% of the time so this allergy is not as dangerous as I thought".

By knowing that it is not an absolute guarantee, I must always be extra careful and not rely on the epi-pen as a fail safe method.
[/b]

You're right--there aren't really any 100% guarantees. And MommaBear was good to point out that that's why more epinephrine is sometimes necessary. That's why we carry a second pen.

But I argue the point that the 100% effectiveness assumption runs the risk of taking greater risks. Who in the world wants to run the risk of painfully injecting their child, frightening their child, having the expense of an ambulance transport and of the ER copay or other expense, plus 4 hours of waiting in a really gross waiting room (often with further peanut exposure) while exposing your child to really sick people and inappropriate TV (even the Cartoon Network)?

No--having a 100% assumption doesn't give me greater license to be careless with food. I have a responsibility to my child. Sometimes I screw up, but I can never be careless intentionally.

It seems at least mostly clear from Carefulmom's post that the 10% has to do with user issues. And maybe a second pen was neeed in the one case mentioned (sorry--I'm getting a migraine, and my memory is failing me).

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By McCobbre on Sat, 08-13-05, 00:05

Okay--I'm obsessing over this. Having gone to the restaurant's website, I remember seeing it now--driving past it near Grapevine Mills Mall. The Baylor he was transported to was 3.6 miles away (one shouldn't necessarily read 3 minutes here). Baylor is on Texas 114--will only matter to those in that area, I know. Initially I thought that maybe he was taken to the Irving Baylor, and that is so far away. But he was close. Maybe they didn't have epinephrine in the ambulance.

Did anyone else catch the fact that his sister predeceased him? His parents must be just dying on the inside right now.

Also, in terms of contamination, the restaurant does serve a thai sauce with their almond shrimp appetizer. It doesn't specify peanut, although our instructions to DS are to "fly when he sees 'Thai.'" There's a barbeque sauce for the brisket (that's barbeque for us folks here in Texas). I think bbq sauces can often be suspect, although we've not personally found any to be unsafe here.

I wonder if it was peanut oil that caused the reaction and if it was cold expressed peanut oil or the more common kind. It's not like we'll ever be going to that restaurant, but I would really like to know if it was regular peanut oil. DS has reacted to it--has had a rash and vomited from eating chips cooked in regular peanut oil. So I think the reaction could go further even though our doctor in Dallas always said it couldn't. Fortunately, our current doctor believes it can.

Anyway, I keep thinking of this and the cause and of his family.

[This message has been edited by McCobbre (edited August 12, 2005).]

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By MommaBear on Sat, 08-13-05, 01:09

Quote:Originally posted by McCobbre:
[b] You're right--there aren't really any 100% guarantees. And MommaBear was good to point out that that's why more epinephrine is sometimes necessary. That's why we carry a second pen.

[/b]

It's only part of the reason ACLS/PALS was developed. There's a whole slew of emergency medications and interventions that might be necessary. Epinephrine might be only part of it.

Anaphylaxis is *one* of the algorithms for ACLS. Did you get a chance to check out the "Acute Anaphylaxis" algorithm in the link posted?

Things that would not surprise me:

If my cub gets an epipen, he's getting an ambulance ride. Not ruling out an ambulance ride even if he didn't get an epipen. Aside from monitoring and preserving his respiratory status, I wouldn't be surprised if he was intubated prophylactically or otherwise. I live where there is ALS ambulance service. I wouldn't be surprised if larger bore IV access was obtained. Expeditiously and probably in more than one place. I'd be prepared for vascular support. I wouldn't be surprised if he was placed on cardiac monitoring. I'd pray he didn't arrest. If he did, there's a whole list of additional medications an interventions that might be used in that situation that wouldn't surprise me. Given the level of care assigned to the area I live in. [i]Epinephrine being only *one* of them[/i]. Not an all inclusive list, but things that wouldn't surprise me in the least.

General Disclaimer: I'm not offering advice in any manner or form. I'm just describing what wouldn't surprise me in my own highly individual, unique and personal situation. I could be way off.

[This message has been edited by MommaBear (edited August 12, 2005).]

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By Carefulmom on Sat, 08-13-05, 01:28

"Anaphylaxis is one of the algorithms for ACLS"---what does that mean? ACLS stands for Advanced Cardiac Life Support, so I don`t follow.

About needing two epis, it is not because epinephrine may not work the first time. It is rather because:
1. It can be administered incorrectly, for example someone on this board got nervous in the moment and injected into the air instead of her child, someone else got confused and injected into their own finger instead of their child. In these kinds of situations, obviously you need another epi to use on your child.
2. If you are more than 15 minutes from medical care, the first dose can wear off and then you need another.
3. If your child is at that in between weight, too much for junior, too little for regular, we were instructed to use junior and if it doesn`t work then use another junior. This is specific to the weight being in between the weight for junior and the weight for regular. It is not related to any general idea of epinephrine as a medication not working.

And in Dr. Sampson`s study about the 10%, he writes, "There are too few data to draw any important conclusion from this information." So he is definitely not saying that in 10% it is used correctly, promptly, and still fails.

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By MommaBear on Sat, 08-13-05, 01:50

Quote:Originally posted by Carefulmom:
[b]"Anaphylaxis is one of the algorithms for ACLS"---what does that mean? ACLS stands for Advanced Cardiac Life Support, so I don`t follow.

[/b]

[url="http://www.americanheart.org/presenter.jhtml?identifier=3011972"]http://www.americanheart.org/presenter.jhtml?identifier=3011972[/url]

Please be directed to the first paragraph, (I believe, since I'm not looking at it right now. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] )

"respiratory emergency" is one of the "10 core cases". Wouldn't surprise me if anaphylaxis is probably considered (among other things) in that scenario. Probably might be considered in other scenarios as well. I mean, if you respiratory arrest, would you expect to cardiac arrest soon thereafter? Is cardiovascular collapse sometimes how anaphylaxis presents? (Among various ways--being a condition with a propensity for multisystem involvement.) Great thing about ACLS is that it abhors tunnel vision, despite patient history.

Hope I make sense. Although we are taught the basic "algorithms", thought is given to possible causes that bring us to those basic algorithms (10 core cases?).

General Disclaimer: I am not offering advice in any manner or form. I do not guarantee the accuracy, currentness or content of the link in this post.

[This message has been edited by MommaBear (edited August 12, 2005).]

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By Carefulmom on Sat, 08-13-05, 01:54

I don`t see anything in that link about anaphylaxis.

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By erik on Sat, 08-13-05, 02:40

I guess my main point was that I am not relying on an epi-pen to be a 100% guarantee. I have never seen it reported in any studies that an epi-pen is a 100% guarantee.

[i]Dr. Robert Wood of Johns Hopkins University accepted a homemade cookie from a colleague, another expert on food allergies, who assured him it was safe.

"You know quickly, typically, if you're having an allergic reaction -- you get an immediate sensation in your mouth that you've been exposed to something," Wood said. "So I knew it within seconds, literally."

His colleague had used the same spatula and maybe cookie sheets in making one batch of peanut butter cookies and a second batch of peanut-free cookies that he gave to Wood.

"But that amount of contamination just from a spatula when it comes to peanut allergy, is enough to cause severe reactions," he said.

[b]It took five shots of epinephrine to stop Wood's reaction.[/b][/i]

[url="http://www.cnn.com/2005/HEALTH/conditions/05/18/peanut.allergies/"]http://www.cnn.com/2005/HEALTH/conditions/05/18/peanut.allergies/[/url]

I am sure Dr. Robert Wood, an allergy expert, knows how to inject an epi-pen. The fact it took 5 epi-pens to stop the reaction is scary. How many of us carry around 5 epi-epns??

If I have a severe reaction, an epi-pen is not enough.. 911 and a hospital asap! Even if I have an epi-pen and use it immediately, it may not work (one reason I have 3 epi-pens, although I usually only carry one with me at a time.. maybe I should re-evaluate this policy???)

[This message has been edited by erik (edited August 12, 2005).]

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By Carefulmom on Sat, 08-13-05, 02:51

I don`t know how often you wander over to the Media Board, but Dr. Gupta is the same one who dispensed all kinds of inaccurate and blatantly incorrect information after Sabrina Shannon`s death. If you go to the Media Section you will find it. Title of the thread is Sabrina`s Story CNN. He is the same one who said to expose your child early to allergens in order to prevent food allergies. Several others on this board commented on his lack of knowledge about food allergies which he admitted. I would take the "5 shots of epi" comment with a grain of salt. I personally doubt it, based on his lack of credibility on the Sabrina Shannon story. Not only that, but since Dr. Wood is a physician, he would have been in an ER before it ever got to five shots.

[This message has been edited by Carefulmom (edited August 12, 2005).]

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By erik on Sat, 08-13-05, 03:04

I rarely visit the media board. Only occasionally.

That's good news to hear... the "needed 5 epi-pens to stop the reaction" comment was scary since I usually only carry one epi-pen with me. I would never have 5 epi-pens, so it was not comforting to think 5 may have been needed.

It seems that the consensus here among pa.com members is that an immediate shot from an epi-pen will stop the reaction in all cases and prevent death (assuming it is injected properly and the individual seeks immediate medical aid) so that is good to know. That means all pa deaths should be preventable if we all carry epi-pens and use them immediately when needed. Good news that should be spread to all pa individuals and their families.

[This message has been edited by erik (edited August 12, 2005).]

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