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Posted on: Tue, 10/14/2003 - 5:17am
Jana R's picture
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Joined: 02/09/1999 - 09:00

Amy - I think this version of Fastmelt is pretty new - I just bought it two weeks ago - and it's not even listed on the Benadryl website under the children's remedies page so it might be possible you looked at Target and they just didn't have it yet!
I think I heard once that the autoinjector was designed during the Viet Nam War (although I can't find a reference for that right now). I don't know how long Epinephrine has been available in this kind of autoinjector. I'd just like to appeal to Dey that it's time to make a really good product even better. And if Dey won't, maybe another pharmaceutical company wants the business.
[This message has been edited by Jana R (edited October 14, 2003).]

Posted on: Tue, 10/14/2003 - 11:48am
Mary Kay's picture
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Joined: 01/25/1999 - 09:00

Jana,
Thank you so much for telling us about the fastmelt Benadryl! As you know, I have been trying to get the makers of Benadryl to package small bottles to go along with EpiPens. Now it seems they don't have to. I checked with our allergist and these tablets are a good substitute for the liquid.
And yes I agree, the EpiPens could be smaller to make it easier to carry. I can present the information to our local support group and see if we can get some consumer advocacy going.
------------------
Mary Kay

Posted on: Thu, 10/16/2003 - 9:39am
Jana R's picture
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Joined: 02/09/1999 - 09:00

Mary Kay - I thought of you when I finally found the Fastmelts and meant to write you but never got around to it!
But now I've got some bad news - at least it is for us. I noticed that the Fastmelts contain Lactitol monohydrate so I wrote Pfizer and asked if it is milk derived and safe for those with severe milk allergies. They wrote that they do [b]not[/b] recommend Fastmelts for DS since it is derived from milk [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img] Why on earth they would use something derived from one of the top food allergens in an antihistamine is beyond me but there you have it. Back to square one for us.

Posted on: Sat, 10/18/2003 - 7:53am
Going Nuts's picture
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Joined: 10/04/2001 - 09:00

Jana, you might want to give FAAN the heads up on that - they'll probably want to include it in their next newsletter.
A milk-derived product in an antihistamine? I'm just sitting here shaking my head in disbelief. Simply amazing.
Amy

Posted on: Fri, 11/07/2003 - 7:41am
Jana R's picture
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Joined: 02/09/1999 - 09:00

I was talking to my Dad yesterday about how bulky carrying two Epi-pens is for a teenage boy and how I wanted them to be redesigned smaller and he said "I wonder if they can make some sort of implant that can activated as needed?" He went on to mention about how those who have side effects from prostate cancer treatments can have self activated ummmmm [img]http://uumor.pair.com/nutalle2/peanutallergy/redface.gif[/img] ummmmmm enhancements as needed - (I don't want to go into details here but maybe you understand what I'm refering to!). He thinks there are other implanted medications, too - has anybody heard of any? The more I think about always having medication on/in your body ready in an instant the more I like the idea! I have no idea if there is a way to design epinephrine so that it can be kept at 98.6 (or a little higher if necessary) or how they would keep it from activating accidentally and how often the medication would have to be changed etc but I sure like thinking outside the box as far as how to make sure epiniphrine is available at all times.

Posted on: Fri, 11/07/2003 - 8:55am
synthia's picture
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Joined: 10/05/2002 - 09:00

Would it be possible to make a device that would detect a anaphylactic reaction before we see it happening,and then possible to auto inject the epi-pen?
Like the diabetics (spelling)
Maybe? I can only hope.
Love this site
Synthia

Posted on: Wed, 12/03/2003 - 3:03am
Ellie's picture
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Joined: 12/03/2003 - 09:00

I teach Physiology and Pharmacology, and I am allergic to peanuts and cashews.
In reference to "auto injectors"... diabetes and allergies have totally different physiological mechanisms.
A dibetic insulin pump responds to a very specific chemical - glucose - in the blood supply. In our bodys, insulin is the natural hormone that causes that glucose to leave the blood supply and enter the muscles. So, an insulin auto-injector responds to something very specific with a hormone the body normally custom makes just for that circumstance.
In allergies, this is not the case. (You probably know this... but...) Allergic reactions increase IgE which increases the release of histamine... but not JUST histamine... also other inflammatory chemicals (prostaglandins, leukotrienes). What epinephrine does, is NOT counteract histamine (benadryl does that). Epinephrine constricts the blood vessels that widen when anaphylactic shock occurs. Thus, it is widely a symptomatic treatment, it does not targe the "cause" of the shock.
An epi auto injector would have no real physiological "trigger", so nothing to key in on. It couldn't really trigger off of the IgE because a rise in IgE does not NORMALLY cause a rise in epinephrine in the body (at least not to the level of combating shock). And, it could not trigger off of a decrease in blood pressure b/c that would involve a complicated sensing system that would have many "false triggers".
An auto-injector for epi would be dealing with a hugely more complicated issue than that for diabetes.
One can wish though [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

Posted on: Sat, 03/20/2004 - 11:17am
Jana R's picture
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Joined: 02/09/1999 - 09:00

After reading this press release, I may not need to worry as much about getting the Epi-pen redesigned smaller! They are having success with sublingual epinephrine which means my son might only have to carry around a wafer or two instead of two awkward pens to always have epinephrine handy in an emergency!!
[url="http://www.aaaai.org/media/news_releases/2004/03/031904.stm"]http://www.aaaai.org/media/news_releases/2004/03/031904.stm[/url]
[i]FOR IMMEDIATE RELEASE
Friday, March 19, 2004, 12 p.m. Eastern Time
Contact: John Gardner (jgardner@aaaai.org)
Trisha Downs (tdowns@aaaai.org)
Ph: (414) 272-6071
----------------------------------------------------------------------
----------
New research on the treatment of anaphylaxis
presented at 2004 AAAAI Annual Meeting
Pediatricians and food-induced anaphylaxis
(SAN FRANCISCO, March 19, 2004) - More pediatrician education is
needed regarding correct dosage and route of administering
epinephrine, according to research presented at the 2004 Annual
Meeting of the American Academy of Allergy, Asthma and Immunology
(AAAAI) in San Francisco.
P. Ponda, MD, and colleagues from Mount Sinai School of Medicine, New
York, administered an anonymous survey to 61 pediatricians regarding
treatment of food-induced anaphylaxis. The survey presented the case
of a 12-year-old boy with peanut allergy and asthma who developed
hives and cough within 30 minutes of ingesting a candy. The boy
received initial treatment at home before being taken to the
emergency department. Pediatricians were asked to answer questions
regarding duration of observation, discharge medications and risk
factors for food-induced anaphylaxis.
Results showed that epinephrine was indicated as the initial
treatment by 91% of the pediatricians participating in the survey.
However, only 48% would have administered the medication
intramuscularly, which would have resulted in the highest level of
absorption. Also, observation for four hours in the emergency
department before being discharged was chosen by only 44%. Upon
discharge, 85% did choose to prescribe epinephrine. Only 16 of the
pediatricians surveyed correctly identified the risk factors for
fatal food induced anaphylaxis (asthma, previous severe reactions and
peanut allergy).
While epinephrine was recognized as the gold standard of treatment,
many of the pediatricians selected the incorrect dose and route of
administration. Also, more than one-third indicated an inadequate
observation period prior to discharge. These results indicate that
further efforts to educate pediatricians on the treatment of food-
induced anaphylaxis are needed.
Treatment of anaphylaxis in the outpatient setting
A greater effort needs to made in educating healthcare providers that
intramuscular injection of epinephrine is the preferred route of
initial treatment of anaphylaxis, according to a study presented at
the 2004 AAAAI Annual Meeting in San Francisco.
Bret R. Haymore, MD, William Beaumont Army Medical Center, El Paso,
TX, and colleagues sought to identify how anaphylaxis is treated in
the outpatient setting. The researchers reviewed records over the
last two years with the primary diagnosis of anaphylaxis, angiodema
or urticaria. They evaluated the dose, route and time of
administration, epinephrine prescriptions and instruction on use.
Records of 28 patients having 31 episodes of anaphylaxis were
reviewed. Eighty-four percent of the episodes were evaluated in the
emergency department and 13% in primary care clinics. The study found
that epinephrine was administered in only 52% of episodes and was
given subcutaneously in 75% of these cases. None of the patients
received intramuscular administration. Also, an epinephrine
prescription was given in only 32% with documented instruction in
only 16% of encounters. Researchers also found that referral to an
allergy specialist was provided in only 35% of cases.
These findings offer further evidence that educational efforts are
needed regarding the importance of intramuscular administration and
providing epinephrine with proper training and referral to an
allergist/immunologist.
[b]Administering sublingual epinephrine
Sublingual administration of epinephrine may be a safe alternative
for patients reluctant to self-inject themselves just before
anaphylaxis occurs, according to a study presented at the 2004 AAAAI
Annual Meeting in San Francisco.
For epinephrine, intramuscular administration is the gold standard of
treatment. However, many patients are reluctant to self-inject and
would prefer an alternate route of administration. While it is not
possible to take it orally or through an inhaler, Keith J. Simons,
PhD, and colleagues from the University of Manitoba, tested whether
the sublingual route, administration beneath the tongue, might lead
to rapid absorption.
Researchers tested healthy men by giving them epinephrine both
sublingually and subcutaneously, or underneath the skin. Epinephrine
levels, blood pressure and heart rate were measured at various
intervals. No serious adverse effects were observed in any of the
patients. Epinephrine absorption after sublingual administration was
confirmed, suggesting this route of administration should be studied
further.[/b]
Use of EpiPen

Posted on: Wed, 03/24/2004 - 10:00am
PeteFerraro's picture
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Joined: 07/10/2001 - 09:00

In addition to world peace and a Peanut Allergy cure, I pray for a EpiPen that I can carry on my keychain in my pocket.
Why the size of an EpiPen can not be reduced is beyond belief.
To say that the EpiPen factory needing re-tooled is a line of BS. It's not like they don't have a monopoly.
Now that I got that off my chest...
Why do we have to throw the whole EpiPen in the trash when it expires is a waste. Why can't the come up with a refill for just the drug?
------------------
Pete Ferraro
[url="http://www.FerraroFamily.org"]http://www.FerraroFamily.org[/url]

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