PA Death in Texas

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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

On Aug 9, 2005

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.

On Aug 9, 2005

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.

On Aug 9, 2005

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

On Aug 9, 2005

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]

On Aug 9, 2005

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

On Aug 9, 2005

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

On Aug 9, 2005

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]

On Aug 9, 2005

...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

On Aug 9, 2005

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

On Aug 9, 2005

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).]

On Aug 9, 2005

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.

On Aug 9, 2005

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

On Aug 9, 2005

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

On Aug 9, 2005

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]

On Aug 9, 2005

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

On Aug 9, 2005

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.

On Aug 10, 2005

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

On Aug 10, 2005

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]

On Aug 10, 2005

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

On Aug 10, 2005

[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]

On Aug 10, 2005

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.

On Aug 10, 2005

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

On Aug 10, 2005

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

On Aug 10, 2005

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

On Aug 10, 2005

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

On Aug 10, 2005

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?

On Aug 10, 2005

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]

On Aug 10, 2005

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

On Aug 11, 2005

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).]

On Aug 11, 2005

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.

On Aug 11, 2005

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.

On Aug 11, 2005

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).]

On Aug 11, 2005

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).]

On Aug 11, 2005

My heart goes out to the family

On Aug 11, 2005

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).]

On Aug 11, 2005

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]

On Aug 11, 2005

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.

On Aug 12, 2005

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%.

On Aug 12, 2005

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

On Aug 12, 2005

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.

On Aug 12, 2005

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).]

On Aug 12, 2005

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).

On Aug 12, 2005

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).]

On Aug 12, 2005

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).]

On Aug 12, 2005

"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.

On Aug 12, 2005

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).]

On Aug 12, 2005

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

On Aug 12, 2005

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).]

On Aug 12, 2005

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).]

On Aug 12, 2005

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).]

On Aug 12, 2005

My father was in the hospital for a test and had an anaphylactic reaction to the dye they injected in him (no he is not shell fish allergic), he almost died, he was given epinepherine (sp?) for hours, they were not sure until the NEXT day if he was going to make it or not.

I don't put too much confidence in the EPIpen although I realize it is better than nothing.

On Aug 12, 2005

erik, sorry, personal question again [img]http://uumor.pair.com/nutalle2/peanutallergy/rolleyes.gif[/img] You have one Epi-pen on your person I'm assuming (in your knapsack or Epi-belt or whatever), but at the office do you have a second Epi-pen in your desk?

We have actually been in the situation, a long time ago, where we only had one Epi-pen and it did wear off. Jess *should* have received another one as we were quite a distance from a hospital. That is the night that he almost died.

When we leave the house, he has one in his Epi-belt on him. I have one in my purse. If we're with his Father also, his Father has one in his knapsack.

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

On Aug 12, 2005

Oh, Canadian specific, I have also noticed a lot of Thai sauces that you can buy in the grocery store, and even Thai dishes (pre-made, frozen), that do not have peanuts in them. Thai is still definitely off limits to our family, but I do think it is possible to cook some Thai items without peanuts.

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

On Aug 12, 2005

Perhaps I missed this in the long discussion, but did the man that died have asthma? His obit mentioned donations to the Canada Asthma Association. I do know that anaphylaxis in patients with asthma can be more severe, or at least that's what I've been told.

I do think we try to find a way to make this a situation that wouldn't happen to our child. My dd is not asthmatic, and so I think "she's a little bit safer." I do not want to contemplate that no matter what, she could die anyways, after everything that we do to try to keep her safe. It is too horrible a thought.

My heart and prayers go out to this young man's family.

On Aug 13, 2005

Quote:

Originally posted by Carefulmom: [b]I don`t see anything in that link about anaphylaxis.[/b]

that's ok. (I mean, not even a "respiratory emergency?)

My guess is that an anaphylactic crisis has the potential to progress rapidly to death without intervention and possibly with intervention.

Be assured if someone dies, regardless of the cause, prior to dying they will present (if they are afforded the chance to) as one of the basic algorithms in ACLS. It's a critical care provider's job to [i]anticipate[/i] and identify people [i]at risk[/i] for this and intervene with prophylactic measures in an attempt to [i]prevent[/i] entering one of those algorithms. (some of these measures may require prescriptive power) When and if possible, they don't wait around for it to [i]just happen[/i]. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] Airway, Breathing, Circulation. They see the potential big picture. I mean, since from beginning to end can only be [i]minutes[/i] difference.

On Aug 13, 2005

Quote:

Originally posted by Carefulmom: [b]Not only that, but since Dr. Wood is a physician, he would have been in an ER before it ever got to five shots.

[/b]

[i]one would hope.[/i]

On Aug 13, 2005

Erik, I just emailed you. Did you receive it?

On Aug 13, 2005

Quote:

Originally posted by Carefulmom: [b]Erik, I just emailed you. Did you receive it?[/b]

yes, thanks [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

On Aug 13, 2005

Quote:

Originally posted by csc: [b]Oh, Canadian specific, I have also noticed a lot of Thai sauces that you can buy in the grocery store, and even Thai dishes (pre-made, frozen), that do not have peanuts in them. Thai is still definitely off limits to our family, but I do think it is possible to cook some Thai items without peanuts.

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

Yes, and when I told DH about this sauce--it's a Thai Chili Sauce for dipping almond encrusted shrimp--he said that chili sauces typically don't have nuts. He said it would most likely have chilis, vinegar, sugar??, and something else. But still, we do tell DS not to eat anything with the word Thai in it. He understands nuances and intricacies wonderfully, but I'm more comfortable with no gray when it comes to Thai food.

On Aug 13, 2005

I printed out that article about Dr. Wood and the 5 epi pens.. I plan to ask him about this when I see him in October. I will also ask him about the 10% failure rate of the epi pen.

I agree with you 100% Erik. I don't want the false sense of security that the epi pens will work 100% of the time. I carry at least 3 epi pens for each girl EVERYWHERE we go.. a minimun of 6 epi pens! At school, they each have 4 epi pens and the nurse has vials of epinephrine.

On Aug 13, 2005

A few things to add...

I attended Matt's funeral in Toronto on Thursday, and it was such a huge reminder of how unforgiving an allergy like this can be. I attended the service with many of his close friends, and a few of them commented that they always knew that a peanut allergy could be fatal, but this event made the severity of the allergy seem so much more real. People just couldn't get over the fact that something as small as a peanut (or a trace of one) had caused this - even though they were aware of the possibility. Needless to say, it was an incredibly sad day because he was so young and full of life. However, his life was well-represented with a very touching service.

There are many unanswered questions about the circumstances surrounding Matt's death, but I intend to find out these details very soon, because there is definitely something to be learned here. Hopefully the knowledge we will gain will help us prevent this sort of thing from happening to someone else.

For those that might be wondering, Matt did in fact suffer quite badly from asthma. Over the past year, he was hospitalized (I believe on more than one occassion, but I could be wrong) with severe respiratory problems. Generally, he did struggle with his health quite a bit. I'm not sure how the asthma might have factored into his death exactly, but it obviously had a negative impact.

I will keep this thread updated with more details regarding Matt's accident as soon as I receive them.

---------- 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).]

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

On Aug 13, 2005

A potential side effect of giving 4 or 5 times the recommended dose of Benadryl is respiratory depression. That is the last thing you need during anaphylaxis. Please, everyone, before you decide it is okay to give your kids 4 or 5 times the recommended dose of Benadryl, please ask your doctors.

On Aug 13, 2005

Quote:

Originally posted by Carefulmom: [b]A potential side effect of giving 4 or 5 times the recommended dose of Benadryl is respiratory depression. That is the last thing you need during anaphylaxis. Please, everyone, before you decide it is okay to give your kids 4 or 5 times the recommended dose of Benadryl, please ask your doctors.[/b]

I agree.. check with your doctor before you consider this. An overdose of medication can be very dangerous, especially with children.

[i]Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately. Antihistamine overdose has caused hallucinations, convulsions, and death in children.

Symptoms of Benadryl overdose may include: Central nervous system depression or stimulation, especially in children, dry mouth, fixed, dilated pupils, flushing, stomach and intestinal symptoms [/i]

[url="http://www.healthsquare.com/newrx/ben1050.htm"]http://www.healthsquare.com/newrx/ben1050.htm[/url]

On Aug 14, 2005

Peanut Allergy Specialist: Did you take more Benadryl because you didn't have the epipen with you? I'm just curious. We appreciate you giving us more details on this death, and I hope you will continue to. As you can probably tell from this thread, we all try to learn from these tragedies to prevent them from happening again.

Thank you Erik and Carefulmom for posting your responses about the dangers of too much Benadryl. I remember a story (I think I read it here) where a daycare was shut down and the owner was jailed because she was giving the children Benadryl every day to make them nap. 1 child in her care died from it [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]. Meg

On Aug 14, 2005

Thank you Carefulmom, Erik and Mommyofmatt. I'm afraid people will take the Benadryl story as gospel and this would be very dangerous. Do not hesitate Use your epi pen Give the recommended dose of Benadryl Call 911 and be transported to the hospital.

Peggy

On Aug 14, 2005

McCobbre, yes, I have been reading the Thai ingredient labels in the grocery store. I guess out of curiosity as to whether or not all things Thai contain peanut. But just for information for myself, not my son, KWIM? I also don't want any "gray" areas. Since moving back home last year, it has become quite obvious that Thai is quite the "trendy" food and there are more Thai restaurants than I can count. Each time we pass one, I tell my guy how it will never be okay for him to eat in one of those restaurants and why.

But that didn't stop my curiosity as far as the Thai sauces and pre-packaged dishes that I see in the grocery stores now and although I would never purchase them for my family (let's just say if I've lived to the age of 46 without trying Thai food, I think I can live without ever trying it), I did want to check the labels, just to see if everything had peanuts in it.

With regard to the Benadryl, enough people have already made their comments. I do not carry Benadryl for my PA son. I carry his Epi-pen. I do not leave Benadryl with the school (to avoid confusion and hesitation). There is an Epi-pen (and one around my son's waist + ).

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

On Aug 14, 2005

Mommyofmatt,

As much as I do not want to admit it, the Benedryl case that I mentioned happened when I had an Epi WITH ME. I remember being driven to the hospital, holding the Epipen in my hand saying: "I'll use it if I have to." This was one of those horrible "wait and see" cases that seems to happen all too often. I now personally believe that it is definitely one of the WORST approaches to adopt. I'd like to make it clear that this incident happened many many many years ago, and I want readers to be certain that the situation was NOT handled the way it should have been - I got lucky. If I was put in the same situation - knowing what I know now - I would definitely use the Epipen as a first course of action, because I am fully aware of the consequences of waiting. A dose of epinephrine properly administered into a person's thigh won't do an individual harm, even if the reaction is not serious. Unfortunately, I think the "wait and see" method is an all too common approach, and I firmly believe that this mentality often leads to tragedy - what a waste of planning and available medication. It's always better to be safe than sorry. I hope parents can build the confidence to administer an Epipen in the event of an emergency. During my incident, I was being driven to the hospital by my father (I was a little kid at the time) and he didn't tell me not to use the Epi, but he didn't push me to use it either - people MUST get over this fear. If people are apprehensive about giving the needle, they need to remember that the whole thing will be over in 10 seconds, and this can mean the difference between life and death.

***About the Benedryl, I am by no means suggesting that an individual should try to treat their reaction with an antihistamine as the exclusive medication. Treatment options are always person-specific, as a dosage that can work for one adult, can definitely harm another adult or a child. Do not ever overdose on an antihistamine, thinking that this will remedy the situation. Many many years later, and after a ton of research, the treatment that I have adopted for myself is:

1) An Epipen administered immediately 2) A prescribed dose of an antihistamine immediately, followed by a second dose if the attack has not been slowed by the time I reach the hosptial. 3) Call 911 or get driven to an ER - whatever method is faster

This is not my advice to anyone - talk to a medical doctor before you create your plan.

I didn't intend to be vague in my last post, and I hope this clears up some concerns.

More to come from...

------------------ 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).]

On Aug 14, 2005

Quote:

Originally posted by Carefulmom: [b]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).][/b]

This is a true story. Dr. Wood spoke about this reaction at one of the FAAN conferences that I attended. I was also told about it by a physician who knows Dr. Wood personally.

I don't recall where the reaction happened, but I am pretty sure he did not use an ambulance.

On Aug 14, 2005

I have since gotten the details of what happened, and the epi DID work. It happened a long time ago, and when the epi wore off he had to be given more. It was five shots during a window of four hours. This was not because it didn`t work, but rather because it worked and then wore off.

On Aug 14, 2005

Quote:

Originally posted by Carefulmom: [b]I have since gotten the details of what happened, and the epi DID work. It happened a long time ago, and when the epi wore off he had to be given more. It was five shots during a window of four hours. This was not because it didn`t work, but rather because it worked and then wore off.[/b]

When my son had his first big reaction we used is epi but he was given more and more epi in the ER. A longer acting epi? But he definitely was given more than our initial epi pen. He was in the ER seconds after using the first epi pen.

Peg

On Aug 14, 2005

[url="http://www.postgradmed.com/issues/1998/06_98/kemp.htm"]http://www.postgradmed.com/issues/1998/06_98/kemp.htm[/url]

Interesting article, mentions other adjunctive therapies and epinephrine in other concentrations as intravenous drips. note "Table 2".

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.

On Aug 14, 2005

PeanutAllergySpecialist, thank-you for clarifying the situation with the massive dose of Benadryl. I really appreciated it. Hey, we all make mistakes and I think the important thing to do is post about them here (no matter how embarrassing or whatever it might be) so that other people don't make the same mistake(s).

That's one of the reasons that I became so active at PA.com once I found it. So that when the need arose (a specific question, situation), I could tell our family's story and make sure that no one EVER made the same mistakes that almost cost my PA son's life when he was 3-1/4 years old.

Our emergency plan is slightly different than yours.

Epi-pen Dial 911 Epi-pen again within 10-15 minutes if ambulance has not arrived

Peg541, I can't remember, it was quite some time ago now and I think I am blocking, but it seemed like the epinephrine in the hospital was in an IV drip for a period of time, but, as I say, I can't remember.

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

On Aug 14, 2005

Quote:

Originally posted by PeanutAllergySpecialist: [b][omitted stuff]

***About the Benedryl, I am by no means suggesting that an individual should try to treat their reaction with an antihistamine as the exclusive medication. Treatment options are always person-specific, as a dosage that can work for one adult, can definitely harm another adult or a child. Do not ever overdose on an antihistamine, thinking that this will remedy the situation. Many many years later, and after a ton of research, the treatment that I have adopted for myself is:

1) An Epipen administered immediately 2) A prescribed dose of an antihistamine immediately, followed by a second dose if the attack has not been slowed by the time I reach the hosptial. 3) Call 911 or get driven to an ER - whatever method is faster

This is not my advice to anyone - talk to a medical doctor before you create your plan.

I didn't intend to be vague in my last post, and I hope this clears up some concerns.

More to come from... (USERNAME--The PeanutAllergySpecialist)

[/b]

I'm grateful for your post--for making your clarification--and my gratefulnes stems from concern about your UserName. I was initially concerned that some folks new to the board and to PA in general might take your UserName literally--and that does concern me. I was concerned that they might think such high doses for their children would be fine based on your post.

I don't know if you're worried about liability, but several on the board seem to be (ever noticed MommaBear's posts--her disclaimers always make me chuckle, but they serve as a good reminder).

Anyway--it's a good thing you clarified. Thanks.

On Aug 14, 2005

I was thinking the same thing. Even the doctors and nurses on the board, and we have several, don`t have it in their User Name.

On Aug 14, 2005

McCobbre and Carefulmom,

I appreciate your concern. Thank you for the warning.

------- 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.

On Aug 15, 2005

OH WOW! [i]COOL DISCLAIMER[/i]!!!!!!!!!!!!

On Aug 16, 2005

Journal of Pediatrics, The December 2000

On Aug 16, 2005

This is very interesting and clears up a lot of my questions, thank you.

Now I have to really wonder what those people ate? I'll bet there we will find our answer.

Peg

I really have to question that just arbitrarily the epi does not work. It has to be tied to the amount of peanut you have eaten.

Erik, Adele, AnnaMarie, Helen, and my son cannot go thru their lives thinking "is this the time the epi does not work?"

They are careful and might make a mistake but it is not going to be the mistake of eating a PB&J sandwich or a big mouthful of something peanut. Most of their exposures are going to be small from cross contamination and undisclosed peanuts.

And with the amount of care they show (I use our adults as an example but I expect our kids will get to that point too) those "mistakes" will be rare. I truly believe this.

I cannot imagine that the 10% of epi not working is not also related directly to the amount of the allergen ingested. I just can't believe that. That kind of thing rolling around in your mind is just too much to bear. Every single time I administered epi in my ICU I saw it work immediately. Every single time my son used his epi we saw it work immediately. Not statistically even in the ball park but a fact.

Yes I know there are no guarantees in anything in our lives. Still I would like to know what those in the 10% ate, how long it took them to realize they were reacting and how long it took them to seek further help.

I recently met a PA adult who kept her epipen in the car. She told me this as we sat in the Hollywood bowl and ate a meal served to us. She just dug in no questions asked [b]With her epi in the glove box of her car![/b] She has also been known to use her epi and NOT go to the hospital. Now there's your 10% in my estimation.

Yes I know things happen but I believe what I believe. And my son has enough to deal with I am not going to inflict this one on him too. I'm not hiding it either but it won't be part of what we discuss when we go over the "what if's."

Peggy

[This message has been edited by Peg541 (edited August 17, 2005).]

On Aug 17, 2005

Wow reading that sure makes it sound like how much life is like gambling. [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img]

On Aug 17, 2005

Hi Peggy,

I do believe that the severity of an allergic reaction is often due to the amount of exposure.

For example, when the ragweed pollen count is low, I have no symptoms... when it is over 400 ppm my symptoms become much stronger. Although this is ragweed, not peanut.

I think an epi-pen will work.. it's just I am sure there are very rare occasions when a combination of factors may occur (such in a plane crash) such as the amount of peanut protein ingested, the body's reaction to the epi-pen, etc.

I know each time I get into a car and drive on the highway that there is a remote chance I may be killed in a car crash.. same with the epi-pen.. I know there may be a remote chance that even if I use it properly, it may not be effective enough. However, I think if used properly, the epi-pen is effective in almost all cases.

On Aug 17, 2005

Hmm - interesting information...but I can't worry about whether the epi pen will or won't work. I have no control over that. I DO have control over what I eat and I make sure my epi pen is in good condition and is kept with me.

Which leads me to another question for Erik & Peg & whoever else would like to add their 2 cents.....

I carry 2 (duo-pack) epi pens. The original prescription includes a refill that I have not filled. Keeping in mind that I travel a lot and am often in fairly remote places - if you were me - would you use the refill prescription and carry four epipens? After all I have read here recently, I'm wondering if two epipens are enough?

Thanks, Adele

On Aug 17, 2005

Adele, I'd say carry as many as you can get. 4 seems right. We own about 10, in various stages of expired to fresh. The ones (2) DS carries are always fresh and one or two at home are fresh but I also keep one or two expired ones just in case.

So yes, I would carry more than two fresh epi pens traveling. And let me know when you come to Redlands I'll drive up to say hello if I can.

Peg

On Aug 17, 2005

Life *is* a gamble, isn't it? And not just for people with food allergies. The one thing you can say for certain is that none of us are going to make it out of this life alive. I just try to take reasonable precautions--whether that's always wearing a seat belt or having three epi-pens on hand and reading labels carefully--and get on with life without worrying too much. Once you start worrying about what *could* happen, you tend to stop enjoying what *is* happening.

Sarah

On Aug 17, 2005

Well said Sarah!!

On Aug 17, 2005

Quote:

Originally posted by Sarahfran: [b]Once you start worrying about what *could* happen, you tend to stop enjoying what *is* happening.[/b]

I understand what you mean, but....

Quote:

Originally posted by Peg451: We own about 10...

Same is true for us. We keep them in various locations (our house (2), my parents house (2), my purse (3), Mariah's purse (1), etc). It's easy, and I worry [i]less[/i]. Feeling prepared allows me to enjoy the moment.

On Aug 17, 2005

I remember once when Paul was little we went to a restaurant and I left my purse at home knowing DH would have his cash. Well the epi pens were in my purse.

I freaked out. Could not let DS eat anything until I went home and got the epis. No one was happy with me that night but that was too much of a chance for me to take. He began to carry his own epis soon after that.

That memory still scares me.

Be prepared. Good motto.

Peggy

On Aug 18, 2005

Adele, sorry, is a dual-pack two Epi-pens to begin with? So, you're carrying two two's (did that make sense) = 4?

We have four in total. My son wears one. I have one in my purse. His Father has one in his knapsack. The school has one.

I am not clear if I would re-think that position if we were traveling a long distance or for a long period of time.

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

On Aug 18, 2005

Quote:

Originally posted by Sarahfran: [b] Once you start worrying about what *could* happen, you tend to stop enjoying what *is* happening.

[/b]

Sarahfran, wow, I think that line is worth repeating over and over again. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

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

On Aug 18, 2005

interesting link:

[url="http://www.emedhome.com/features_printfriendly.cfm?FID=19"]http://www.emedhome.com/features_printfriendly.cfm?FID=19[/url]

quote:

[i]"Although some patients will die even with appropriate treatment, early use of epinephrine, IV fluids and airway support are vitally important for the patient

On Aug 18, 2005

Quote:

Originally posted by MommaBear: [b] that's ok. (I mean, not even a "respiratory emergency?)

My guess is that an anaphylactic crisis has the potential to progress rapidly to death without intervention and possibly with intervention.

Be assured if someone dies, regardless of the cause, prior to dying they will present (if they are afforded the chance to) as one of the basic algorithms in ACLS. It's a critical care provider's job to [i]anticipate[/i] and identify people [i]at risk[/i] for this and intervene with prophylactic measures in an attempt to [i]prevent[/i] entering one of those algorithms. (some of these measures may require prescriptive power) When and if possible, they don't wait around for it to [i]just happen[/i]. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] Airway, Breathing, Circulation. They see the potential big picture. I mean, since from beginning to end can only be [i]minutes[/i] difference.[/b]

Actually, ABC[b]D[/b].

"Airway, Breathing, Circulation, Early [b]D[/b]efibrillation"......

On Aug 18, 2005

csc, I carry just two epi pens (one duo-pack). I've decided to get another duopack...so I'll have four.

Peg - thanks for your feedback. I wouldn't eat either, if I forgot my epi. Not worth the risk. Is it ok with you, if I email you off-list?

Many thanks.

On Aug 18, 2005

Quote:

Originally posted by Gail W: [b] Feeling prepared allows me to enjoy the moment. [/b]

Feeling prepared is not the same as letting worry take over your life. Feeling prepared is often what lets us all get on with our lives.

Adele: I was going to say that I travel long distances with just two epi-pens. But then, I realized - when we travel I carry two for me and two for my son. So, in reality I do have four to travel with. (Currently two are juniors - but appointement next month son will be graduating to full strength epi's.)

On Aug 18, 2005

Quote:

Originally posted by Adele: [b]csc, I carry just two epi pens (one duo-pack). I've decided to get another duopack...so I'll have four.

Peg - thanks for your feedback. I wouldn't eat either, if I forgot my epi. Not worth the risk. Is it ok with you, if I email you off-list?

Many thanks.

[/b]

Any time Adele. It's [email]Peg541@gmail.com[/email]

On Aug 29, 2005

What a sad story. One of my close friends is teaching a Special Day Class at a high school and I sent an email about food allergys and gave her the link to this webiste. It's better to overinform a person on this subject even if they think they know it all it's good to reinforce it. Please email this story to keep people aware about the dangers.

On Aug 30, 2005

Well, there's this information (and I believe the 10% failure figure comes from the same journal and issue, although I can't locate it at the moment):

JACI March 2005

On Oct 3, 2005

Hi, I just was thinking about my brother, and decided to google his name and this is what I found. Matt Deluce was my big brother, he died on my birthday. I just thought I could perhaps answer anybody's questions regarding his situation. I figure this may help anybody who may suffer from allergies, or love somebody who does. I will not however answer any personal questions that I don't see being a benefit to allergy sufferers, and that are private to my family. As far as Matt's history goes, he was a sever asthmatic and has been hospitalized for it on many occasions. He also has suffered from allergic reactions before (at camp, school, etc.) I have been told by his doctors that each time he suffers a reaction, the next one will come on quicker and more severe. This may explain why although he did take the epi pen right away (he did not wait and see, as he has learned from this mistake), he did get to the hospital in 6 minutes, and the doctors did do everything they could. He was also not a smoker. As far as what he ate, he had steak and french fries, but only a couple of bites before he told my dad to call an ambulance. They also had a couple of beers (about 2 pints), but they were home-brewed sample sizes, and these may have been what had come in contact with nuts. The restaurant was informed prior to ordering that Matt had a severe nut allergy, and my dad and my brothers were assured that Matt was safe. Yes my sister did pass away shortly before Matthew, in fact it was one year ago from this month (she did not die of PA, she was bipolar). I am a little overwhelmed with the amount of people saying they refuse to believe the epi pen doesn't always work, and that it works for sure if you use it. I have been with Matt on a few occasions before he was hospitalized for reactions, and the epi pen may give you time but it will not stop the reaction. The more reactions you have, the less time the epi pen will give you next time (or the more severe the reaction will be). I think it wise not to turn a blind eye on the fact that the epi pens will not always save a life. I don't mean to live in fear either. My best advice is be safe, carry an epi pen, don't hesitate to call an ambulance, and always ask about nut content when you eat out/buy food. However, also know that sometimes this isn't enough. It is one thing to be safe yourself, but the WORLD needs to be safer. There needs to be raised public awareness about how serious peanut allergies are. Most people don't realize how long peanut oil lasts on your hands (think of washing away oil with water, it's not easy to get it all off), and sometimes thats all that it takes for somebody to react. Think of cooking food in the same pan that had peanuts earlier. Think of kids at school eating lunch and touching and playing with the same toys as a kid with a PA. They are everywhere, and it is important for the public to realize this and perhaps be more cautious about peanut policies (should they be allowed at school? Have we washed our utensils well enough? Do I let my customers know there is no garuntee the food hasn't come in contact with nuts...at all?) Hershey's chocolate for example prides themselves in having a separate factory for nut free chocolates (Matt knew this, they were his favourite chocolate bars because they were just about the only ones he could eat). I hope this helps to answer everything so far, thanks.

Matt's Sister

On Oct 3, 2005

Hi Matt's Sister!

Thank You for your post.

First of all let me offer my deepest sorrow and sympathy for what you have gone through. I am very, very sorry.

Second I agree with you the more reactions/exposure does not help and can cause your reactions to become more severe.

Third even though we do everything we can to carry epi pens, read labels and call about foods there is a chance like you experienced with your brother that just a trace amount can be life threatening.

My dd and myself are both PA/TNA as well as having other food allergies. So, I am well aware of what you, as well, as your brother would have gone through on a daily basis. I am sorry for your lose.

Will you be setting up a foundation in memory of your brother? Are you interested in raising more public awareness? What do you see as being helpful to you and family and the allergic community at large? Is there anyway any of us can help you and your family in this time?

Take Care, toomanynuts

You can also e mail me at [email]toomanynuts@att.net[/email]

On Oct 3, 2005

Matts sister, thank you for your post. sarah

On Oct 3, 2005

Matt's sister,

I am so very sorry for your loss [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img] As a parent of a child with PA, my heart goes out to you and your parents. Your poor dad, being there with him and doing everything possible to treat him and have it not work.

I really appreciate you taking the time to try to answer our questions. We were asking/talking about this to try to learn from it, so that it doesn't happen to one of us.

Again, so sorry for your loss.

[This message has been edited by mommyofmatt (edited October 03, 2005).]

On Oct 3, 2005

Matt's Sister - thank you so much for posting to the board. We all offer our deepest sympathies to you & your family, and our appreciation to you for caring enough about others to add your experience to our discussion.

------------------ Sherlyn Mom to 5 year old twins Ben & Mike - one PA & the other not. Stay Informed And Peanut Free!

On Oct 3, 2005

Mattsister-

Thanks for posting. I'm so sorry for your loss. The info you shared was very helpful

Paula

On Oct 3, 2005

Dear Matt's sister,

Thank you so much for the information.

I think I am the loudest person here complaining about epi not working and apologize if I upset you.

I think I WANT the epi to work 100% of the time so I have to believe it will. I guess that's how I get thru my day with my son out in the world.

I send you my deepest sympathies. I imagine how it must have been for you and hope you find some peace knowing how much you have helped all of us here.

Peggy

On Oct 3, 2005

Quote:

Originally posted by Carefulmom: [b]I have since gotten the details of what happened, and the epi DID work. It happened a long time ago, and when the epi wore off he had to be given more. It was five shots during a window of four hours. This was not because it didn`t work, but rather because it worked and then wore off.[/b]

So, being a Doc. Dr. Wood didn't have enough common sense to go to an ER and get an IV of epi?

On Oct 3, 2005

Matt's sister, I am very sorry for your loss. Thank you for visiting our site and letting us know your brother's story. For many of us, I think it too scary to think the epi was used promptlyand properly. It is much easier to think, "Well, it wasn't given quickly enough, or it wasn't given properly, so that won't happen to me/my child." Knowing that the epi and a swift trip to the ER wasn't enough means it could happen to anyone on this board, and that is terrifying. Let me say again, how truly sorry I am. Please feel free to keep in touch--you are always welcome here.

On Oct 3, 2005

Last night we took our 2 year old PA daughter to a restaurant in Dallas. We dont usually let her eat *anything" in a restaurant (we take her food) but last night we did - long story why. We spoke to the chef and advised of the nut allergy etc. He was extremely understanding and they went out of their way to accommodate us. The reason they were so great about it was because our waiter actually worked at the restaurant where Matt ate the contaminated food that caused his death. He was there that night and saw what happened - he now "gets it" and therefore so do many of the other staff members he now works with. Im not sure if this is accurate or not, but he said that the cause of the contamination was that they cook almond shrimp in the same oil that they cooked the fries in ??? Matts sister did not mention this, and Im not here to get into that, butit definitely gave me something to ponder as I have let my daughter eat fries in a restaurant twice because I considered them safe.

On Oct 3, 2005

Matt's Sister,

I am so sorry for your loss. Thank you for posting. I apologize if any of our comments caused more pain. Many people 'want' to think they would handle something differently so to have a different outcome. Most of us are moms of PA children and the thought that this might happen to our child is too much to comprehend. We try to rationalize, thinking something (anything) could, would, should have been done.

I lost my 19 year old brother to a drunk driver that was never even charged (his punishment was a $25.00 ticket for failure to yield). That was over 20 years ago. I still miss him dearly. The could, would, should rationalizing almost drove me insane.

Thank you again for taking the time to post and share with us. We need each other to learn from and lean on. I agree with you, the world needs to know what PA people deal with daily. Please keep telling Matt's story to others. Let them know how special he was and that it should not have happened.

My heartfelt prayers go out to you and your family that you may feel love and peace.

Bridget

On Oct 4, 2005

Hi, it's no problem posting a message, I like talking about him, and I think this message board is a great idea, I never even knew it existed. It's a great way to learn about PA's and raise awareness. As far as my family's plans go, we're looking into the exact cause of death. We didn't even know about using the same oil as the almond shrimp. We knew it was an allergic reaction, but it was difficult to pinpoint exactly what it was (food, a table not properly cleaned, somebody not washing their hands properly). It's just difficult to prove where the exposure came from. We just want to bring awareness to all the restaurants in the area so that something like this doesn't happen again, because it was completely preventable. We havn't started a fund, but we did ask people to make donations at the wake's to the asthma and allergy societies. But some family members have decided to do things like talk to their children's principles about how easy it is to come in contact with nuts, and to change their policies on what should be allowed and what shouldn't at school.

[This message has been edited by Matt's Sister (edited October 04, 2005).]

On Oct 4, 2005

Matt's sister, I am so sorry for your loss. I really respect you and your family for trying to raise awareness. Your family members are providing invaluable support to all families with food allergies by speaking at schools.

I have brought this topic up myself about raising awareness and I think that what your family is doing is the most important thing that can be done. Thank you for what you are doing, and for keeping in touch with us.

On Oct 27, 2005

I came across this and thought I'd share - the face of another life lost to anaphylaxis: [url="http://to05.endcancer.ca/site/TR?JServSessionIdr012=yh80vdd851.app13a&pg=team&fr_id=1000&team_id=11390"]http://to05.endcancer.ca/site/TR?JServSe...0&team_id=11390[/url]

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

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

On Oct 28, 2005

A beautiful face. And an obviously loving family. [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img]

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