Anaphylaxis

anaphylaxis

What is anaphylaxis?

Following on from the post about how to use an EpiPen in cases of anaphylaxis I thought I would discuss what anaphylaxis actually is.

Anaphylaxis is a severe allergic reaction and should be treated as a medical emergency as it can be life threatening.  Anaphylaxis occurs after a person is exposed to the thing that they are allergic to.  It is usually a food, medicine or insect that causes the reaction.  Not everyone who has an allergy has anaphylactic reactions.

 

Signs and symptoms of anaphylaxis

Anaphylaxis can start as less severe symptoms such as swollen lips, eyes, mouth, hives and vomiting (insect allergy) then progress to severe symptoms such as the following;

  • Swollen or tight throat
  • Swollen tongue
  • Trouble breathing/noisy breathing
  • Cough or wheezing
  • Dizziness/collapsing
  • Husky voice

Reactions can be worse if it is hot or the person has been drinking alcohol.  If someone is allergic to a food it can depend how much of the food they ate and how it was prepared.

 

What to do in an anaphylactic reaction

If you are aware that someone is an anaphylaxis sufferer and you notice any of the above symptoms ask them where their EpiPen is.

  • If the person is able they should administer the EpiPen themselves.
  • If they are not you should administer it for them.
  • In either case 000 should also be called as sometimes the person improves quickly and sometimes they don’t. Even if someone improves they can deteriorate again quickly.

 

What is in an EpiPen?

EpiPens contain adrenalin.  Adrenalin works by quickly reversing the allergic reaction.

Sometimes one dose of adrenalin is enough and sometimes a second dose is needed after a time.  This is why it is important for medical assistance to be sought immediately.

How to use an EpiPen

EpiPen

EpiPens

 

With children starting back at school and childcare and recent changes to how EpiPens are used it’s a good time for a review.

 

Why are EpiPens used?

An EpiPen is used in a situation where someone has a severe allergic reaction.  This reaction can be life threatening and requires immediate use of an EpiPen which contains adrenalin.

Anaphylaxis sufferers can be allergic to various things such as foods, insect bites and stings, medicines, latex and more.

In any situation where an EpiPen is used an ambulance should also be called.

 

How to use an EpiPen

  • If the sufferer is able to they should give themselves the EpiPen. If not it should be administered by someone else
  • An EpiPen comes in a carry case and is easily removed from this by flipping open the cap and sliding the pen out.
  • Make sure to sit or lay the person on the ground before using the EpiPen
  • Grip the EpiPen around the middle by making a fist. It is important not to have any part of your hand around the bottom of the EpiPen as this is where the medicine comes out.
  • To remember which way to hold the EpiPen remember the rhyme

“blue to the sky and orange to the thigh”

This means point the blue end away from the person and point the orange end towards the thigh

  • When the EpiPen is held correctly the blue safety cap can be removed and the EpiPen placed against the persons thigh
  • It is fine to give the EpiPen through clothing just remember to avoid seams, buttons etc as the needle won’t be able to pass through these
  • Push the EpiPen in hard against the person until a click is heard
  • The EpiPen should be held in place in the persons thigh for 3 seconds
  • After this time the pen can be removed from the person
  • Keep the person laying down and call 000
  • Record what time the EpiPen was given because if there is no response after 5 minutes a second EpiPen can be given
  • Each pen can only be used once. When the pen has been used the viewing window becomes black
  • Always check the viewing window before using an EpiPen and if it is not clear then that EpiPen should not be used
  • Check expiry dates regularly to make sure the EpiPen you have is in date
  • Store your EpiPen out of the sun

 

EpiPen usage changes

The recommended time to leave the EpiPen in the thigh used to be 10 seconds.  The recommended time is now 3 seconds.

It was previously recommended to massage the site where the EpiPen was injected.  This is now no longer recommended.

To watch an EpiPen training video visit www.allergy.org.au

The dreaded “school sores”

school sores impetigo

Impetigo/school sores

Impetigo is a bacterial skin infection caused by staphylococcus or streptococcus bacteria.  These bacteria live on and in our bodies, such as on our skin and inside our nose, without causing harm.  If there is a break in our skin such as a cut, scratch or eczema an infection can occur below the skin’s surface.  Insect bites that are scratched with germy fingers are another common source of school sores.

This condition is commonly called school sores as it is highly contagious and easily spread between children at school.

 

Symptoms of impetigo/school sores

The sores themselves are itchy and red and look like little blisters.  They can occur in clusters especially around the nose and mouth.  A sticky yellow liquid emerges from the blisters when they pop.  The blisters then crust over and eventually the crust falls off.

Treatment of impetigo/school sores

Mild cases can sometimes be treated with topical antibacterial creams/ointments.

Most often prescription antibiotic cream/ointment is needed and sometimes oral antibiotics are used.

Children should not attend school or child care unless they are being treated and every sore is covered with a dressing that completely covers the sore.

Important points about impetigo/school sores

Wash hands well with antibacterial soap and water if the sores are touched.

Don’t share towels.

Keep children’s nails short to prevent scratching and nose picking!

Covering the sores is important even when at home until the scab forms.  This is to prevent the infection being transferred to other parts of the body through scratching/touching and transferring to other people.

Asthma – Preventers and Relievers

asthma

Asthma medications

The main types of asthma medications are preventers and relievers.  There is also a type of preventer that also contains a reliever.  They come in different kinds of devices to be inhaled and there is also a preventer, montelukast, that comes in a tablet.  Prednisone tablets are only used for severe asthma flare ups in addition to the inhaled medications.

 

Preventers – red, orange or brown devices

It is important for anyone who is prescribed a preventer medication by their Doctor to use it!  So many people do not use their preventer correctly or at all and this can lead to asthma attacks and poorer lung health.

Preventers are available on prescription only.

Most adults with asthma use an “inhaled corticosteroid” preventer.  This needs to be used every day once or twice daily depending on what has been prescribed.  This type of medicine reduces the swelling and “twitchiness” of the airways so that they are not so sensitive.  They also reduce excess mucous and can help airway cells repair themselves and return to normal. The airways in our lungs can be thought of as trees with thick branches changing to smaller branches down to twigs at the end. It is important that as much of our airways as possible is used.

Preventers can take a few days to a week to “kick in” so don’t stop if you don’t notice a difference straight away.

The asthma guidelines suggest that a preventer is prescribed if

  • You have had asthma symptoms more than once in the last month
  • You have woken at night because of symptoms in the last month
  • You have had a flare up in the last year

Guidelines for children are slightly different depending on their age.

Preventers should be used every day even if there are no symptoms and they should also be continued during flare ups and colds.  Keep using it until the Doctor says it is ok to stop or reduce the dose to see what happens.

Examples; Flixotide, Alvesco, Pulmicort, QVAR,

Additional preventative treatment

Spiriva Respimat

  • Spiriva has previously been used in COPD (Chronic Obstructive Pulmonary Disease) only but is now able to be used in asthmatics who need an extra preventer added in.

 

 

Relievers – blue devices

Anyone who has asthma should have a reliever on hand in case they get asthma symptoms.  Relievers can be obtained over the counter at a pharmacy by speaking with a Pharmacist or on a Doctor’s prescription.

Relievers work quickly to relax the muscle around the airway so that the airway can open up.  They start to work in a few minutes.

If you need to use your reliever more than twice per week this is a sign that you should see your Doctor for an asthma assessment as it is likely that you will need to use a preventer.  This does not include using it before exercise.

A lot of people rely on their reliever as they notice that it works straight away and therefore do not use a preventer or do not use it often enough.  This can cause damage to the lungs and worsening of asthma over time.

Examples; Ventolin, Bricanyl

 

Combination medications – purple devices

These contain an “inhaled corticosteroid” as well as a long acting reliever.  These have the benefits of the preventer as well as the ability to open up the airways.

Examples; Seretide, Breo, Flutiform, Symbicort

Important

If you’re an asthmatic and you use your reliever more than twice per week and you aren’t using a preventer see your Doctor for assessment.

If you have been prescribed a preventer use it every day regardless of how you feel.

 

 

Worms

worms

Itchy bottom? It could be worms!

 

Worms are the first thing we think of when a child has an itchy bottom!  Threadworms, also known as pinworms, are the most common worm infection in Australia.  Infection is common.  Anyone can get worms though it is usually small children who get infected and this is probably because they are more likely to put their fingers in their mouths.

 

Worm infection

Infection occurs when threadworm eggs are swallowed or breathed in.  This usually occurs when eggs come in to contact with hands that then go near the mouth.  Sometimes eggs can be picked up from food, clothing or other items.

The eggs travel from the mouth to the gastrointestinal tract where it takes about 4-8 weeks for them to hatch and grow in to mature worms.  The female worm travels down to the anus where she lays thousands of eggs and then dies.  This seems to happen at night hence the itchy bottom at night time.  Children often reinfect themselves by scratching and catching eggs under their fingernails which can be transferred to the mouth again or other items.  The eggs can survive about 2-3 weeks on objects where other people can catch them.

 

Symptoms/detecting worms

  • Itchy bottom, especially at night
  • Not feeling hungry
  • Feeling a bit unwell or irritable
  • Worms may be seen moving in faeces or around the anus. They look like thick white cotton and are about 0.5-1.5cm long
  • The best time to check the bottom of a child you think may have worms is at night in the first hour after they have gone to sleep. Grab a torch and have a look!
  • Pressing a piece of sticky tape to the anus first thing in the morning can sometimes catch some eggs

If anyone experiences severe symptoms seek medical advice.

 

Treatment

Anyone over 2 years of age who is not pregnant or breastfeeding needs to have only one tablet or chocolate square treatment.  It is a good idea to treat everyone in the house and do it at the same time and then treat again two weeks later.  This is because the treatment only kills the worms and not eggs so more can hatch over those two weeks.  There is a treatment available for 1-2 year olds.  Pregnant and breastfeeding women should not treat themselves just in case and should discuss with their Pharmacist or Doctor if they have worms.

 

To prevent reinfection

  • Wash towels, sheets and pyjamas with hot water to kill eggs
  • Don’t share towels
  • Clean children’s fingernails and keep them short
  • Vacuum and wipe down furniture
  • Make sure everyone washes their hands well after toileting and before eating

 

Do people get worms from animals?

People can not catch threadworms from animals.  Other worms such as hookworms and tapeworms can be passed from animals to humans but this is not common in Australia.