Elizabeth (Beth) Strong is a board certified Family Nurse Practitioner. She completed her Bachelor of Science in Nursing at SUNY Buffalo and went on to earn her Masters of Science in Nursing at the University of Rochester. Beth learned world-class allergy care while working closely with and training under top researchers and experts. For the past eleven years, she worked through the Jaffe Food Allergy Institute at Mount Sinai in NYC. She treated patients with food allergies, eczema, seasonal allergies and asthma. She managed several clinical trials studying immunotherapies for food allergy and was highly integral in opening the Food Allergy Treatment and Research Center to treat food allergic patients with an advanced oral desensitization protocol. In her free time, Beth enjoys being outdoors and traveling. Most of all, she loves spending time with her husband and two young children.
Preventing allergy is a priority for both physicians and parents. There have been many studies attempting to lessen the risk of both food and environmental allergies.
Here are a few examples of possible interventions to decrease the risk of allergy;
- Frequent application of emollients (moisturizers) from birth.
- Breast feeding, hypoallergenic formulas, early introduction of foods.
- Avoiding pets OR adding more pets.
A study, started in 1990 and recently completed and accepted for publication, looked at fish oil supplementation in pregnancy*. Over 500 pregnant mothers were given supplements containing fish oil, olive oil or no oil. The hypothesis was that maternal supplementation with long chain n-3 polyunsaturated fatty acids (PUFAs) may have immunological effects on the developing fetus and decrease allergies and asthma. The children were evaluated when they reached 18 years of age.
The probability of having had asthma medication prescribed was significantly reduced in the fish oil group compared to the olive oil group (HR=0.54, 95% CI: 0.32-0.90, p=0.02). The probability of having had allergic rhinitis medication prescribed was also reduced in the fish oil group compared to the olive oil group (HR=0.70, 95% CI: 0.47-1.05, p=0.09), but the difference was not statistically significant. Self-reported information collected at age 18-19 years supported these findings.
Maternal supplementation with fish oil may have prophylactic potential for long-term prevention of offspring asthma.
Hansen S, Strøm M, Maslova E, Dahl R, Hoffmann HJ, Rytter D, Bech BH, Henriksen TB, Granström C, Halldorsson TI, Chavarro JE, Linneberg A, Olsen SF, Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring, Journal of Allergy and Clinical Immunology (2016), doi: 10.1016/j.jaci.2016.02.042.
Sanofi US Issues Voluntary Nationwide Recall of ALL Auvi‑Q®
Due to Potential Inaccurate Dosage Delivery
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Due to high volume of calls being received on the Auvi‑Q customer service phone line, callers may periodically receive a message that the line is down. We appreciate your patience and please call back.
Sanofi US is voluntarily recalling ALL Auvi‑Q® (epinephrine injection, USP). The recall involves ALL Auvi‑Q currently on the market and includes both the 0.15 mg and 0.3 mg strengths. The Lot numbers include every consecutive lot number beginning with 2081278 through 3037230. The products have been found to potentially have inaccurate dosage delivery.
If a patient experiencing a serious allergic reaction (i.e., anaphylaxis) did not receive the intended dose, there could be significant health consequences, including death because anaphylaxis is a potentially life‑threatening condition. As of October 26, 2015, Sanofi has received 26 reports of suspected device malfunctions in the US and Canada. None of these device malfunction reports have been confirmed. In these reports, patients have described symptoms of the underlying hypersensitivity reaction. No fatal outcomes have been reported among these cases.
Auvi‑Q (epinephrine injection, USP) is used to treat life‑threatening allergic reactions (anaphylaxis) in people who are at risk for or have a history of these reactions. Auvi‑Q is packaged with two active devices and one trainer device in a corrugate box. Auvi‑Q was distributed throughout the United States via wholesalers, pharmacies and hospitals. All Auvi‑Q is being recalled.
Sanofi US is notifying its distributors and customers who include doctors, pharmacies, wholesalers and other customers in the supply chain by letter, fax, email and phone calls and is arranging for return and reimbursement of all recalled products.
Customers with questions regarding this recall can go to www.Auvi‑Q.com and call 1‑877‑319‑8963 or 1‑866‑726‑6340 Monday through Friday 8 a.m. to 8 p.m. ET for information about how to return their Auvi‑Q devices. Sanofi US will provide reimbursement for out of pocket costs incurred for the purchase of new epinephrine auto‑injectors with proof of purchase.
Customers should immediately contact their healthcare provider (HCP) for a prescription for an alternate epinephrine auto‑injector. In the event of a life‑threatening allergic reaction (anaphylaxis), patients should only use their Auvi‑Q device if another epinephrine auto‑injector is not available, and then call 911 or local medical emergency services. Customers should contact their physician or HCP if they have experienced any problems that may be related to taking or using this drug product.
Any adverse events or quality problems experienced with the use of this product should be reported either to Sanofi or to the FDA’s MedWatch Program.
To report an adverse event to Sanofi US: call 1‑800‑666‑1630, Option 2.
To report an adverse event to the FDA Med Watch Program: by fax 1‑800‑FDA‑0178, by mail at MedWatch, FDA, 5600 Fishers Lane, Rockville, MD 20852‑9787 or on the MedWatch website at www.fda.gov/medwatch/report.htm
This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.
Sanofi US is committed to patient safety and the quality of Auvi‑Q, and will continue to work closely with customers and regulatory authorities to resolve this issue in a timely manner.
Chronic hives are a common problem in the general population and in my practice. Children and adults can suffer daily itching and hives for months or years without explanation. However, symptoms often resolve spontaneously and most importantly, the risk of a severe reaction is very low.
On the other hand, there is a separate condition called idiopathic anaphylaxis. People with this condition will have more severe allergic reactions; symptoms may include hives and swelling but there may also be upper airway obstruction, wheezing, shortness of breath, decreased blood pressure or fainting.
If a patient presents to the office after having a severe reaction, my primary goal is to identify what caused the reaction. Subsequent avoidance can prevent future problems. The most common (known) causes include foods, medications and stings. Unfortunately, a thorough history and physical exam may night identify a cause (or even a suspect). This situation occurs in 30-60% of adults and up to 10% of children. Risk factors include female gender and reported penicillin allergy.
Here are some possible explanations for idiopathic anaphylaxis:
- Hidden food allergens. Expanding testing to include a large food panel may help to identify the cause. Unfortunately studies have shown little success, finding a cause in only 7% of cases. Other studies have ruled out food preservatives as causes of idiopathic anaphylaxis, including sulfites, MSG and aspartame.
- Female hormones.
- Immune abnormalities.
- Increased sensitivity to histamine.
- Autoimmune disease.
- Delayed allergy to beef, pork or lamb. An allergic reaction to the oligosaccharide alpha-gal. Transmitted by the Lone Star tick.
- Conditions which mimic anaphylaxis: somatoform disorder, scromboidosis (poisoning form “spoiled” fish).
Here are some tests that may be done:
- Skin (or blood) testing to foods and/or medications.
- Serum anti-alpha-gal IgE.
- Tryptase level. Prostaglandin D2.
- Urinary histamine metabolites.
- Genetic analysis.
Here are possible treatments:
- Oral Steroids.
- Oral albuterol.
The FDA has approved omalizumab (Xolair) for the treatment of chronic hives. This is the first medication with a specific indication for [glossary slug=’chronic-idiopathic-urticaria’ /] (CIU). There are many patients with CIU that remain symptomatic, covered in hives and itchy despite multiple medications. The addition of Xolair may help these patients get their symptoms under control.
– Current treatment options are limited and often ineffective.
– Convenience. Xolair is given as an injection on a monthly basis. Current medication regimens may include up to 20 pills per day.
– Xolair is expensive and will require pre-approval.
– Several clinical studies have demonstrated a high degree of safety. However, there are concerns that Xolair use may increase the risk of cardiac events and severe allergic reactions.
– Xolair, like other available medications, suppresses the hives but does not fix the underlying problem. Optimally, a cause can be identified and corrected or avoided.