Month: April 2016

Epinephrine Auto-Injectors

The Allergy Doctor Centreville, VA Relies On Explains Epinephrine Auto-Injectors
Severe sensitivity to certain foods, insect venoms, and certain medications can lead to a life- threatening reaction called anaphylaxis.  The symptoms usually begin within a few minutes after exposure and can progress very rapidly.  Anxiety is often the initial symptom and the other usual manifestations include generalized itching, redness, hives, swelling of the eyelids, lips, tongue, and/or throat (i.e., angioedema) leading to difficulty in swallowing and breathing. Other signs can include excessive sweating, rapid pulse, and a sudden drop in blood pressure.

Epinephrine (adrenaline) is a self-injectable medication and is the first line treatment option for anaphylaxis.  It can stall the progress of the reaction and can be life-saving by reversing the deleterious effects of anaphylaxis.  To be maximally effective, epinephrine needs to be administered as soon as possible after the onset of the first symptom.  In fact, delayed use of epinephrine is the leading cause of mortality in anaphylaxis.  It is therefore imperative for all people susceptible to severe allergic reactions to have a self-injectable epinephrine immediately available at all times.

The foods most likely to cause anaphylaxis include peanuts, tree nuts, fish, and shellfish.  In children and adults who are severely sensitized, other foods like milk and eggs can also cause severe adverse reactions.  The insect stings that are known to cause anaphylaxis belong to the Hymenoptera family and include honeybees, yellow jackets, hornets, wasps, and fire ants.  Penicillin and related antibiotics are the most common drugs that are associated with a tendency to cause life-threatening reactions.

Epinephrine auto-injectors are available by prescription only and are covered by most insurances.  One of the products marketed under the trade name Auvi-Q was voluntarily recalled by the manufacturer in October 2015 and two other products Epipen and Adrenaclick are currently available.  A generic version of an epinephrine auto-injector is also offered by certain pharmacies. Note that there are generally 2 doses (0.15 cc. and 0.3 cc.) of each epinephrine auto-injector.  The dose depends on the weight of the individual, such that the 0.3 cc. dose is the dose usually given individuals weighing greater than or equal to 66 lbs.  The 0.15 cc. dose (e.g., EpiPen Jr.) is generally given to children weighing 33-66 lbs.

Although the medication is identical, different brands have different administration methods and it is crucial that the patient receive adequate training and practice with a training device to get familiarized with the specific technique. The medicine is usually injected intramuscularly (IM) into the outer part of the thigh, even through clothing, and the device is kept in place for about 10 seconds.  It is recommended that two doses be carried at all times, as the second dose may be needed if the symptoms persist about 10-15 minutes after the first dose.

The most common side effects of epinephrine include palpitations, tremors, and restlessness. However the benefits of epinephrine almost always outweigh the risks.  After using the epinephrine, it is important to go to the nearest emergency department to be monitored.  In some individuals with anaphylaxis, a late phase reaction can occur anywhere from 4 to 72 hours (4-8 hours is more typical) after the initial anaphylactic reaction.  Patients and/or parents should also contact the allergist for reevaluation and for replenishment of epinephrine auto-injectors.  The devices should be stored at room temperature and should never be frozen or exposed to high temperatures or direct sunlight.

The board certified allergists and the staff at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area are trained and experienced in evaluating the need for, prescribing, and teaching the technique for epinephrine auto-injectors.  We have 3 offices in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and the Washington, DC and McLean offices are Metro accessible.  We offer free shuttle service between our McLean office and the Spring Hill metro station on the silver line.  To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been providing quality care allergy, asthma, and immunology services to the Washington, DC , Northern Virginia, and Maryland metro area community  for more than a half century.

Can Sleep Disorders be Due to Allergies?

A top allergist Arlington, VA trusts examines the correlation between allergies and sleep disorders
Sleep disorders affect about 30% of the population.  Several sleep disorders have been linked to allergies.  People who suffer from hay fever (allergic rhinitis) are more than twice as likely to have insomnia as those individuals who do not have hay fever.  They are also more than twice as likely to have problems falling asleep.  A little more than one-third of individuals with hay fever complain of insomnia.  Almost two-thirds of these same allergic people complain that they do not get enough sleep.  For comparison, only one-sixth of individuals without allergies say they have insomnia and one-quarter of individuals without allergies say that do not get enough sleep.  The severity of the sleep disorders also increased as the severity of the allergies increased, showing a direct proportional relationship.  Sleep disorders are linked to sleepiness during the day, fatigue, depression, decreased ability to learn, decreased memory, decreased productivity at school and/or work, and a decreased quality of life.  Interestingly, allergic rhinitis has been linked to many of the same symptoms.  The combination of allergic rhinitis and a sleep disorder can have deleterious effects on these individuals.

Obstructive sleep apnea is a sleep disorder that is caused by repeated interrupted breathing which does not allow an individual to get enough “deep” sleep that is required to rejuvenate the body.  As a result, excessive daytime sleepiness or falling asleep at inappropriate times is the hallmark of this condition.  It is often caused by one’s tongue sliding back in the throat, in combination with a relaxed airway which changes shape to a more oval (rather than round) shape which gives way to less “room” for air to be able to get to the lungs from the nose or mouth.  This combination of things often causes the individual to snore.  People with obstructive sleep apnea are unable to breathe in air due the blockage caused by a tongue that is blocking the airway on top of an already relaxed smaller diameter airway.  These individuals literally stop breathing for typically 20 to 60 seconds.  When this occurs, there is an “emergency” sensor called the carotid body near the carotid arteries in one’s neck, that detects the lowering of the oxygen and rise in carbon dioxide in the blood.  This triggers the awakening center in one’s brain and the individual awakens for a few seconds allowing them to unknowingly move their tongue and re-form their throat shape to the normal awakened state.  Breathing is then reestablished.  This cycle in people with obstructive sleep apnea occurs many times per hour.  It can occur greater than 50 times per hour, resulting in a lack of restful sleep.  Obstructive sleep apnea has been linked to allergic rhinitis.  People with allergic rhinitis often have nasal congestion which causes the upper airway to narrow.  Individuals with hay fever also are more prone to sinus infections.  Most people with sinus infections also have nasal congestion as part of their symptoms.  The upper airway narrowing that occurs due to nasal congestion increases the likelihood of snoring and obstructive sleep apnea.  Obstructive sleep apnea should not be taken lightly as some of the complications of obstructive sleep apnea include heart disease, stroke, increased risk for motor vehicle accidents, and sexual dysfunction.

If you snore, experience insomnia, have difficulty falling asleep, and/or have daytime sleepiness, the board certified allergists at Black & Kletz Allergy can order a sleep study as well as diagnose and treat you for allergic rhinitis, if applicable.  We treat both adults and children and have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All our offices have on-site parking and our offices in Washington, DC and McLean are Metro accessible.  We offer a free shuttle between our McLean office and the Spring Hill metro station.  If you have a sleep disorder and/or hay fever symptoms, please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy strives to provide quality allergy, asthma, sinus disease, hives, and immunologic care to the Washington, DC metro area community in a caring and professional manner as we have done for more than 50 years.