Category Archives: allergic reactions

Important EpiPen® recall information

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The FDA (Federal Drug Administration) recently issued a voluntary recall for certain lot numbers of the injectable EpiPen® and EpiPen Jr. This is due to a possible problem with the injector itself.

EpiPen® contains epinephrine, a drug used to treat severe allergic reactions. In a couple of cases outside the United States, the injector failed “due to a potential defect in a supplier component,” according to the FDA.

The affected lots were distributed between December 17, 2015 and July 1, 2016. Not all lots are affected, and you don’t need to replace any EpiPens that aren’t on this list.

If you do have an EpiPen® on this list, don’t get rid of it until you have obtained a replacement. Any time you use an EpiPen®, you should seek emergency medical help right away, especially if it did not activate.

Mylan, the company that distributes EpiPen®, has this information on its website (from the manufacturer Meridian):

If you think you may be impacted by this recall, please follow these steps:

STEP 1: Check the lot number on your carton or device to see if your EpiPen® Auto-Injector is affected by the recall.

STEP 2: If your EpiPen® Auto-Injector has been recalled, contact Stericycle at 877-650-3494 to obtain a voucher code for your free replacement product. Stericycle also will provide you with a pre-paid return package to ship the product back to Stericycle.

STEP 3: Visit your pharmacy with your voucher information to redeem your free replacement.

STEP 4: Send your recalled product to Stericycle. Do not return any devices affected by the recall until you have your replacement in hand.

Contact your pharmacist if you have questions, or if you’re unsure if your current EpiPen® is on the recall list.

New information about preventing peanut allergies

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An extensive study of children and peanut allergies has recently been released, and it encourages pediatricians to re-assess the recommendations that have been in place for some time. The study, called LEAP (Learning Early About Peanut Allergy), looked at children who have a severe or mild risk of developing peanut allergy and those who don’t.

Peanut allergies have been on the rise in recent years. Conventional wisdom has been that infants and toddlers should not be given peanuts or peanut products until they were older. That wisdom is now changing as a result of the LEAP study, conducted by the National Institute of Allergy and Infectious Diseases (NIAID).

The director of NIAID said in a recent press release: “We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”

So, what are the new guidelines, and what should parents do about introducing peanuts to the diets of their young children?

For babies who are considered to be at NO risk for developing a peanut allergy, parents can begin introducing peanut butter with solid foods at about six months of age. The LEAP study concludes that once peanut butter is introduced and tolerated with no allergic reaction, it should remain in the baby’s diet with some regularity.

There are different guidelines for babies and young children who are determined to be at moderate or severe risk of developing peanut allergy. How do you know whether or not your child is at risk? There are several factors that contribute to that risk, and it’s a conversation you should have with your child’s pediatrician in the office before introducing peanut butter into the diet.

Your concerns are our concerns, and we look forward to answering any questions you may have at your child’s next checkup.

Ticks

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Ticks and spiders are both arachnids, but their method of attacking the skin is very different. While a spider merely bites, a tick burrows under the skin to gorge itself on blood. Sometimes ticks on the body can go unnoticed for a few days, which is why it is important to do a body check of your kids when they have been playing outside in the spring and summer. Ticks like hiding places— under your child’s hair, between the toes, etc. After it is finished feeding, the tick will drop off the body.

How to remove a tick? Very carefully! See this brief description from the Centers for Disease Control and Prevention (CDC) about safe removal.

There are a few tick-borne diseases that can be very serious.

Rocky Mountain spotted fever (RMSF) is carried by the dog tick or wood  tick, which is usually about a quarter inch long. The disease is caused by a particular type of bacteria, and the symptoms, according to an American Academy of Pediatrics ( AAP) article, include: “Flu-like symptoms such as fever, muscle pain, severe headaches, vomiting, nausea, and loss of appetite. A rash develops in most cases of RMSF, typically before the sixth day of the illness. This rash tends to appear first on the wrists and ankles, but within hours it can spread to the torso. It can also spread to the palms of the hands and soles of the feet. The rash is red, spotted, and raised. Other symptoms may include joint pain, stomach pain, and diarrhea. In severe cases, the blood pressure can drop and the patient may become confused. As the infection spreads, many organs, including the brain, can be affected.”

If your child has any of these symptoms and you suspect a tick bite, call your pediatrician immediately.

Lyme disease is most common in the Northeast, North Central, and West Coast states. It is spread by deer ticks. The most common symptom is what is sometimes called a “bull’s-eye” rash. This rash is a pink or red circle that can expand over time, even to a diameter of several inches. Another AAP article lists further symptoms:

  • “Headache
  • Chills
  • Fever
  • Fatigue
  • Swollen glands, usually in the neck or groin
  • Aches and pains in the muscles or joints.”

Lyme disease is very treatable in most cases, but if left untreated can cause long-term health problems.

There is also another tick-borne disease that presents itself a little like Lyme disease. It’s called STARI (Southern Tick-Associated Rash Illness) and is most prevalent in, as you may guess, more southern states like ours. The organism that causes this disease is, as yet, unknown, but it is carried by the lone star tick. The rash is similar to the one caused by Lyme disease (see above) and other symptoms according to the CDC include “fatigue, fever, headache, muscle and joint pains.” If your child presents with any of these symptoms and you suspect she has been bitten by a tick, contact your pediatrician immediately. For easy-to-read information about STARI, there is a good series of short articles from the CDC here.

Use insect repellent and avoid places where ticks live, when possible. Have a safe and enjoyable rest of the summer and fall!

© MBS Writing Services, 2015, all rights reserved

Spider bites

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Both spiders and ticks are common in our area. We’ll deal with ticks next time.

While most of their bites aren’t dangerous to most people, it’s good to be informed about different types of spiders, their bites, and diseases that might result from some of them.

Spiders use a venom to anesthetize and paralyze their tiny prey. The venom from most species is not dangerous to most humans (see below for exceptions). Watch for signs of infection and report those immediately to your pediatrician. If you are concerned that a bite is getting much larger, note the edges with a Sharpie marker so you can see if it’s continuing to grow.

The female black widow spider can be extremely poisonous to humans, sometimes even fatal. She has an hourglass shape and is dark colored with yellow or red on her abdomen. Symptoms can be severe muscle cramping and pain. Call EMS if you think someone has been bitten by a black widow spider.

The brown recluse spider is fairly common in Kentucky, and can also be fatal at times. People often don’t know they’ve been bitten until the bite starts to swell and get painful. Reactions greatly vary. Call EMS if you are concerned about a brown recluse bite.

According to this article by the American Academy of Pediatrics (AAP), here are things to watch for after a spider bite, and a signal to call your pediatrician or EMS:
• “Tiny fang marks
• Pain
• Pain begins as a dull ache at the bite site
• Pain spreads to the surrounding muscles
• Pain moves to the abdomen, back, chest, and legs
• Blister at the bite site
• Mild swelling and a blue-gray mark at the bite surrounded by lightening of skin color
• Progressive soft tissue damage; the skin becomes dark blue and then black (necrotic).”

Wash the affected area with soap and water, and treat a bite with an ice pack (make sure you put a layer of cloth between the ice pack and the skin) Another resource for your questions about spider bites is the Poison Control Center.

As with anything, whenever you have a concern, call our office.

© MBS Writing Services, 2015, all rights reserved

Stinging insects

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Nothing quite puts a damper on outdoor fun like a sting from a bee, yellow jacket, hornet, or wasp.

Art by Corinne

Art by Corinne

While most stings, though annoying and painful, aren’t dangerous, sometimes they can be severe in certain cases.

First things first – how to avoid getting stung:

  • Check the spots where your child plays for nests of stinging insects. Nests can be in trees or bushes, on structures like houses and barns, under picnic tables or by the porch. If you see an unusual number of the same type of stinging insects in one area, it’s possible there is a nest nearby. Once you’ve located a nest, you should consider calling an exterminator. If it is a honey bee hive, locate a beekeeper who will almost certainly be interested in collecting a new hive, and who knows how to do that safely. On rare occasions you might see a honey bee swarm. This occurs when a hive has gotten too large and is in the process of dividing. Be very careful to avoid the swarm and call a beekeeper immediately.
  • Wear shoes outdoors. Even sandals or flip-flops are not good protection from stinging insects hiding in the grass.
  • Wear light-colored clothing, and don’t wear anything with a floral pattern. Bees can be attracted to that as if it were a real flower!
  • Watch what you eat outside. Insects are attracted to sweet foods and beverages and other food items like peanut butter.
  • Don’t allow your child to touch even a dead stinging insect; the stinger still contains venom.
  • As difficult as it may be, don’t swat at an insect because that may make it attack.
  • Read about these and other preventative measures in this article by the American Academy of Pediatrics. The article contains this additional warning: “If you have disturbed a nest and the insects swarm around you, curl up as tightly as you can to reduce exposed skin. Keep your face down and cover your head with your arms.”

So, what to do after a sting?

If the child or adult is highly allergic to stings, watch closely for signs of anaphylaxis. Another article by the AAP describes an anaphylactic reaction like this:

  • “A severe life-threatening allergic reaction is called anaphylaxis.
  • The main symptoms are difficulty breathing and swallowing starting within 2 hours of the sting.
  • Anaphylactic reactions to bee stings occur in 4 out of 1,000 children.
  • The onset of widespread hives or facial swelling alone following a bee sting is usually an isolated symptom, not the forerunner of anaphylaxis. Your child’s doctor will decide.”

In the case of anaphylaxis, administer epinephrine in the form of an EpiPen or AUVI-Q, if available, and call 911.

More common reactions to stings are redness and swelling, pain and itching.

If the stinger is in the skin (only honeybees leave their stingers behind), scrape it out with your fingernail, or if it’s completely under the skin just leave it alone and it will be shed naturally.

Here are the AAP’s recommendations for care after a sting:

  • “Meat Tenderizer:
    • Apply a meat tenderizer-water solution on a cotton ball for 20 minutes (EXCEPTION: near the eye). This may neutralize the venom and decrease pain and swelling.
    • If not available, apply aluminum-based deodorant or a baking soda solution for 20 minutes.
  • Local Cold: For persistent pain, massage with an ice cube for 10 minutes.
  • Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen immediately for relief of pain and burning.
  • Antihistamine: If the sting becomes itchy, give a dose of Benadryl. (See Dosage chart)
  • Hydrocortisone Cream: For itching or swelling, apply 1% hydrocortisone cream to the sting area 3 times per day (No prescription needed).
  • Expected Course: Severe pain or burning at the site lasts 1 to 2 hours. Normal swelling from venom can increase for 24 hours following the sting. The redness can last 3 days and the swelling 7 days.
  • Call Your Doctor If:
    • Develops difficulty breathing or swallowing (mainly during the 2 hours after the sting) (call 911)
    • Redness lasts over 3 days
    • Swelling becomes huge or spreads beyond the wrist or ankle
    • Sting begins to look infected
    • Your child becomes worse
    • And remember, contact your doctor if your child develops any of the “Call Your Doctor” symptoms.”

© MBS Writing Services, 2015, all rights reserved

Bug bites

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It’s summertime. Mosquitoes and other bugs are in hot pursuit of you and your family. What’s the best way to keep from being bitten? When should you be concerned about a bite?

If your kids spend any time at all outside— which they should, for the exercise and fresh air— they will be bitten from time to time. “Bugs,” of course, is not an accurate scientific term. Even so, we’re using it here as an all-inclusive word to refer to insects (mosquitoes, bees, wasps, chiggers, biting flies, etc.) and arachnids (spiders, ticks, etc.).

Most bites on most people are relatively harmless, causing irritation, itching, and redness. Different bug bites can result in different types of skin reactions, and not all people react the same. Rarely, even serious allergic reactions or illness can result.

The best medicine, as always, is prevention. Avoid times and places where mosquitoes and other biting bugs congregate.

Mosquitoes are most active around dawn and dusk. They love standing water in puddles and ponds. You are more likely to attract mosquitoes if you’re wearing dark clothing, including socks. They are attracted to your perspiration and sometimes to a scent to you may be wearing. Biting flies may be most common in wooded areas and around animals or garbage.

Repellents can be very helpful, especially against mosquitoes. However, you need to be cautious when choosing a repellent, especially for children. DEET is particularly effective against mosquitoes and some other bugs, but should be used with caution (see below). This is also true of permethrin, which is effective against ticks. Insect repellents should not be used at all on children younger than two months old.

There is terrific information in this article from the American Academy of Pediatrics. Here is their list of do’s and don’ts when you use insect repellents:

“Dos:

  • Read the label and follow all directions and precautions.
  • Only apply insect repellents on the outside of your child’s clothing and on exposed skin. Note: Permethrin-containing products should not be applied to skin.
  • Spray repellents in open areas to avoid breathing them in.
  • Use just enough repellent to cover your child’s clothing and exposed skin. Using more doesn’t make the repellent more effective. Avoid reapplying unless needed.
  • Help apply insect repellent on young children. Supervise older children when using these products.
  • Wash your children’s skin with soap and water to remove any repellent when they return indoors, and wash their clothing before they wear it again.

   “Dont’s:

  • Never apply insect repellent to children younger than 2 months.
  • Never spray insect repellent directly onto your child’s face. Instead, spray a little on your hands first and then rub it on your child’s face. Avoid the eyes and mouth.
  • Do not spray insect repellent on cuts, wounds, or irritated skin.
  • Do not use products that combine DEET with sunscreen. The DEET may make the sun protection factor (SPF) less effective. These products can overexpose your child to DEET because the sunscreen needs to be reapplied often.”

To treat a bug bite, you may apply ice for a few minutes every hour or two. Calamine lotion may be applied to stop the itching. Some people also find that baking soda mixed with water decreases their itching.

When should you seek medical attention for a bug bite? If anaphylaxis (a severe allergic reaction, which may include difficulty breathing – see definition from the Mayo Clinic here) occurs, get to an emergency room immediately.  Sudden hives are also a cause for concern and could be a sign of anaphylaxis. Otherwise, if the bite begins to look infected, or the reddened area around it is increasing in size larger than a quarter, keep an eye on it and check with your pediatrician’s office. You can use a Sharpie to mark the edges of the red area in order to note its progression.

Next time, more about stinging insects.

© MBS Writing Services, all rights reserved, 2015

 

Should we go gluten-free?

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“Gluten-Free” is the new catchword for “healthy diet,” or so it would seem if you read grocery store labels.  Do gluten-free foods really make your family healthier?  It’s not always a simple answer.

Just what is gluten?  It’s a protein found in wheat and some other grains.  Why do some people avoid gluten?  There are several reasons.

Less than 1% of the population cannot eat gluten because they have celiac disease.  According to the National Institutes of Health page on the subject, “celiac disease is an immune reaction to gluten, a protein found in wheat, rye, and barley.”  It can be diagnosed as early as infancy or at any later time, and you can find a list of symptoms here from the American Academy of Pediatrics.  The only way to get relief from those symptoms is to completely eliminate gluten from the diet, a task that isn’t easy because so many products contain wheat flour.

Others think that a gluten-free diet makes them feel better, though that could simply be because they are eating fewer carbohydrates and calorie-laden fast foods.

Still others believe that gluten contributes to behavioral problems or may even have a link to autism.  Those ideas remain unproven, but there is a great article here.

Gluten-free advocates often tout a huge list of health benefits that are completely without scientific basis.

Celiac disease cannot be diagnosed without specific tests.  If it’s something you suspect your child may have, talk to your pediatrician.  And if you have to put your child on a gluten-free diet, you need to speak to a dietician about what nutrients you may be missing in the process.  Don’t forget that our office has a dietician on staff for just this type of consultation.

Bottom line:  there’s nothing wrong with eating gluten-free foods, but don’t go totally gluten-free without consulting your pediatrician.

 

© 2014, MBS Writing Services, all rights reserved

Fact or fiction: a few winter health myths

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Do you remember all those things your grandmother taught you about staying healthy in the winter?  Many of them hold true (chicken soup really is good for you!), but there are some commonly held beliefs about cold weather and health that just don’t hold up to scientific scrutiny.  Here are three.

1. “Stay inside, because cold air will make you sick.”  Viruses and bacteria cause illness, not air temperature.  Chilly weather shouldn’t keep children from getting the exercise they need.  Just be sure to dress them warmly and use common sense.  Don’t forget that cold and wet together (think playing in the snow) can cause frostbite fairly quickly.

2. “Never go out without a hat—you’ll lose all your body heat through your head.”  Well, not exactly.  Yes, staying covered keeps you warm.  And yes, staying covered includes wearing a hat.  But if your child got on the bus without her hat, she’ll be okay unless it’s super cold.  You lose heat through any exposed skin, but no more through the head than through any other part of the body.  Just keep your children warmly dressed.  A hat or hood is often a good way to feel (and be) warm.

3. “Allergies go away in the winter.”  Maybe.  If your child has pollen allergies, those will likely improve.  But if he has allergies to dust mites or pet dander, those may worsen because of increased time spent indoors.  Many people with allergies have a sensitivity to live Christmas trees, not only because of the greenery, but because of outdoor allergens that cling to the needles.

Stay warm and healthy this winter!

Artwork by Damion

Artwork by Damion

 

© 2013, MBS Writing Services, all rights reserved

The truth about poison ivy

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There’s that little bumpy rash, trying to keep from scratching, pink lotions…  Just reading the description makes you start to itch.

More time out of doors in the summer leads to more exposure to lots of things, including poison ivy.  But there are lots of myths about how it’s spread and how to treat it.

True:  The rash results from exposure to a poison ivy plant.  All poison ivy is three-leaved, but it doesn’t all look the same.  Sometimes the leaves have a reddish tint; sometimes the plant is all green.  It can grow low to the ground or vining up a tree.  Leaves can be quite small or 8 to 10 inches across.  The rule often quoted is:  “Leaves of three, let it be.”  Good advice.

True:  It’s the oil of the plant that causes the rash.  So, it’s possible to get a rash even if you were wearing long pants through a poison ivy patch, by touching the clothing later.  Some people have contracted poison ivy when burning brush, as they inhaled the smoke.

False:  You can get a poison ivy rash by touching someone else’s rash, especially if it is oozing fluid.  This is only true if there is still oil from the plant remaining on the rash—an unlikely scenario.  You can, however, get the oil from the fur of a pet that has been out of doors.  And if you have the oil on your hands, any skin that you touch can develop a rash.

False:  Some people are immune to poison ivy.  While it’s true that everyone’s susceptibility level is different, exposure to enough of the plant oil can cause anyone to break out in a rash.

According to an article by the American Academy of Pediatrics (AAP), if you believe your child has been exposed to poison ivy, wash the affected area as soon as possible with soap and water for several minutes, and wash the clothing immediately.  Use calamine lotion 3 or 4 times per day to reduce itching, and/or 1% hydrocortisone cream to decrease swelling.  Call your pediatrician if the rash covers a very large area or doesn’t respond to treatments, if there’s a severe rash on the face, a fever or any other indication of infection, or a new outbreak.

The best treatment of all is to avoid contact with the plant in the first place, so teach your child what it looks like.

Shelby, age 5

Shelby, age 5

© 2013 MBS Writing Services.  All rights reserved.