treating peanut allergy

How to Determine If You Have an Allergy

It is important to see a doctor who specializes in food allergies to determine your individual risks. To make sure you are diagnosed properly, you may have to undergo a series of questions, blood tests, and a skin-prick test.

Exposure to even small amounts of peanuts may cause anaphylaxis (an-uh-fuh-lak-sis), or a severe allergic reaction. Symptoms such as itching, redness, swelling, shortness of breath, wheezing, nausea, abdominal pain, lightheadedness, or loss of consciousness may occur and usually begins within minutes after exposure to a peanut or peanut-containing product.

It is possible, however, to experience a delayed reaction, if symptoms do not appear immediately. Touching peanuts may result in hives, or areas of itchy and red skin, which may spread across your body. An allergic reaction also can occur if you inhale dust from peanut flour or mist from peanut oil cooking spray. Examples of peanut-containing products are listed in the Table.

Avoiding an Allergic Reaction

Avoidance is the best way to reduce your chances of experiencing a severe allergic reaction. It is important to read all food labels to look for peanut-containing products. Also, when dining out, ask the server about the types of oils in which the entrees are cooked. If your child has a peanut allergy, you should inform and educate school personnel, parents of your child’s friends, and other caregivers about foods the child needs to avoid.

Both children and adults are advised to wear a medical alert bracelet or necklace. This alert should list the specific allergy and possible reaction symptoms, and provide first aid instructions for others during an emergency.

Treating a Serious Allergic Reaction

Table

Peanut-containing Food Products

Peanut butter Peanut flour Ground or mixed nuts Baked goods, such as cookies and pastries Ice cream and frozen desserts Energy bars Salad dressing Cereals and granola Grain breads Peanut oil Marzipan

The emergency treatment during a severe allergic reaction involves several steps. First, an injection of epinephrine (EpiPen or EpiPen Jr) should be given to reduce the severity of the reaction. Second, taking liquid diphenhydramine (Benadryl) at a dose of 5 mg for every 10 lb of body weight, up to a maximum dose of 75 mg, also is recommended. Third, if not already done, emergency services should be contacted.

A visit to the emergency room is necessary because additional treatment may be needed. While at the hospital, the patient may be given medication such as albuterol in the form of a nebulizer, or special breathing machine, to open up your airways, as well as additional epinephrine injections and intravenous fluids.

After a severe reaction, you should be observed by medical personnel for at least 4 hours, as some patients may have another reaction that can be delayed for several hours. These secondary reactions are very dangerous and require immediate treatment. Upon leaving the emergency room, you may be given prescriptions for antihistamines (eg, diphenhydramine) and corticosteroids (eg, prednisone), which should be taken as the doctor prescribes. It is important to follow up with your primary care physician within 3 days.

EpiPen and EpiPen Jr

These injections, also known as auto-injectors, are designed to provide a quick dose of epinephrine for patients during severe allergic reactions. The EpiPen 0.3 mg is for patients weighing 66 lb or more. The EpiPen Jr 0.15 mg is for patients between 33 and 66 lb. The injection should begin to work quickly after it has been given. Some patients may feel a rapid heartbeat, slight nervousness, sweating, dizziness, and headache from the injection.

The EpiPen or EpiPen Jr should be kept nearby and ready for use at all times. The manufacturer recommends that you store these injections at room temperature, and they should never be exposed to extreme temperatures, such as in your vehicle’s glove compartment. The injection should be stored in the container provided to protect the medication from light. An expiration date will be printed on each product (eg, “DEC 08” = December 31, 2008). The EpiPen should be replaced before the expiration date, even if you did not use it. A window on the outside of the pen allows you to see the solution on the inside. If the solution is discolored or contains solid particles, you should replace the injection.

Make an Action Plan

Make sure your child knows what symptoms to look for and how to ask for help if he or she has an allergic reaction. All individuals with peanut allergies should develop an action plan with their medical provider detailing what should occur once they have been exposed to any peanut-containing product. Once the action plan is complete, copies should be made available for easy access.

How to Use the EpiPen

A short film on how to use the EpiPen is available at www.epipen.com/howtouse.aspx. Unscrew the yellow or green cap from the carrying case, and remove the auto-injector from its storage tube. Grasp the unit with the black tip pointing downward. Form a fist around the unit with the black tip pointing downward. With your other hand, pull off the gray safety release. Hold the black tip near the outer thigh. Swing and jab firmly into the outer thigh until it clicks so that the unit is making a 90° angle to the thigh. (The auto-injector is designed to work through clothing.) Hold firmly against the thigh for approximately 10 seconds. (The injection is now complete, and the window on the auto-injector will show red.) Remove the unit from the thigh, and massage the injection area for 10 seconds. If you have not already done so, call 911, and seek immediate medical attention. Place the used injector, needle-end first, into the storage tube, and screw the cap of the storage tube back on completely, and take it with you to the hospital emergency room.

How to Treat Common Skin Infections

Elaine Wong, PharmD, and Lana Borno, PharmD

Helpful advice for your patients on treating bacterial skin infections.

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Drs. Wong and Borno are assistant professors of pharmacy practice at Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York.

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Bacteria can cause different types of skin infections. Three common skin infections that you and your doctor may encounter are: (1) cellulitis, (2) folliculitis, and (3) impetigo. Keep in mind that skin infections vary in presentation and treatment. Therefore, it is important to talk to your doctor to obtain an appropriate diagnosis and treatment plan.

Cellulitis

Cellulitis is an infection that involves the outer layers of the skin. It is commonly caused by bacteria known as beta-hemolytic streptococcus or Staphylococcus aureus. You may experience pain, swelling, tenderness, warmth, and redness in the infected area. If you have a severe case of cellulitis, you may experience fever, tiredness, and a lowering of blood pressure. If left untreated, pus may form and cells may die in the infected skin area. Cellulitis can involve any part of the body but most often affects the leg. It typically results from an injury to the skin, such as scratches or animal bites—these allow bacteria to enter the body and cause an infection. An additional cause of cellulitis is skin breakdown around the anal area, typically seen in children. This can lead to redness, swelling, and painful bowel movements.

Oral antibiotics are used to treat mild cellulitis; more severe cases must be treated with intravenous antibiotics in a hospital. Antibiotics that may be used include cephalosporins, dicloxacillin, clindamycin, or vancomycin. Swelling can be lessened by elevating the affected area, such as the legs or arms. To stop cellulitis from occurring again, it is important to keep applying lotion to the skin and to maintain good skin cleanliness.

Folliculitis

Folliculitis is a general term used to describe an infection of the hair follicles commonly caused by Staphylococcus aureus, resulting in red pimples. You may experience redness, tenderness, or swelling of the affected area. It also can spread to the deeper parts of the hair follicles and pus can form, also known as furuncles or boils. Carbuncles is a term used to describe a group of infected hair follicles. Folliculitis, furuncles, and carbuncles can be seen on any part of the body with hair, such as the face, scalp, thighs, underarms, and groin area. This includes areas that are bearded or shaved.

Mild folliculitis can be treated with topical antibiotics, such as erythromycin, clindamycin, or mupirocin. More severe infections, such as carbuncles and larger furuncles, may require a surgical cut and drainage of the affected area. After drainage, it is important to clean the area with antibacterial soap; then you should apply the antibiotic ointment to the affected area of the skin. If needed, your doctor may prescribe oral antibiotics such as cephalosporins or dicloxacillin. Keep in mind that your doctor may recommend monthly treatments with mupirocin ointment if you have folliculitis that occurs repeatedly.

Impetigo

Impetigo is a contagious skin infection commonly caused by Staphylococcus aureus. Although this infection may occur in adults, it is most often seen in children aged 2 to 5 years and is usually spread through direct contact with another person who has the infection. You may experience tenderness, itching, sores, or blisters that can rupture and form honey-colored crusts. It can affect different parts of the body such as the face, arms, or legs. It also can affect moist parts of the body, such as the armpits, neck folds, and diaper areas.

Impetigo can be treated with a topical ointment or oral antibiotic. Mupirocin is a typical ointment that may be prescribed by your doctor. Oral antibiotics such as penicillins or cephalosporins are used for more severe infections. To prevent the spread of the infection to other parts of the body, avoid scratching the blisters or sores. Because impetigo is commonly seen in children, it may be helpful to cut the fingernails and cover the affected areas of the body with bandages or gauze. It also is important to prevent the spread of infection to other individuals in close contact by not sharing things such as blankets, linens, toys, or clothing.

What about MRSA Infections?

MRSA stands for methicillin-resistant Staphylococcus aureus. It is a form of Staphylococcus aureus or "staph" bacteria that is resistant to certain antibiotics. It is transmitted by directly contacting an infected person, touching contaminated surfaces, or sharing personal items that have been in contact with infected skin. MRSA is a large problem in hospitals or health care facilities (like dialysis centers and nursing homes). MRSA also can infect people in the community, however, such as children at day care centers and children who are involved in sports that involve close contact. This is known as community-associated MRSA or CA-MRSA.

MRSA infections can appear like a pimple or boil, with redness, swelling, pain, or pus. Serious infections may spread into the blood and cause blood infections. If you experience a MRSA infection, your doctor may drain the infected area and prescribe antibiotics such as linezolid, clindamycin, or doxycycline. Do not try to drain the wound yourself! This can worsen the infection or spread it to others.

To prevent the spread of MRSA, here are some helpful tips:

1. Cover your wound with clean, dry bandages until the affected area is completely healed.
2. Maintain good hand hygiene—you and those in close contact with you should wash hands frequently with soap and water.
3. Do not share personal items, such as linens and clothing, with others.

General Management of Skin Infections

With antibiotic treatment, signs and symptoms of skin infections begin to improve after approximately 2 to 3 days. If your skin infection does not improve or gets worse (especially if you develop a fever or the infection spreads), notify your doctor right away. If you are prescribed topical or oral antibiotics, be sure to finish the full course of antibiotics unless otherwise directed. Keep in mind that the length of treatment will differ depending on the type and severity of the infection. Lastly, as is true among all skin infections, you should keep the affected area or wound clean with good skin hygiene.

Depression

Joseph P. Vande Griend, PharmD, BCPS

This article will help patients with depression to understand their treatment options and know what to expect from their medications.

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Dr. Vande Griend is an assistant professor at the University of Colorado Denver School of Pharmacy, Aurora, Colorado.

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Everyone has felt down in the dumps at some point in life. For patients with depression, being sad or depressed does not go away quickly. It can last for a few weeks or longer. Patients with depression also can lose interest in areas of life they used to enjoy. They may have gained weight or lost weight. Other symptoms include trouble sleeping, being tired a lot, feeling guilty or worthless, and difficulty with focus. At worst, patients with depression may want to end their lives.

People with depression can have a poor quality of life. They may no longer be interested in their family, their job, or hobbies they used to enjoy. Depression also can affect a patient's overall health. A patient with depression and heart disease is likely to have more problems with their heart.

Depression affects both men and women. Women are almost twice as likely to be depressed. It can also affect children. It is most common, however, in patients 25 to 50 years old. Depression also can run in families. It is more common in patients living in a nursing home, hospitalized patients, and patients with many health problems.

What You Can Do if You Feel Depressed

If you have symptoms related to depression, talk to someone. Talk to your pharmacist, your regular doctor, or a family member or good friend. If you are depressed, visit your doctor. Feelings of depression that do not go away are not normal. Depression also is not a normal part of getting older. People who are depressed are not alone. In fact, nearly 1 of 10 people in the United States will become depressed at some point in their lives.

Table

Treating Depression

Depression is most often treated with medication. Talking to a therapist can also be useful. Taking a medication and talking to a therapist will provide the most benefit. Many different medications are used to treat depression. Medications used today for depression are effective. They have few side effects or drug interactions.

Old medications for depression had many drug interactions and side effects. One old class of depression medication was not very safe. Patients taking this drug could not eat aged cheeses, sauerkraut, or cured meat, and could not drink draft beer. Another older class of medication for depression has many side effects. These drugs cause constipation, drowsiness, dry eyes, and weight gain. These drugs also are not safe with certain heart conditions.

New depression medications have fewer side effects. They also can be taken safely with many other drugs. They treat depression as effectively as the old drugs. The new drugs are used first, instead of the old drugs for depression. The most common new medications are listed in the Table. Several are available in generic form at a lower cost.

Depression can affect a person's quality of life. It can make you sad, and make you lose interest in things you enjoy. Treatment for depression is available. Medication is most commonly used. It is most effective at treating depression when a patient understands the therapy and uses it correctly. When treated with medication for depression, be patient. Take your medication as your doctor tells you, and visit your doctor and pharmacist often. Be prepared for changes in your medication and lifelong treatment. Following this advice can help you beat the blues.

4 Tips for treating depression with medication

Medication for the treatment of depression can make the condition go away. Depression is most commonly treated with medication. Patients must understand their medication and how to use it correctly. This will help them feel better faster. The following information can help patients get the most from their medication:

1. It takes time for depression medication to work.
Depression medication takes at least 4 weeks to work. Many patients often stop the medication because they think it is not working, but they have not yet given it a chance to work. If you think the drug is not working, do not stop it. Continue taking the medication the way your doctor has instructed. If you feel worse with the medication, call your doctor. It can take up to 4 months for a depression medication to work best. Give the medication time to work. It can make you feel better over time.

2. See your doctor or pharmacist regularly.
Patients with depression are often jittery, anxious, or uneasy. Taking a medication to treat depression can make this worse at first. This will go away. If you feel really bad taking the medication, call your doctor. You can also talk with your pharmacist. Talk to your doctor or pharmacist before stopping a medication. They may give you a lower dose or try a different medication. They will make sure you have a good treatment for your depression. Your doctor and pharmacist also understand depression. Talking to them about your depression can make you feel better. They will help you get the most from any treatment.

3. Different medications may be needed to treat your depression.
Investigators did a large study on medication for the treatment of depression. In the study, every patient started on citalopram (see Table above). This medication is commonly used. It has few side effects and is easy to tolerate.

Patients in the study took this drug for 3 months. One of 3 patients no longer had depression after 3 months. Two thirds of patients required a change in medication. For some, the depression medication was switched. For others, another depression medication was added to citalopram.

This study showed that depression is not an easy fix. Very few people will no longer have depression after one medication. Your doctor will often need to change your medication. Finding the right medication for you may take time. Do not get frustrated, but continue to see your doctor or pharmacist. They can help find the medication that is best for you.

4. Depression may be a lifelong disease.
Depression often goes away but then comes back again. This is common. If depression is treated well the first time, it is less likely to come back. To prevent future depression, it is important to take your medication for as long as your doctor tells you. Even if you feel better, continue your medication until you are told to stop. You may need to take your depression medication for 2 to 3 years after you feel better. Some people will need to take depression medication for the rest of their lives. If you think you should stop, talk to your doctor or pharmacist. They will be able to explain to you how long you need the treatment.