Food allergies and EpiPens: The latest news and research

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Peanut and food allergies can be stressful for parents and patients. The skyrocketing EpiPen price tag has outraged parents and pediatricians, and many families may be unsure about their options. John Lee, MD, clinical director of the Food Allergy Program at Boston Children’s Hospital, shares his insights on the EpiPen price increase and and offers updates on peanut allergy research.

What you need to know about EpiPen now

  • Cost
    • EpiPen recently raised its commercial price to $600 for a standard twin pack. For families with no insurance or high-deductible plans, this can pose some serious challenges. However, the good news is there are a few strategies for lowering the cost.
      • Parents can go to Epipen.com, and download a free, reusable, discount card for up to $300 off a prescription.
      • Mylan, EpiPen’s parent company, has an EpiPen assistance program for families with incomes up to four times above the poverty line.
      • Adrenaclick is an alternatives to EpiPen. Although it has the same epinephrine doses as EpiPen, the mechanism is slightly different. Most school nurses and staff are not trained on Adrenaclick, so it is important to talk to a child’s school nurse before choosing this option.
      • EpiPen has announced it will release a generic model at half the current retail price sometime this fall.
  • New instructions
    I always remind parents to make sure there are unexpired EpiPens with their child’s name at school. Schools typically ask for two injectors that won’t expire during the school year (EpiPens last about one year).
    Parents should also review their child’s Anaphylaxis Action Plan, and be sure to understand the written plan they give to the school.
    • EpiPen recently updated its instructions, because there were numerous reports of kids suffering lacerations in their legs. It’s important for parents to note the changes.
      • Step 1: Stabilize the patient’s leg to minimize movement.
      • Step 2: Hold the EpiPen against the thigh for three seconds.
      • Step 3: Monitor for signs of infection at the injection site.

Advances in peanut allergy research

food_allergy_and_epipens_news_for_pediatriciansBoston Children’s Hospital is involved with two promising, multi-center clinical trials studying peanut allergy desensitization.

The first trial is studying the effectiveness of an epicutaneous patch. (Many families call this  “the peanut patch.”) The patch, which is manufactured by DBV Technologies, is placed on the child’s back and absorbs trace amounts of peanut through the skin. The goal is NOT for children to ultimately be able to consume peanuts as if they had no allergy; it is to prevent reactions from occurring if the child is accidentally exposed to small amounts of peanuts.

After one year of treatment in a phase-two multi-center trial, more than half the children were able to ingest a tenfold increase or up to 1,000 mg peanut protein before experiencing a reaction. After two years, 80 percent of children showed benefit from this therapy.  Phase-three trials are currently in progress.

Another clinical trial of note tests the efficacy of an oral immunotherapy produced by the company Aimmune. In this phase-two study, all patients in the treatment arm were able to tolerate up to 443 mg of peanut protein (almost two peanuts).

Now for the age-old question: When should you refer a patient to a food allergy specialist?

Any time you diagnose a child with a food allergy or have a strong suspicion one is present, you should refer him or her to a pediatric food-allergy specialist. The allergist will then determine what tests are necessary.

Broad food allergy screenings run the risk of false positives and imposing unnecessary dietary restrictions on families. If a food allergy diagnosis is confirmed, appropriate education about food allergy management can be provided to families to keep their children safe.

The Boston Children’s Hospital food allergy team is not only dedicated to providing the most advanced, comprehensive care for individual patients, but we are equally committed to the education and training of parents and family members.

john_lee_md2About the author: John Lee, MD, is the clinical director of the Boston Children’s Food Allergy Program, co-director of the Eosinophilic Gastrointestinal Disease (EGID) Program and Instructor in Pediatrics at Harvard Medical School.

 

 

Learn more about the Food Allergy Program.