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 After a two-year test of an epinephrine autoinjector stocking
program in Hamilton, Ontario, diners with allergies as well as
restaurant owners and staff said that having the devices onsite made
them feel better about possible emergencies, researchers report in
The Journal of Allergy and Clinical Immunology: In Practice.
The costs varied by how many staff needed to be trained to use the
devices, but the expense was low compared with that of automated
external defibrillator (AED) devices, the study authors note.
"Self-management of food allergy and anaphylaxis is sub-optimal,
particularly among adolescents and young adults who most often
engage in risk-taking behaviors such as neglecting to carry
epinephrine autoinjectors or delaying its timely administration to
treat reactions," said lead author Dr. Susan Waserman, a professor
of medicine at McMaster University in Hamilton and director of the
Adverse Reactions Clinic at the Firestone Institute of Respiratory
Health.
Between 1986 and 2011, about half of anaphylaxis deaths in Ontario
were due to food allergies, and 14 percent occurred after eating at
restaurants, fast food chains or shopping mall food courts.
In the U.S., more than half of anaphylaxis deaths occur at
restaurants or other food establishments such as ice cream shops and
food courts, the study team writes.
"Challenges also exist in food establishments, including the lack of
knowledge and training of food service personnel about food
allergies and the reluctance of food-allergic individuals to
disclose their allergies to restaurant staff due to embarrassment,"
Waserman told Reuters Health by email.
To test the feasibility of stocking epinephrine injectors in places
where severe allergic reactions to food might occur, the researchers
implemented a program at a Hamilton shopping mall between 2014 and
2016. Security guards had access to autoinjectors in first aid kits
in the mall's central administration office and received training on
recognizing allergic reactions and how to use the injectors.
In two mall restaurants, staff were also given the three-hour
training session and had access to injectors kept in a central area,
such as behind the counter, as well as back-up doses kept in an
office area. Each location also had a site leader and an anaphylaxis
emergency response plan.
Only one critical incident occurred during the study period, so it
is difficult to show the full benefits of the program, the study
team writes.
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However, since the pilot program, government-owned properties in
Hamilton such as recreation centers, arenas, senior centers and
community halls have installed autoinjectors. After finding that
firefighters often arrive on the scene for anaphylaxis emergencies
before ambulances, the Hamilton Fire Department also stocked its
fire trucks with autoinjectors. The program is now in 50 restaurants
across the city, with the goal of reaching all 2,000 restaurants in
Hamilton.
The success of the epinephrine autoinjector stocking program depends
on several factors, including local government support, effective
staff training, low resource requirements and embedding the program
into existing policies and procedures, Waserman's team writes.
Costs in the pilot program ranged from C$715 ($543.93) for the
sit-down restaurants to C$2,155 ($1,639.41) for the mall-wide
program, they note.
"Whether you're diagnosed with an allergen already or have your
first allergic reaction at a restaurant, this could stop a
potentially life-threatening moment," said Dr. Scott Sicherer of the
Icahn School of Medicine at Mount Sinai in New York City, who was
not involved in the study.
"When you eat outside of your home, you depend on other people to
make food for you," he said in a phone interview. "This program is a
good model that makes sense."
Legislation and liability issues may pose more of a problem in the
U.S., he added, since epinephrine autoinjectors are typically only
available by prescription. Now that some schools are beginning to
carry them, however, that could open the door for other public
places.
"At a restaurant, you can say you have an allergy and you can carry
a card with instructions," Sicherer said. "A chef or server may
guarantee they can provide a safe meal, but when that means just
scraping nuts off the top of a salad, that doesn't work, and you may
not realize."
SOURCE: https://bit.ly/2nEwQIW The Journal of Allergy and Clinical
Immunology: In Practice, online August 2, 2018
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