Health Scan: Take the Epi-Pen along

Children and young people with serious and even life-threatening allergies are often not properly trained in the use of self-administered epinephrine injections in cases of emergency, according to allergy specialists at Schneider Children’s Medical Center in Petah Tikva. Such people could quickly go into anaphylactic shock from unwittingly eating something to which they are allergic, unless they react to the initial symptoms by injecting epinephrine with an EpiPen.

The latest tragic case that comes to mind was that of a woman in her early 20s with a severe nut allergy who ordered pancakes with chocolate spread after the waitress in the cafe assured her more than once that there were no nuts in them. The waitress was unaware that there were nuts, and failed to check it out. The woman died of anaphylactic shock and reportedly did not have an EpiPen with her.

Between 2006 and 2009, Dr. Nirit Segal, Dr. Ben-Zion Garty, Dr. Vered Hoffer and Dr. Yael Levy evaluated 141 patients with allergies, aged around two to 23, who had been taught to use the EpiPen in their first diagnostic visit to the clinic. At their next follow-up visit, the patients or their parents were asked to list the indications for epinephrine shots and to show the five steps involved in using the injection pen. The researchers published their findings in a recent issue of the English-language IMAJ (Israel Medical Association) journal.

According to the findings, 14 of the participants (almost 10 percent) had used the pen before for self-injection. Just 65 (46%) brought the device with them to the follow-up visit. Fifty-three didn’t remove the plastic cap of the device before trying to use it. Only eight (less than 6%) had a perfect score.

The Schneider team gave them more lessons in using the device, and that improved their scores.

The team concluded that patients with severe allergic reactions, usually to food, are not sufficiently skilled in the use of the EpiPen after only one instruction session with a specialist. “Repeated instruction may improve the results, and we therefore recommend that the instructions be repeated at every followup visit,” they concluded.

Such instruction is also likely to get the message across to relevant patients that they shouldn’t go anywhere without the pen.

TOWARD NERVE REPAIR

Several years ago, Prof. Michael Fainzilber and his group in the Weizmann Institute of Science’s biological chemistry department made a surprising discovery: Proteins thought to exist only near the cell nucleus could also be found in the far-off regions of the body’s longest cells – peripheral nerve cells called axons, which extend processes and can reach up to a meter long in adult humans.

These proteins, known as importins, have a well-studied role in the vicinity of the nucleus: They shuttle various molecules through the protective nuclear membrane. Fainzilber and his group showed that when a nerve cell is injured somewhere along its length, importins in the long axons hook into a sort of “railcar” mechanism, which then transports the “Help!” message from the injury site all the way to the nucleus.

These findings raised an intriguing question: How did importins get to the axons in the first place? Initial evidence suggested that one critical importin named importin beta1 was produced locally upon injury near the site where it was needed. The problem was that years of scientific thinking on the subject indicated that proteins did not get manufactured in the axons, as investigations had turned up few of the cellular protein factories known as ribosomes there.

Settling the issue was far from simple. Importins are so crucial that even the smallest embryo could not survive without them. But Rotem Ben-Tov Perry, a joint research student in Fainzilber’s group and department colleague Dr.

Avraham Yaron’s, found a way to distinguish the importin beta1 in the cell body from that in the axon. The axonal protein was apparently made from a longer messenger RNA. To see if they could selectively affect just the axonal version of the protein, the groups, together with Prof. Jeff Twiss of Drexel University in Philadelphia, took advantage of high precision knock-out technology. Rather than knocking a whole gene out of the system, they managed to remove one little piece of the messenger RNA that carries the encoded instructions for manufacturing importins: just the longer bit that sends the RNA to the axon.

Now they observed plenty of importin beta1 in the cell body, but none in the axons. Mice with the knocked-out segment of RNA took much longer to recover from peripheral nerve injury, and the genes that are normally active in response to nerve damage were activated to a lesser degree. All of this suggests that the importin beta1 that normally helps inform the extended nerve cell about injury is, indeed, produced locally in the axon.

Fainzilber concluded that “the data shows conclusively that importin beta1 protein is produced in axons, and Rotem’s work has validated the importins’ crucial role in nerve repair.” The findings, which appeared recently in Neuron, could help point the way toward better treatments for nerve damage and aid in finding ways to speed up the repair, he said.

PARAMEDICAL WORKER DEADLINE DELAY

A bill that the Knesset is expected to approve on its second and third readings will extend the deadline for arranging for Health Ministry authorization to continue working in a paramedical profession, to April 2013. The Knesset Labor, Social Welfare and Health Committee approved the bill last week.

The change aims to help physiotherapists, occupational therapists, communications specialists and clinical dietitians who did not know about the need to get the certificate and would lose their right to work without it. Some paramedical workers have already received dismissal notices, which will be canceled under the new legislation.

REDUCING STRESS FOR MS

A new study shows that taking part in a stress management program may help people with multiple sclerosis prevent an attack on their nervous system.

The study, published recently in the journal Neurology, involved 121 people with MS. Half participated in the stress management program, meeting with a therapist for 16 individual 50-minute sessions over five to six months. They learned about problem-solving skills, relaxation, increasing positive activities and enhancing their social support. They could also choose optional sessions on topics such as fatigue management, anxiety reduction, pain management and insomnia treatment.

After the treatment ended, researchers followed the participants for another five to six months. The remaining participants were put on a waiting list as a control group.

During the treatment period, a total of 77 percent of those receiving the stress management training were free of new lesions, or brain damage that indicates disease activity, compared to 55% of those in the control group.

“The size of the effect is similar to other recent phase II trials of new drug therapies for MS,” said study author Dr.

David Mohr of Northwestern University Feinberg School of Medicine in Chicago. “While it’s premature to make any specific recommendations about using this type of stress management training to manage MS disease activity, it will be important to conduct more research to identify specifically how this treatment is benefiting people with MS.”

Questionnaires showed that those receiving the training had greater reductions in their stress levels than the control group. But the positive effects of the training did not continue after the treatment period.

“This was unexpected,” Mohr said. “It’s possible that people were not able to sustain their new coping skills once the support ended or that some aspect of the treatment other than stress management skills, such as the social support, was the most beneficial part of the treatment.”