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
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.
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,”
Such instruction is also likely to get the message across
to relevant patients that they shouldn’t go anywhere without the
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.
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.
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.
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.
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.
treatment ended, researchers followed the participants for another five to six
months. The remaining participants were put on a waiting list as a control
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
“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
“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.”