Dr Andrew Baker MBChB FRACP Auckland Immunologist Allergist (Allergy Specialist Doctor). At our clinic in Takapuna, North Shore, Auckland we provide desensitisation treatment for dust mite allergy, grass allergy, tree pollen allergy, cat and dog allergy and plantain (a weed). These are the most common hay fever rhinitis and asthma allergies in Auckland. Desensitisation is an excellent treatment for allergic rhinitis or rhinoconjunctivitis (hay fever), and asthma. Dust mite desensitisation treatment has benefit for some selected patients with eczema as well. Desensitisation is a common treatment in hospitals and private medical clinics in Europe and the United States. It is funded by the public health system in many parts of Europe. Desensitisation involves giving you an increasing amount of a substance you are allergic too. Done in specific ways/doses, this makes the immune system become tolerant to it, so that you become more tolerant / less reactive. Skin testing and an accurate review of your symptoms is essential first to definitively diagnose the allergen. We prescribe both sublingual desensitisation (tablets/sprays under the tongue) and allergoid subcutaneous desensitisation (small injections under the skin). Our subcutaneous allergoid version is an injection once monthly for three years. Recent advances in the treatment mean the injections are monthly from the start, so do not require the initial weekly injections that previous protocols needed. Our sublingual versions are Actair, Oralair and Oraltek, and involve sprays or tablets under the tongue, daily for three years, and these courses are taken at home, except for an initial supervised first dose at our clinic. The benefit of desensitisation treatment for hay fever rhinitis and asthma allergies is that the improvements when the course finishes are often long term. It is the only treatment that offers the possibility of long term remission of your symptoms. Simone Stephens, our specialist nurse, is involved with setting national standards on desensitisation and her extensive experience is an invaluable asset. For long term treatment of significant allergy, desensitisation is the treatment of choice. A 2013 analysis by the US Department of Health examined all the evidence for desensitisation to dust mite, grass, cat and dog hair, for asthma and hay fever (rhinitis). The conclusion was there is very clear scientific evidence from multiple studies that desensitisation gives significant benefit in improving asthma, hay fever, allergic rhinitis and allergic conjunctivitis as well as quality of life. Click here to find out more about the scientific evidence for desensitisation in asthma and hayfever. Desensitisation has costs for the product and for any appointments needed. Some aspects can be covered by health insurance, but often the products themselves you would need to pay for. For more information about desensitisation, (costs and other practical aspects) you can email me on: andrew.baker@waitemataallergy.co.nz For bee and wasp desensitisation, we are now diagnosing the allergy with testing, providing you with an emergency management action plan, but for desensitisation we will refer to ADHB Immunology at Auckland City Hospital. We provide you management plans for large local reactions as well. Click here for more information about our north shore auckland hay fever and asthma densensitisation clinic.

Rhinoconjunctivitis is the inflammation of the lining of the nose and eyes due to allergy. It causes a blocked, runny and itchy nose, sneezing and itchy running eyes. Hay fever is allergic rhinitis due to grass allergy and is mostly during spring/summer. Allergic rhinitis due to dust mite lasts year round and can be worse overnight, in the mornings or around vacuuming or dusty environments. Certain houses or a dusty old bach might set you off. Cat/dog allergy can also cause year round symptoms. For some people bad rhinitis can be associated with asthma so it is hard to breathe at the time. In the case of allergic rhinitis, the specific allergen (the thing that you are allergic to) may be identified by skin prick tests. This involves placing a drop of the allergen on your skin and then scratching your skin through the drop. If you are allergic, your skin will become red and swollen at the site. Skin tests are only of value if interpreted with respect to a careful history of a patient's clinical symptoms. They are not a diagnosis by themselves. When the correct allergy is identified, desensitisation can be a very effective long term treatment for allergic rhinoconjunctivitis. Before an appointment with us, it is good to avoid all antihistamines for 4 days prior, so we can do this testing if needed. We can work to improve your symptoms by: - identification and minimisation of the allergen - best medical therapy options - desensitisation - a treatment that makes you less allergic and has sublingual and subcutaneous forms

Urticaria (hives) is an itchy rash which comes and goes. It can cause small bumps or large patches over 15 cm. Causes of urticaria hives include not only allergy but also non-allergic causes. Causes of Hives Urticaria Carefully listening to a patient's symptoms and history is the key to distinguishing what causes hives, and is essential for proper management. Stress, low mood, illness, fever, exercise, temperature change and anti-inflammatories (NSAIDs) are a few of the non-allergic causes, and testing for allergy is necessary in some cases but not others. Hives can be associated with dermatographism (also known as skin writing) in which a raised red itchy line appears on scratching the skin. Hives is actually quite common with one in four people getting hives in their lifetime. Sometimes hives is associated with angioedema (swelling of the lips, tongue and eyes). Treatment of Hives Urticaria Treatment of urticaria involves addressing the underlying cause and this is different in each case. Antihistamines are often necessary, as well as minimising precipitants

This is episodic swelling of the lips, tongue or around the eyes that is usually painless. For some it can cause shortness of breath, voice change, or a sensation of tightness around the neck. Angioedema can be due to allergy or have other causes. Again, carefully listening to a patient's symptoms can help distinguish the causes. Sometimes further tests are needed. Anti-inflammatories (NSAIDs) are a commonly missed cause, as are ACE inhibitors (a blood pressure medication). Angioedema can also occur in association with non-allergic causes such as infection or chronic, non-allergic urticaria. If breathing or voice change, or large tongue swelling has occurred an adrenaline autoinjector such as Anapen and Epipen should be considered, and an action plan must be provided. If you think you may get angioedema it is useful to take a photo of any tongue swelling, eye swelling, lip or hand/feet swelling, as well as a photo of any rashes, and bring these photos to clinic.

For those with bee or wasp allergy, reactions can range from mild, through to life threatening. Bee or wasp allergy can cause anaphylaxis. There is a fatality approximately once every 2 - 3 years in New Zealand from bee or wasp anaphylaxis. For those who have had anaphylaxis, the chance of a severe reaction with each bee sting in future is about 75%. For bee or wasp allergy, we can assess, test and diagnose the allergy. I can provide an emergency management action plan for you and educate on Epipen use. I can identify if you have had anaphylaxis, or are at risk of anaphylaxis and what to do about that. If you have had a large localised reaction (spreading to the tissues from the sting site) I can provide a management plan for future stings. Desensitisation is very beneficial if you have had anaphylaxis to a bee or wasp sting and is an option to consider. The treatment has several different protocols, with frequent injections in the initial days/weeks but then monthly injections for 5 years after that. The risk of an allergic reaction after doing desensitisation is <5%. I can discuss if desensitisation is right for you, and if it is I will refer you to Immunology at Auckland City Hospital to be considered for the desensitisation program there. It would be their decision though whether they felt it was needed or not.

Samters triad - Aspirin Exacerbated Respiratory Disease (AERD) Some people develop a running, blocked nose in early adult life that may progress to asthma and sinusitis. Some of these people turn out to have nasal polyps. This is known as Samter's triad. The complete combination is: rhinitis (constant or frequent running nose) asthma nasal polyps (and sinusitis) aspirin or anti-inflammatory (NSAID) sensitivity. Click here for an article on Samters triad that I have written for Allergy New Zealand. Treatment of Samters triad can be started with nasal sprays, sinus rinses however many people require surgery such as polypectomy. Furthermore, some people with these symptoms can have adverse reactions when they take aspirin or anti-inflammatories. Aspirin desensitisation is an important treatment in this scenario. Aspirin desensitisation has the following benefits: improved asthma symptoms fewer episodes of sinusitis slower polyp regrowth (from average 3 years to 10 years) less steroid medication required. fewer hospitalisations. Click here for more information on our Asthma Allergy Rhinitis North Shore Auckland Clinic. Samters Triad.pdf (PDF, 179 KB)

Patients who are sensitive to aspirin may need aspirin desensitisation. There are two main groups of patients who need this: Those who have had reactions to aspirin but need to take it as a regular medication (e.g. for their heart) Patients with asthma/sinusitis/polyps/aspirin sensitivity (also known as Samter's Triad). Aspirin desensitisation is an effective treatment for the right patient group. We are happy to review these issues and see if it is right for you.

Dr Andrew Baker Auckland Allergy Specialist Immunologist Testing for food allergy The diagnosis of food allergy has also become much more common in the last 20 years. Food allergy is much more common, and the reasons for this are still undergoing investigation. Not everyone who has been labelled as allergic to a food, actually is, or perhaps the allergy may have gone away. It is really helpful to get accurately tested, to then know what precautions you do have to take, and what precautions are no longer necessary. Diagnosing food allergy - symptoms of food allergy, skin tests, and blood tests Investigating food allergy requires careful discussion of a patient's symptoms. Simply ordering skin tests or blood tests alone is not sufficient. These are useful diagnostic tests, but only when analysed together with a patient's symptoms because they are probability markers, so interpretation depends on the type of test, the level of positive result and the pre-test probability (as judged by your symptoms). There is an extensive scientific literature to help guide the interpretation of these tests. Typical symptoms for food allergy should occur within about 90 minutes of eating, and include: hives urticaria after eating sudden itch of body or mouth with eating swelling lips tongue or eyes angioedema after eating lightheadedness with eating or collapse wheezing, coughing or difficulty breathing with eating sudden marked nausea, vomiting or diarrhoea after eating (usually with some of the above symptoms also) If any of these symptoms occur within about 90 minutes of eating a specific food, a food allergy is possible. For people who do not have symptoms of food allergy, then large panels of allergy testing with skin tests or allergy blood tests can be unreliable, and give incorrect diagnoses. For this reason, accurate assessment by a doctor with good experience in allergy diagnosis is critical. We can help look at all the possibilities for food related symptoms. The gold standard for food allergy testing is a food challenge, which we also do at our clinic (but at a later date, not on your initial appointment). There is no good quality scientific evidence to support "hair testing" for allergies, and numerous websites can be found on the internet offering non-evidence based IgG blood tests for allergy and large panels of unguided IgE testing which can also be unhelpful and misleading, so beware of that. If you can't see an immunologist/allergist, then see your GP if you want to consider allergy testing. Common food allergies Some food allergens that can be an issue: Milk allergy Egg allergy Peanut allergy Treenut allergy (Cashew, Pistachio, Almond, Walnut, Hazelnut, Brazil Nut, Pecan) Soy and other legume allergy Wheat allergy Fish allergy Shellfish allergy. Sesame/tahini Wheat and exercise/co-factor allergy Alpha-gal allergy (delayed allergy to mammalian meat Buckwheat allergy Goats cheese Which food allergies affect children? All of these allergies can occur in children. Milk and egg allergies in infants often resolve (but not always). Which food allergies affect adults? New onset allergies in adults are most often shellfish, fish, peanut, or treenuts. Also we see, buckwheat, wheat and exercise, alpha-gal, goats cheese, candlenut It is rare to have new onset cows milk or egg allergy as an adult. Sometimes wheat can be associated with exercise induced urticaria hives or anaphylaxis in adults and this can occur at rest too. Some rarer and occasionally missed allergies (can be adult onset) Wheat and exercise induced allergy Buckwheat Goats cheese / milk Alpha-gal (delayed allergy several hours after eating to red meat or offal) Candlenut Treatment for food allergy The first step is accurate diagnosis. Next, information must be provided about which foods need to be avoided. Click this link for information on peanut, treenut and seed allergy An action plan for allergy should be provided with a supply of antihistamines. A discussion with your doctor should involve whether an adrenalin auto-injector such as an Epipen or Anapen is necessary. Do I need an Epipen® or Anapen®? For those with food allergy, an Epipen® or Anapen® is necessary if: there has been anaphylaxis (a severe allergic reaction which compromises breathing or blood pressure causing lightheadedness, weakness or fainting) there is asthma as well (this increases the chance of severe reaction). Click this link for more information on Epipen® and Anapen® (Adrenalin Auto-injectors) Will I die from food allergy like peanut allergy? Dying from food allergy is very rare. If you have a peanut allergy, one study estimated the yearly risk of dying from peanut allergy as one in 50000. Alternatively, US statistics say the lifetime risk of dying in a car is one in 80, (more than ten times higher). Therefore if you have a peanut allergy, you should be more afraid of a car ride than the chance of unknown peanuts in a meal. This does not mean we should be complacent about taking appropriate precautions, but it is reassuring to know for those with peanut allergy who sometimes can be constantly fearful for their lives.

Anaphylaxis is often due to allergy (but not always). Patients experience a severe reaction which can involve skin rash, shortness of breath, dizziness or even loss of consciousness. Some patients can feel nauseated or get abdominal upset, vomiting and/or diarrhoea. Treatment involves identifying the cause and avoiding it. Causes include foods, insect stings and medications. A commonly missed cause is anaphylaxis due to NSAIDs (non-steroidal anti-inflammatories) such as Nurofen, Voltaren, Brufen etc. Anaphylaxis can also be due to non-allergic causes as well such as exercise, cold temperatures or sudden water immersion, or be exacerbated by infective illness and alcohol. Causes and co-factors must be identified. An accurate history of a patient's symptoms is the most important part of this, rather than large screens of tests which can be unreliable. This is why we have a 60 minute first appointment with all patients. An action plan and supply of antihistamines will be provided and we will show you how to use an adrenalin autoinjector such as Epipen or Anapen, and where best to obtain them.

Skin prick tests involve placing on your skin drops of extracts from things you may be allergic to. We then scratch the skin through the drop. If you are allergic, a small red lump will form on your skin after a few minutes. Don't worry - it goes away a few minutes later. Skin tests are only of value if interpreted with respect to a careful history of a patient's clinical symptoms. They are not a diagnosis by themselves, and should only be used after carefully listening to a patient's symptoms. A negative skin test does not completely rule out allergy, but does make it much less likely. A positive skin test does not prove allergy, but does make it more likely, and in some situations can provide the clinching piece of evidence for a diagnosis.

Andrew Baker MBChB FRACP Immunologist Allergist What causes eczema? Eczema is probably multifactorial, but it may be predominantly a deficiency in the bonding between cells in the skin. This leaves small breaks in the skin which can become inflamed, hence the red itchy rash. Should I stop certain foods for eczema? There is a lot of mis-information about this. Advice to avoid large numbers of foods can be very harmful both nutritionally, psychologically and socially, both for adults and children. Almost all eczema in adults is not food related. In only a small proportion of eczema cases in children should foods be avoided just because of eczema. In most cases it is better managed by other means. Steroid creams can be safe with excellent relief Certain creams, such as 1% hydrocortisone, are so mild they can be put on the skin every day for 25 years without causing any skin damage. The skin will be less damaged if steroid creams are used, and eczema kept away. Heard of Bleach Baths? In one study, patients were randomised to normal baths, and the others to a bath with half a cup of Janola in it. This makes the bath basically about the same chlorine concentration as a swimming pool. Those having the bleach baths twice weekly for 15 minutes each time had a 30 - 40% improvement in their eczema. Bleach baths work by killing a bacteria on your skin called Staph Aureus, which drives eczema. What about dustmite desensitisation? In those patients with a positive dustmite skin test, or IgE RAST blood test to dustmite, a study has shown that eczema improves on average by about a third if they have dustmite desensitisation. For people with only mild eczema this may not be worth it, but for those with more severe eczema, this may be valuable.

Allergy Testing – what do skin tests and allergy blood tests mean? Dr Andrew Baker MBChB FRACP Immunologist Allergy Specialist Auckland Skin testing and blood tests for IgE (RAST tests) are the only proven tests for allergy. We use both skin testing (skin prick testing) for allergy and specific IgE allergy blood tests at our Auckland clinic. Skin tests are a safe and easy way to investigate allergy. Skin testing should however be interpreted by a doctor who has experience with allergy and allergy testing, in combination with a careful history of symptoms from the patient. There are several reasons for this as follows: Are skin tests and blood tests for allergy accurate? Skin tests can prove a diagnosis of allergy, but not always. Skin tests for some allergies are more accurate than others. Furthermore, the size of the skin test reaction also increases the chance that the test is a true positive result for allergy. The most important thing however, is whether the skin test result matches the symptoms of allergy from the patient. If positive skin test does match the symptoms, then the diagnosis may be clear. If it does not, then the skin test can be a "false positive". Alternatively, if a patient has a very clear history of symptoms to suggest allergy to a particular substance and the testing is negative, it may be a false negative test, and further evaluation is required. As such, the interpretation of skin prick tests (and IgE blood or RAST allergy tests), can only be done in combination with a history of a patient's symptoms to see if these are consistent with allergy as well. This is one of the most important aspects of allergy testing and allergy diagnosis. A good allergy review must involve a detailed discussion of precisely what symptoms have previously been associated with the substance in question. Timing of exposure, type of exposure, and exact symptoms give important evidence to the experienced allergist/immunologist. For this reason, our appointments are 60 minutes long. Oral food challenge For food allergy testing or medication allergy testing, a "challenge test", also known as an oral food challenge can be considered. This should only be considered by an experienced Immunologist/Allergist. The advantage of an oral food challenge is it can definitively disprove allergy. For patients this can be very helpful, to free up this worry from their life. An understanding of skin test and allergy blood tests, as well as a good clinical knowledge of probabilities, and good communication and discussion with a patient about their preferences, helps guide any decision whether to progress to an oral challenge. Which allergy test is best, skin test, blood test, or food challenge? This actually depends on the clinical situation and the allergy in question. Sometimes a blood test is preferable, sometimes a skin test gives more information, sometimes both are necessary, and in some clinical situations actually neither should be done. Any broad statements about one type of testing being better than another will be incorrect over simplifications. Food challenge (if performed correctly) does give the definitive answer, however should only be done if clinical history and skin tests/blood tests suggest it is safe. At the Waitemata Allergy Clinic, skin testing will be performed by Dr Andrew Baker, who is experienced in the technique and interpretation. We may choose allergy blood tests instead, or as well. The most important factor however, is that the testing will be combined with a one hour appointment to review all symptoms and plan management together, which is actually where good allergy diagnosis and management occurs Click the following link for more information on Allergy Testing and Skin prick testing at our North Shore Auckland Clinic Did you know? Hair testing has no scientific basis and no evidence to support it. Hair testing is not an accepted part of medical practice, and is not supported by major international allergy organisations. This is also true for sending IgG blood tests to foreign countries. Use of alternative sham allergy testing like Hair tests and IgG testing is unfortunately common in New Zealand, spreading false information, which actually can be very harmful. Please see this link to a commerce commission ruling regarding these false allergy practices. Also, large screens of numerous allergy tests should not be ordered either, because they greatly increase the chances of false positive test results. Harms of unproven allergy tests Unproven allergy tests can be very harmful. Here is a list of some of the potential harms of hair testing and IgG testing Missed non-allergic diagnosis. For example, if symptoms were due to another disease, not allergy, and the disease was serious (for example cancer), if missed this could be very harmful. Giving a false allergy diagnosis might stop a patient pursuing investigation for the real cause. Allergic reaction. Hair testing for allergy and IgG blood tests for allergy have no reliable evidence to support their use. A risk is these tests stating a patient is not allergic to a substance when in fact they are. In the case of serious allergic reactions, such as urticaria, anaphylaxis or angioedema, this could be very dangerous, or even fatal. This is why accepted testing methods which have extensive evidence to support their efficacy should be used, which are skin prick tests, specific IgE or RAST blood tests, followed by oral challenge if considered safe and appropriate by an experienced Allergist / Immunologist. Harms of unnecessary avoidance diets. For people with food allergies it can be very stressful avoiding foods. Did you know that rates of depression in carers for children with allergy are high? Also, patients can become significantly malnourished due to food avoidance. Food anxiety and food aversion can develop. For young children the stigma of not being able to join in at birthday party meals and being an "allergy kid" can be very significant. For these reasons unnecessary avoidance diets are very harmful. Causing these problems unnecessarily with unproven and unscientific allergy tests is unfortunately commonplace in Auckland Placebo then nocebo. Many people embark on an unnecessary avoidance diet and feel better. This is due to a placebo effect. Unfortunately, this tends to wear off by a few months, leaving a patient feeling confused. The avoidance diet seemed to help, but now symptoms have returned. It is natural to think "It must be something else I need to avoid as well". As a result, a whole cycle of ongoing food avoidance continues, yet symptoms intermittently continue as well. This is the "Nocebo" effect (effectively like a placebo effect but actually negative and harmful). This is another risk of "sham" unproven allergy tests such as hair testing or IgG testing.

Often many non-specific symptoms are put down to a food allergy or an intolerance. One of the best tests to investigate this is a double blinded placebo controlled food challenge (DBPCFC). With this test the patient is given either the food in question (disguised in a capsule, or something like yoghurt) or a placebo. Neither the patient nor the doctor knows if the patient is given a placebo or the food. That way both the patient's and the doctor's preconceptions of what might happen are removed. This is in fact the "gold standard" test of food allergy. It should only be done in a monitored environment and in patients in whom the history of allergy and skin testing/blood tests do not suggest any significant risk. In NZ self-reported rates of food allergy are up to 15%. In studies of food allergy done by double blind test, these are usually positive in only 2 - 5%. This means that a large number of people believe they have a food allergy when, in fact, they don't. This is quite problematic for them for two reasons: 1 - They have to avoid food and all the social issues with food avoidance can be significant 2 - The 'real' cause of their symptoms does not get diagnosed because it is put down to food allergy. In general symptoms such as headache, tiredness, bloating, trembling, fatigue, constipation are very unlikely to be a food allergy. Tests such as "hair analysis" or "IgG blood testing" make claims without proof with regard to such symptoms. For symptoms that are mostly abdominal such as tummy bloating, pain, wind, constipation or diarrhoea I recommend consulting a gastroenterologist and registered dietitian. For symptoms or brain fog, fatigue or headaches I recommend asking your GP who is best to consult or an opinion from a general medicine physician. Link to general medicine diabetes specialist Doctor North Shore Auckland

Diabetes and General Medicine Physician on the North Shore Auckland Dr Steven Miller has been running a practice at the Waitemata Specialist Centre in Shea Terrace Takapuna, on Auckland's North Shore. This will complement Dr Miller's work in the public system at North Shore Hospital. Dr Miller is happy to accept referrals for patients over the age of 16, for diabetes management and advice, endocrinology referrals, and general medicine referrals. He is an expert in diabetes as well, and new options for diabetes management are now funded by Pharmac which he can advise on. Contact details can be found on Healthpoint as well for Dr Steven Miller Diabetes Endocrinology Specialist Doctor Auckland North Shore

Dr Andrew Baker MBChB FRACP Auckland Immunologist Allergist What is an Immunologist? An Immunologist is a doctor with the highest level of qualification in training for allergy treatment. They are also foremost experts on immune deficiency, and treat some autoimmune diseases. What training is required to become an Immunologist in New Zealand? To become an Immunologist a doctor must first spend at least 4 years working in the hospital with all general types of medical conditions. They then must sit 2 different specialist exams. After this, a further 3 years of full time specialist training in Immunology/Allergy is required. This involves being supervised throughout by a qualified Immunologist. Doctors must also complete an original immunology or allergy research project, and present at an International Immunology Allergy conference. If all these conditions are met, and the doctor is considered of suitable knowledge, experience, and personal skills to provide excellent immunology and allergy diagnosis, treatment, care and communication with patients, then they will be awarded an FRACP in Immunology and they are now a qualified specialist. What type of specialist is an Immunologist? Clinical Immunology and Allergy is a specialty branch of internal medicine. Other branches of internal medicine include cardiology, gastroenterology, respiratory medicine, renal medicine, healthcare of the elderly, rheumatology and general internal medicine. All of these physicians are internal medicine specialists. Who should see an Immunologist? Some allergy problems can be dealt with by your GP. If further advice is needed on accurate diagnosis and treatment of allergy, they should be referred to an immunologist. Did you know there are only 10 Immunologists in the whole of New Zealand? Our number of immunologists per capita is one of the lowest in the world at 1 Immunologist allergist per 400 000 people. In France and the USA this rate is much better at one immunologist per 20 000 people. Some statistics suggest up to 30% of people have an allergy. Furthermore, many people are falsely diagnosed as having an allergy, which causes a lot of unnecessary stress. This is a big burden, for a very large number of people. I believe we need to train more immunologists so we have better leadership in accurate diagnosis and management of allergies. Furthermore, Immunologists need to communicate their specialist allergy knowledge more effectively with GPs and patients.

Dr Andrew Baker MBChB FRACP Auckland Immunologist Allergist Is New Zealand the dustmite capital of the world? Did you know that New Zealand has roughly ten times more household dustmites than most areas in Europe? If you find you have year round watery nose running, sniffing, nose/eye itch, or sneezing, you may have dustmite allergy. This can occur anytime of the day, but may be more noticeable around old blankets, a dusty cupboard, or when someone does the vacuuming. It often gets worse overnight or in the morning, but can be any time of the day. Did you know something can be done about it? Desensitisation to dustmite is the best treatment for dustmite allergy. It is the only treatment that offers the possibility of long term cure. For more information about our clinic for dustmite desensitisation and treatment click this link on densensitisation treatment for dustmite allergy.

Dr Andrew Baker Allergy Specialist Immunologist Auckland Epipen® and Anapen® patient information EpiPen® and Anapen® Auto-injectors are for emergency use in anaphylaxis (severe allergic reaction) for people with a history of anaphylaxis. About EpiPen® and Anapen® These are single use, disposable, spring loaded injections that contain 0.3mg adrenaline which counteracts the effects of a severe allergic reaction and can be life saving. They are designed as emergency supportive therapy only and are not a replacement or substitute for emergency medical or hospital care. We will show you how to use the Epipen® or Anapen® and give you a practice. They have pictures on them which show: the needle end is orange the blue safety cap they can be injected into the thigh muscle through clothes if necessary, even jeans, but its best to avoid seams and pockets. When should I use my Anapen® or EpiPen®? This information is to be read alongside your Australasian Society of Clinical Immunology and Allergy (ASCIA) action plan for anaphylaxis which is your personal plan and tells you what to do if you are having a reaction and when to use your EpiPen®. A blank action plan can be downloaded from http://www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-action-plan-for-anaphylaxis How to use an EpiPen® or Anapen® Take the EpiPen® out of the plastic holder. Grip the EpiPen® in a tight fist. Do not put your thumb on the end (this is in case it’s the wrong way round and the adrenaline injection goes into the thumb which can cause damage to your thumb or fingers). Hold the middle of the pen in a tight grip. Remove the grey cap. You may have been shown one of two ways to do this: you can either position the pen on the outer middle of the thigh, and push hard into the thigh until the unit functions and a click is heard, or you can take off the grey cap and then aim the pen and hit the outer thigh from a short distance away. Hold the pen on the leg and COUNT TO TEN to allow the adrenaline to be injected by the auto-injector pen. If your EpiPen® has not clicked push harder into the thigh. Massage the area for several seconds to allow the adrenaline to spread out. What should I do then? If you have just given yourself the injection you should: phone or ask someone to phone an ambulance on 111 (in New Zealand) and tell the operator you are having anaphylaxis and have given yourself adrenaline don’t sit upright if you feel light headed or dizzy as it can be dangerous lie down and wait for the ambulance record the time the injection was given and take it with you to the emergency room. Disposal Dispose of the Anapen® or EpiPen® by putting it back the plastic holder. Advice on funding and cost You don’t need a prescription to get an EpiPen®. An EpiPen® costs about $140 and you usually have to pay for the first one, but if you are receiving support from WINZ they may help. Prices vary and some pharmacies charge up to $180. When I researched this recently I found the cheapest option to order it online at http://www.allergypharmacy.co.nz/. If you have to use your EpiPen® it is usually because of an accident (e.g. you accidentally ate peanut when you were peanut allergic, or you got stung by a bee). In this case the cost of a replacement Epipen® and any ambulance costs may be ACC refunded, so please keep your receipts and approach ACC about this. Unfortunately pens that go past their use by date are not refunded. Also pens used for reactions of unknown causes are not funded. An EpiPen® should last 18 months but some pharmacies will sell you one which lasts less time because it has been waiting on the shelf already so check the expiry date. Shop around and get the cheapest one and make sure you get one that lasts over 12 months. Epipen Anapen® maintenance and travelling Regularly check the EpiPen® expiry date. Renew the EpiPen® before the expiry date and record the expiry date on your calendar. Always have your EpiPen® with you at all times even if travelling abroad. DON’T put it in sunlight, in the glove compartment of your car or anywhere it may get too hot or in the fridge which is too cold. Room temperature is best. Pouches are available for men, women tend to use their handbags. You can buy Epipen® trainers off the internet to practise with. Dr Baker will have shown you how to use Epipen® with one of these. It is better to use an out of date EpiPen® / EpiPen® junior than nothing at all in the event of a severe allergic reaction. Some people have 2 Epipens® – e.g. if they are going to be significantly long way away from any medical help (on a boat/ship or tramping/mountaineering).