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Allergy doctor: Anaphylaxis affects not only schools, but all environments

DuBOIS — Life-threatening anaphylaxis was one of the topics at Monday’s teacher in-service day in the DuBois Area School District.

An allergy and immunology doctor, Dr. Jeff Rosch, of Central PA Asthma and Allergy Care, Hollidaysburg, told the teachers that anaphylaxis — a severe, potentially life-threatening allergic reaction — is an issue that affects not only schools, but all environments.

Between 1,500 and 1,700 deaths a year occur from life-threatening allergic reactions or life-ending allergic reactions, Rosch said.

“The horrible part of this is, it’s generally, every one of these people are otherwise pretty healthy,” he said. “And if it wasn’t for this episode, they’d still be alive. So, if we can do some things to either prevent these episodes, or to better treat them acutely, so this ultimate horrendous outcome doesn’t occur, then everyone gains.”

When we think about anaphylaxis, it’s important to realize that it’s only a very, very small part of the total allergic diathesis or allergic tendency, that people have. But interestingly, it doesn’t necessarily have to be in combination with other larger problems.

About one in 13 children have some degree of food allergy, said Rosch, noting that an allergic reaction is a systemic immune response.

“It can present various ways, but it’s involving the immune system and it requires that a person be sensitized. That they have exposure at one point or another. That may be one exposure, that may be thousands. And that this response then, can be triggered by exposure to minute quantities of the allergen,” Rosch said.

Foods are the leading cause of life threatening allergic reactions — about 2.5 percent to 3 percent of the U.S. population has confirmed food allergies, he said. Some of the common foods are peanuts, milk, shellfish, tree nuts, eggs and pink fish.

“But certainly peanut is the number one,” Rosch said. “But interestingly, it’s the number one in developed countries. It’s not the number one food allergy in many other places in the world.”

About every five minutes, there’s an emergency room visit with food anaphylaxis in the U.S. And only about 20 percent of the people who die from anaphylaxis had a previous severe allergic reaction to it.

Photo by Chris Wechtenhiser 

Johnsonburg's Maria Jones (40) drives strong to the basket against Brockway's Kaitlyn Morelli (1) during first-half action Wednesday. JOnes scored 12 points in the Ramettes' 44-42 victory.

Water line work continues in DuBois

DuBOIS — Despite freezing temperatures, water line work continues in the City of DuBois, according to Manager John “Herm” Suplizio.

Last week, work began to install an 8-inch water line on Hammer Street from New Street to DuBois Street, Suplizio said.

In addition, a new water line is being installed on Sandy Street in front of Prontock Beer, he said.

“Also, there is the installation of a couple new hydrants,” Suplizio said. “All of this will help the infrastructure in that area even more.”

This work is expected to finish by today.

Next week, a new water and sewer line will be installed off of Highland Street down to Tunnel Avenue, Suplizio said.

Work is being done by Roman Construction, DuBois.

Doctor discusses symptoms and treatment of anaphylaxis

DuBOIS — If a child is having a severe, potentially life threatening allergic reaction — anaphylaxis — the treatment of choice is epinephrine.

Epinephrine auto-injectors are now available in public locations without prescriptions, Dr. Jeff Rosch, of Central PA Asthma and Allergy Care, Hollidaysburg, said during a presentation at Monday’s teacher in-service day in the DuBois Area School District.

“I’m not a big fan of action plans when it come to asthma or other things. But with anaphylaxis, I think it really is important,” Rosch said. “If you’ve seen any of it, it comes as a duo pack. It comes as two. That’s not so they leave one at home and take one with them to school. That’s so they have two of them, because if they don’t start to improve, within 10 minutes of the first does, you give them a second dose. Most people don’t know that. That’s the purpose of a duo pack.”

One thing Rosch emphasized is that antihistamines have no place in the treatment of severe, acute anaphylaxis.

The onset of epinephrine is five to 10 minutes.

So what are the signs and symptoms of anaphylaxis? About 80-90 percent of people, not 100%, but the vast majority with anaphylaxis will have skin involvement — hives, itching, that kind of thing, as well as the tongue, the mouth can be itchy and swell.

About 70 percent will have involvement of the lungs. About 45 percent will have heart involvement, hypotension, decreased blood pressure, decreased heart rate, or the opposite, rapid. About 45 percent will have TI symptoms. About 15 percent will have neurologic symptoms. Often you talk to these people and they get this feeling of dread and mental illnesses. About 10 percent, which is not on here, will have urinary events, spontaneous abortions, peeing themselves, all kinds of symptoms.

“So it isn’t just skin and it isn’t just breathing,” Rosch said. “The most common symptoms, and they aren’t the only ones and they aren’t required. To have a definition of an anaphylaxis we need involvement of two of these five symptoms, two of the five, that’s anaphylaxis. Epinephrine basically treats all of these symptoms. Antihistamines treat just skin.”

It’s important to educate people, Rosch said.

“That’s the the kid, the parent, and ideally any other caregivers. We want to plan what to do. Epinephrine, 911,” Rosch said. “We need to respond — be it epinephrine in the classroom, be it epinephrine in the nurse’s office, be it epinephrine in the kid’s backpack, wherever it is. As a provider of care for that kid, ideally you know where that is.”

Ridgway taking steps toward broader ATV operation

RIDGWAY — If the Ridgway borough opens its streets up to all-terrain vehicles, you probably won’t be able to ride yours outside borough limits any time soon. The ordinance that Borough Manager Paul McCurdy said is being developed wouldn’t connect riders to national forest trails, but would be a first step toward that goal.

McCurdy said the borough worked over the summer to develop an ordinance that would have allowed ATV travel directly from the borough to the Timberline Trail in the Allegheny National Forest. But neither the Pennsylvania Department of Transportation nor the Allegheny National Forest, he said, gave the go-ahead to operate ATVs on roads under their jurisdiction that connect the borough to the trail.

The borough would have also needed firm commitments from Ridgway Township and Spring Creek Township, which McCurdy said it did not receive.

“It’s not a simple process,” he said.

What the borough’s Street Lighting, Parking and Traffic Committee will work to develop next week, McCurdy said, is an ordinance that would permit the dual-use of motor vehicles and ATVs only within the borough.

The borough has been working toward dual-use in some form since last spring, when residents belonging to the Elk County Wilds Tourism Association approached council with the idea. There has been confusion between the two, McCurdy said, because the group approached council later that spring with a separate idea for a one-day ATV street ride that was ultimately scrapped.

Proponents of dual-use in the borough say that it would bring tourists into the area, provided they could ride their ATVs from the borough to the trails. Several attended council’s regular meeting Monday, where they urged members to take some form of action on the matter.

According to the Pennsylvania Department of Conservation and Natural Resources, there are 1,908 active ATVs registered in Elk County. DCNR Spokesperson Terry Brady said that several smaller townships in the Northern Tier region already have dual-use ordinances in place, but said it can be tricky for borough’s to do so because they are more densely populated.

“Boroughs have to be cognizant of which roads they picked,” he said.

Police, commission hopeful governor's disaster declaration over opioid crisis will help

Last week, Pennsylvania’s governor declared the state’s opioid addiction epidemic a public health emergency and ordered a command center be set up to treat the crisis like it would a natural disaster.

The order puts in place a 90-day disaster declaration, which widens access to the state’s prescription drug monitoring program and makes it easier for medical professionals to get people into drug treatment more quickly.

“St. Marys has seen an undeniable increase in much more potent heroin in the past several years. That potency has been linked to the inclusion of fentanyl and similar additives, and this has led to responses by our agency to opioid related overdoses. Some of those overdoses have resulted in deaths, while some have been able to be reversed by officers and EMS personnel carrying naloxone,” said St. Marys Police Chief Tom Nicklas, when asked how severe the problem is on the streets.

The City of St. Marys Police Department began carrying the overdose antidote naloxone during mid-2016. He said nearly all successful reversals by officers in the city have required two doses of the medication due to the enhanced impact by the fentanyl.

Susan Ford, executive director of the Clearfield-Jefferson Drug & Alcohol Commission, said in their coverage area there have been five Narcan saves in Clearfield County and 10 in Jefferson County between June 1, 2016 through October 2017. However, she cautioned that those are the saves reported by first responders and that the number is likely higher.

She added that there were 13 overdose deaths in Clearfield County in 2016 and 8 in Jefferson County. By comparison, the Elk County coroner recently reported at least six overdose deaths last year and two so far in 2018.

The state’s rate of drug overdoses has been more than twice the national average, and preliminary data indicates the number of overdose deaths rose again last year.

Ford said this is the first time in her lengthy career in drug and alcohol services that such a declaration has been made. Disaster emergency declarations are normally issued after severe weather emergencies. An aid of Gov. Tom Wolf told the Associated Press that seven other states have taken similar actions to address the opioid problem.

Without hesitation, she said it is “absolutely warranted.” And she is hopeful it will have an impact.

The disaster declaration focuses on three areas, including enhancing coordination and data collection to bolster response; improving tools for families and first responders; and speeding and expanding access to treatment.

“I think that giving EMS the ability to leave doses (of naloxone) behind for those individuals or family is a step in the right direction and waiving some of the regulatory requirements for treatment providers will also help,” Ford said.

Chief Nicklas didn’t have an immediate prediction of how the governor’s declaration would impact police departments like his, however he did say that, “I hope for the sake of the those unable to break free of their addiction that these initiatives help some on the road toward recovery, because that is what is most important.”