FDA Approves New Epinephrine Injector That Talks

Sanofi US has introduced a new epinephrine injector (competitor to the more commonly known EpiPen made by Dey Pharma LP) that is equipped with audio and visual cues that helps a patient or care-giver administer epinephrine in cases of a severe allergic reaction (anaphylaxis).

Known as Auvi-Q, it was FDA approved Aug 13, 2012, and should soon become available for purchase by prescription.

Just like EpiPen, Auvi-Q comes in two different dosages of epinephrine... 0.3mg for patients who weigh more than 66 pounds and 0.15mg for those who weigh between 33 and 66 pounds. Each pack contains two devices with active drug plus a non-active training device.

During a life-threatening allergic reaction, Auvi-Q talks the patient or care-giver through each step of the injection process. If more time is needed, it can repeat the instructions step-by-step. The device also comes with written instructions printed on the side. In addition, there are visual cues with an alert light to signal when the injection is complete. Watch video.

Auvi-Q is about the size and shape of a credit card, the thickness of a cell phone and fits comfortably in a pocket or small purse. This size and shape is in contrast to the EpiPen which looks like a fat marker. Being compact and easy to carry should remove one obstacle that could be a reason why as many as two-thirds of patients do not carry their epinephrine injector device.

Like the EpiPen, the device also has an automatic retractable needle mechanism to prevent accidental needle sticks.

Source:
FDA Approves Auvi-Q Voice Activated Epinephrine Injector. EmaxHealth 8/13/12

Intra-Nasal Trigger Point Injections for Facial Headache

Do you suffer from a stabbing headache in the areas denoted in red? Do these headaches seemingly come out of nowhere one day? Perhaps started after a viral upper respiratory infection?

You may be suffering from a condition known as contact point headache or a type of neuralgia involving one of the nerve plexuses found inside the nose:

• Anterior ethmoid neuralgia (Sluder's neuralgia)
• Sphenopalatine ganglion neuralgia (Pterygopalatine ganglion neuralgia)

This type of headache has often been confused with cluster headache, migraine without aura, sinusitis, or other undefinable pathology especially since CT scans and MRI scans that are obtained often do not reveal any tumor or presence of infection.

In the event of a contact point headache, surgical removal of the offending anatomic abnormality is curative.

However, for neuralgia, trigger point injections may be helpful according to a recent study. Using a 1:1 mixture of 0.5% bupivacaine and Kenalog-40, either the sphenopalatine ganglion or the anterior ethmoid neurovascular bundle or even both are injected. For the sphenopalatine ganglion, the injection is where the middle turbinate inserts into the lateral nasal wall. For anterior ethmoid injection, identify the arch where the middle turbinate inserts superiorly to the lateral nasal wall and inject 5mm above this site.

In a total of 882 nerve blocks in 147 patients, 99.3% had no complications. 2 patients reported visual changes that resolved within 2 days. More importantly, 81.3% claimed improvement in their headache, 17.9% reported no change and 0.79% reported worse pain after the injection.

The typical duration of pain relief was 3-4 weeks. As such, for continued pain relief, the injection needs to be repeated monthly on average.

Reference:
Endoscopic neural blockade for rhinogenic headache and facial pain: 2011 update. Int Forum Allergy Rhinol. 2012 Apr 5. doi: 10.1002/alr.21035. [Epub ahead of print]

Vocal Cord Botox Injections to Treat Asthma???

Yup... It's true...

A clinical trial is under way in Australia to see if botox injections to the vocal cords can improve the shortness of breath some asthmatics have. Though nobody disputes that asthma is a pulmonary problem, it is not uncommon that the vocal cords in asthmatics may be dysfunctional exacerbating the breathing problem.

What is meant by dysfunctional? It's when the vocal cords come together when the person is trying to breath. It is also known as paradoxical vocal cord motion, vocal cord dysfunction, or laryngospasm at its worst. Read more here.

Botox injections will paralyze the vocal cord muscles preventing the vocal cords from coming together thereby allowing easier airflow into the lungs... or at least that's the hope. This procedure is commonly performed in patients suffering from spasmodic dysphonia and the technique used to treat these patients would be the same as that proposed for asthmatics. Watch a video here on how this is performed.

What's the downside? Aspiration, breathy voice, and trouble swallowing are common but temporary side effects. Problem is if aspiration occurs in a patient with significant pulmonary compromise, it can potentially be devastating leading to asthma exacerbation and even pneumonia.

Read a news article regarding this clinical trial here.