AUVI-Q and Epi Confidence with Dr. Vivian Hernandez-Trujillo

In this episode, I’m joined by Dr. Vivian Hernandez-Trujillo, board-certified allergist and food allergy mom and patient, for a grounded and practical conversation about epinephrine confidence.

We talk about what it’s like to manage food allergies both personally and professionally, why so many families hesitate in emergencies, and how familiarity, not fear, is what truly helps in moments of anaphylaxis. Dr. Hernandez-Trujillo walks us through how patients can build confidence using epinephrine, including the unique features of AUVI-Q.

The goal of the episode is to help families understand their options and feel more supported as new tools become available in the food allergy space. This episode is not sponsored, and I am not promoting any single epinephrine device. 

🎥 The full video version of this episode, including the AUVI-Q demonstration, is available on YouTube: @dontfeedthefear 

Links:

• AUVI-Q information and training resources: https://www.auvi-q.com
• Dr. Hernandez-Trujillo: https://www.sflallergy.com/about-us
• Previous episodes with Dr. Pistiner:
  • New Criteria for Infant and Toddler Anaphylaxis:
    https://dontfeedthefear.buzzsprout.com/2371319/episodes/18014268
  • Safe Epi Use for Infants and Toddlers:
    https://dontfeedthefear.buzzsprout.com/2371319/episodes/18209067

Special thanks to Kyle Dine for permission to use his song The Doghouse for the podcast theme!
www.kyledine.com

Find Dr. Whitehouse:
-thefoodallergypsychologist.com
-Instagram: @thefoodallergypsychologist
-Facebook: Dr. Amanda Whitehouse, Food Allergy Anxiety Psychologist
-welcome@dramandawhitehouse.com

Transcript

Speaker 0:01

Welcome to the Don't Feed the Fear podcast, where we dive into the complex world of food allergy anxiety. I'm your host, Dr. Amanda Whitehouse, food allergy anxiety psychologist and food allergy mom. Whether you're dealing with allergies yourself or supporting someone who is, join us for an empathetic and informative journey toward food allergy calm and confidence.. Today I am excited to introduce you to Dr. Vivian Hernandez-Trujillo, a board certified pediatric allergist, and someone who truly lives professionally and personally the realities of managing allergies and anaphylaxis. Dr. Hernandez is a clinical professor at Florida International University Herbert Wertheim College of Medicine, in Miami, Florida. She serves as the medical director for the Division of Allergy and Immunology at Nicklaus Children's Hospital, along with serving as the program director of the Allergy Immunology Fellowship training program. And today she's here on behalf of AUVIQ to give us firsthand information about the specifics of the device to better inform you in your decision making about what to carry yourself. I want to be clear that I'm not sponsored or compensated by AUVIQ or any epinephrine manufacturer for this episode or for my show in general. And I'm not promoting one device over another. I have invited representatives from Neffy to come on the show and talk about it, they declined but remain welcome at any point. And I'm also in touch with representatives from Aquestive who's developing the sublingual or under the tongue epinephrine. That process is stalled as the FDA is asking for further study of real world usability to show that patients can manage the correct opening and placement of the product under the tongue. At some point in the future, I certainly hope I can bring you a conversation about that exciting product as well. My goal with these episodes is to support you in understanding your options so you can make informed, empowered decisions for yourself and your family. Confidence matters and confidence comes from clarity practice and trusted information During this episode, you'll hear me demonstrate the AUVIQ tester, and if you'd like to see the full video of that, it's available on the video version of this podcast on my YouTube channel Don't Feed the Fear.

Amanda Whitehouse, PhD 2:06

Dr. Hernandez, thank you so much for being here on the Don't Feed The Fear Podcast. I'm excited to have you.

Vivian Hernandez-Trujillo, MD 2:11

And I'm very excited to participate. I, I really cannot tell you how much it means to me, not only as a physician, but as a mom of two girls with life-threatening food allergy, and as a patient myself. Your message is so important and I, I really, I thank you for the opportunity to be part of it today.

Amanda Whitehouse, PhD 2:27

Oh, thank you. Thanks for saying that. Especially for those of us who are moms and who are in this field, it just, it hits differently and I think it's important for us to communicate and hear and support each other. So I appreciate that it's landing. Can you give the audience just a little bit of your background and how you ended up doing what you're doing now?

Vivian Hernandez-Trujillo, MD 2:43

I am a pediatric allergist. I think that initially I became interested in allergies because as a child, I had many allergies. I had food allergy, I have asthma. But I really just love the challenge of when I meet a family. We're all different, and sometimes we have one condition, sometimes there's more than one condition. So I think that allergy immunology, for me was really a perfect fit because I am a patient myself. And then when I had my own girls, which was after I already had chosen my specialization, but. know, I, it's like you said, it hits differently. I can understand. I can share stories like today, we'll, we'll share what we've been through as parents, not only as professionals, but I think that it, it is so important to be able to share. I call it the therapeutic use of myself, because I also can help others. We have walked similar, not always the same, but we've walked similar paths and journeys. So I think that that really is what made me become interested in, in allergy in particular.

Amanda Whitehouse, PhD 3:47

Yeah, that's such a good point because there's so much overlap, yet so much variation between all of us and our allergy experiences. So, that's important to keep in mind. Do you mind telling us about your experience as a patient just briefly.

Vivian Hernandez-Trujillo, MD 4:00

Absolutely. So I was born, actually was a very severe asthmatic. Back then we did not have many treatments at all. So I spent a lot of time in the hospital as a young child and, it was difficult. It was difficult for my parents. So growing up I would hear those stories. I also had food allergy, and allergic rhinitis and other atopic conditions. As I've, as I've grown, obviously my asthma has gotten better, but I've developed other food allergies. And that's not atypical, right? We see that. Some of them

Amanda Whitehouse, PhD 4:27

improved

Vivian Hernandez-Trujillo, MD 4:28

and went away. Milk and egg allergy went away. And then I developed shrimp allergy as a medical student. And now peanut and tree nuts as well. The good news, and I always say, I'm an optimistic person. There's a lot of hope in 2026. There's a lot of hope in the last few years. When I first started in practice in 2004, everything was very, very standard. But now we have so many different options, and I think that is what gives us hope, because at the end of the

Amanda Whitehouse, PhD 4:55

day, yes,

Vivian Hernandez-Trujillo, MD 4:56

we all have our conditions, our medical conditions, but there's always something that, that we know it's gonna get better and, and we have control over the situation. And we'll talk about all that

Amanda Whitehouse, PhD 5:06

Yeah. And you're giving the perfect lead in to why you're here and what we're talking about. I've put together this whole season of the podcast, um, because of exactly what you're saying. You know, there used to be no options when you and I were kids and we're dealing with allergic conditions. Uh, you know, I had my own story. And now you can share a little bit about your kids and where you entered into, but when I entered into Allergy Parenthood, it was, "avoid and epi and now we have so many choices, which is amazing, but it gets really overwhelming and confusing and it puts it, it's a different dynamic for parents and for patients to be navigating the decisions themselves instead of just being told, cut and dry, here's what to do. Um, so obviously shared decision making is a part of that, and I know you'll touch on that, but was that your experience too when you came into allergy parenting? Or are your kids a little bit younger where you caught some of these new exciting options when they were young?

Vivian Hernandez-Trujillo, MD 5:57

Yeah, I'll tell you a little bit about, so I had twins and one of the two had anaphylaxis. And she was a little bit older. She was about three to four. But then when I had my third child, at 18 months, she had her first anaphylactic episode. And it was scary. Even though I'm a physician and I'm an allergist, and even though I have it, it's different when it's your own child. So I recognized the symptoms and I was able to treat, but you never expect it. Right? And I, and I understand that sometimes I hear families say, There's no one else in the family that has a food allergy." And that's sometimes hard to understand. Why is it my child? But even when it is part of a family with food allergy. It can still surprise you, especially when they're little. As a pediatric allergist, i'm very passionate about the youngest children because I experienced it with my daughter and she couldn't talk, but she made it clear what was going on even at 18 months and they can give us cues. I know Dr. Pistiner has spoken with you before, and he's a cherished friend and colleague, honestly. He also does so much for improvement of identification of infants and toddlers with anaphylaxis. We all have to share our voices and our experiences because that is really where we're going to have the best outcomes for everybody.

Amanda Whitehouse, PhD 7:10

Oh my gosh. And I'm so glad you mentioned that because that is so helpful and such an important part of this. What he's sharing about teaching us to recognize it and like him, you're sharing it now too, I think it's really helpful for those of us who are not in the medical profession to hear those of you who are physicians, say, "My child has an allergy, and it's different when it's your own child having a reaction. It's really validating for us because I think a lot of us look back and think, "oh, I should have known, or if only I had recognized, and it's just not that simple. Even when you are an expert on the condition.

Vivian Hernandez-Trujillo, MD 7:41

I like to tell families we can't look back, but we can look forward and we can, we can learn from past experiences whether you think you should have acted differently, moving forward and you learn from that and we try not to get stuck in the past or a bad experience. Again, always just remembering like, we can take control over these situations and we have the ability to do that and just improving recognition and speaking to families and friends and just the general public. We need to have a better understanding. When someone tells you they have a food allergy, it's not just a food allergy, it's every time you're gonna sit and eat. For some people it affects them in a different way. So it's being respectful and trying to understand what they may be going through and everybody's different. So we're there to help each other.

Amanda Whitehouse, PhD 8:27

Thank you for reminding us and for saying it. We need to keep saying it over and over again. You are here to help us talk about what's changed in epinephrine options. EpiPen used to be the only choice. And now we have so many more. So can you guide us through, as you've seen that shift with more options becoming available.

Vivian Hernandez-Trujillo, MD 8:44

Again, as a specialist, I'm so happy that there are different treatment options and, and some people may have a preference for one over another. And the way that I handle it in my office, in my professional setting is I will actually show the different products and the family can tell me, look, this is the one I feel most comfortable with, and we will write for that. We'll write the prescription. Sometimes the insurance doesn't allow that, so then I'll have them tell me what would be your second option? But I think having a choice is the, is really the most important take home because there are different devices. It's nice to have different options because, again, not every insurance is gonna cover whatever that person's first preference would be.

Amanda Whitehouse, PhD 9:21

Right. Can you say, in a general sense, what are the concerns? What are the misconceptions that families bring into those conversations about making this decision?

Vivian Hernandez-Trujillo, MD 9:31

So I think at first, especially when it's a new diagnosis, it can be very overwhelming. There's just a lot of information,

Amanda Whitehouse, PhD 9:37

so it's about

Vivian Hernandez-Trujillo, MD 9:38

the identification. So what are the signs and symptoms? Understanding, if there's two system involvement, when would you use the epinephrine? When is it indicated? And the reason that we demonstrate the different products, honestly, is that I want everyone to be educated on how to use them because you never know when you can even help someone else, but you may have a preference, patients or their parents will say, "I'm scared I'm gonna forget." And, and today I'm here on behalf of Kaleo. And, and I will say the AUVIQ is a device that actually does have audio instructions and visual cues so it can help when feeling most frustrated. It's that voice that can kind of walk you through it.

Amanda Whitehouse, PhD 10:20

Yeah, and I will say, um, obviously I'm not giving medical advice to people on which device to choose, but from a mental health standpoint, that's the first thing that I always point out to people about the AUVIQ is that when we're in that emergency mode that you talked about, that when there's an emergency, there's something about that calming voice walking you through it, almost like if there's another person there co-regulating with you and walking you through step by step what you probably already know but might not be able to remember or access in that moment. I have it right beside me, but I was gonna hold mine up so that I can show people, some people I think aren't familiar yet with what it looks like.

Vivian Hernandez-Trujillo, MD 10:57

So it's a small size. Adolescents, teenagers, males that may want to have a smaller device, it's easier for them to carry it. They've told me that. They've told me they can put two in their pockets. They can put two in the, the front pocket of their, of their shirt or their pants. And just having the accessibility, right? Because one of the big problems that we have not only is identification of the signs and symptoms, but sometimes and even more scary, is you identify them, but you're not carrying it with you. So having it available, and I tell families at all times. I can give examples of physicians, pediatric trainees, residents on their way to the hospital with food allergy. "I wasn't carrying it because I was on my way to the hospital." It happened on the way to the hospital and they needed it. So having it available at all times, because we can't predict obviously, when it's going to happen. And for that, I will say, like as a patient myself and as a parent, I carry and I have to carry more than two devices because there's three of us. So at times it's four to six devices, literally. At all times that I'm carrying because we need to have them available should something happen. So the, the carriage, I think is just really important.

Amanda Whitehouse, PhD 12:06

I agree. Tell me if you have language that you like better, but I always tell people that it's, it's basically it's credit card size. It's a little thicker than a credit card, obviously, but that's why it fits in pockets so easily. We are used to originally the long injectors, and so yeah, it's so much more convenient.

Vivian Hernandez-Trujillo, MD 12:22

Yeah, it's the size of a credit card, but it's just a little thicker. I say, a small wallet, the thickness of a small wallet.

Amanda Whitehouse, PhD 12:26

. Yep. Yeah, only one of my three has food allergies. He's a teen now. Our little trick: there's male underwear that have little zipper pockets in them, so if he doesn't want it to be seen, he'll even put those in one, in each side of those, and then it's not a concern about it falling out. So I like to share that tip wherever I can for anyone who's concerned their teen might drop it out of their pocket or whatever it might be. There's so many options of where to put it and where to carry it that works for you.

Vivian Hernandez-Trujillo, MD 12:52

Absolutely. My daughter's a runner, so she has the thin little expandable pocket, right? That she can put it in with the belt,

Amanda Whitehouse, PhD 12:58

Yep.

Vivian Hernandez-Trujillo, MD 12:58

yeah, just having, having it available at all times.

Amanda Whitehouse, PhD 13:01

Yeah, absolutely. Yeah. We use one of those two depending on the circumstances. I love it. Maybe I'll demonstrate it, but the voice activation on the AUVIQ is one of the other things that really sets it apart. So tell us about that and then maybe when you're done, I'll, I'll pull it and let it talk for us.

Vivian Hernandez-Trujillo, MD 13:17

Perfect. It does give audio instructions and there is a calming voice. It'll walk you through how to prepare it, how to administer it, how long to hold it. I think it would be great if you can, if you can show that, because then people can understand that is really one of the things that sets it apart from the other devices.

Amanda Whitehouse, PhD 13:34

Absolutely. It's so different. This is a brand new one I just pulled out, so it's probably gonna be a little, there we go. This trainer contains no needle or drug and is for training purposes only. Do not use this trainer during an allergic emergency. If you are ready to use pull Red Safety Guard down and off of this trainer. Place black End against Outer Thigh. Then push firmly until you hear a click and hiss sound and hold in place for two seconds. Obviously, you do this on your thigh, but I'll do it on my hand for purposes of the camera against outer thigh. Then push firmly until you hear a click and hiss sound and hold two, one. Training complete." I think people still have that misconception that they have to really whack the epinephrine in the leg to click it. So I like to show how gentle of a push it takes to activate the injection.

Vivian Hernandez-Trujillo, MD 14:31

That's very true. It really is just putting some pressure. I always encourage everyone: speak to your pediatrician, or your allergist, or your healthcare provider, because everybody has different needs and they can help you identify the shared decision making is so important. What would be, best, and also just to understand exactly how to use it correctly, but, you don't need the, the high swing. We don't need that, which is nice. It's just, it's, it's not, not that much pressure either. You'll feel it. I always say practice. The trainers are there for a reason. And you can

Amanda Whitehouse, PhD 15:00

request trainers

Vivian Hernandez-Trujillo, MD 15:01

if you don't have them, but to, to practice and just feel like it's a little bit of resistance. But then once you push, then you'll hear, with AUVIQ it counts down

Amanda Whitehouse, PhD 15:09

Mm-hmm. Yeah, I love that. And it tells you how long to hold because I think that's the other thing that people forget, especially if it's with a younger child. And as Dr. Pistiner had talked about on the show, if they're squirming and they're resisting, how do we manage that? And I'll link back to those episodes for those of you listening who might have missed it. In addition to calming us when we are stressed, I think another thing that people find reassuring, about the voice command on the AUVIQ is if there's a person who doesn't have as much experience administering it. Can you talk about that and what you've seen and experienced with other people benefiting from that voice command?

Vivian Hernandez-Trujillo, MD 15:41

Yeah, so that's actually one of the reasons I've had families say to me in my office, "They're gonna be with an aunt, or I'm sending them to daycare and I want whoever is going to be responsible to be able to administer." And I'm a big believer, whatever treatment we use, the parent should speak to whoever's going to be the caregiver for the child, right? So whether it's daycare, although many people have been trained on different devices, I think it's just very important. Let's be clear on which device, how to administer it, how to use it, and then again, reviewing identification of the symptoms. As the medical team, we can teach parents, but parents, you can teach others and you should, and you should teach the family members, the siblings that are older, any caregiver. I think it's just an opportunity for really everyone to understand how is this used?

Amanda Whitehouse, PhD 16:34

Can you talk to us about the needle size? I know that's a question that I hear a lot. I think it looks less intimidating because it's not as long as the long shaped devices that we're used to.

Vivian Hernandez-Trujillo, MD 16:44

The infant dose, the only FDA approved device for infants, the 0.1 milligram is the AUVIQ device, and it does have a 40% shorter needle. So that's something that also sets it apart. And just keeping that in mind because we never want a needle to strike bone, so that is another asset of the AUVIQ infant dose, which is a 0.1 milligrams, and that's indicated 16 and a half pounds to 33 pounds.

Amanda Whitehouse, PhD 17:09

Yeah, and I actually just within the last year or so, had learned that and didn't realize. Tell us more about why this works particularly well for those youngest and smallest children.

Vivian Hernandez-Trujillo, MD 17:20

So for any medication we really do try to use the appropriate dose, and for an infant or a toddler who may be 16 and a half. to 33 pounds the 0.1 milligram dose really is an effective dose. So I think it's something that gives reassurance also to families that were giving the appropriate dose and that the patient has that as an option.

Amanda Whitehouse, PhD 17:43

You're touching on something I think that's really important is our confidence in carrying and using, especially again with the youngest and most teeny tiny little kiddos. So let's talk about, how we build confidence in our epinephrine devices and use it without fear. How do you approach that with your patients?

Vivian Hernandez-Trujillo, MD 18:01

Here I come back to being a mom with children that have life-threatening food allergy and anaphylaxis. And I think I always talk about control. For me it's about, okay, there may be a potentially scary situation, life-threatening situation. Epinephrine does provide you control over that particular event. The guidelines are slowly changing that perhaps not every time you ha may have to go to the emergency room after using epinephrine. However, that's something definitely to discuss with your particular physician, because everyone is different and there are some patients that truly will need to go every time but that varies. I've heard people say, you know, I, I'm just scared. Well, we can be scared of the situation. We can be scared of anaphylaxis, we can be scared that we may have to go to the emergency room. You're never going to the emergency room because you gave epinephrine. I think that's something we need to change the mindset, right? You're going to the emergency room because you're having anaphylaxis. There's a difference. We have control over this situation. And I do try to spin it that way because maybe 20 years ago we didn't have all the information that we have now, and I didn't have the experience that I have as a mom, but I can tell you, having had to administer epinephrine to one of my daughters, we did it, and she looked at me and she said, mom, I feel better. And that's all we need to hear. Right? That's all we need to hear. The converse is, and I tell families, I never want to hear you say, I should have given it. No. If it's indicated, you will give it because you are empowered to give it. You have control. And I think that's what we need to talk about more is just empowering patients, families, and caregivers. Because at the end of the day, it's very overwhelming. No matter who you are, it can be overwhelming, but you're never alone. That's the other thing. This food allergy community is very special and we're there for each other. And that's something that can't be said of every condition. I'm really proud to be part of this community.

Amanda Whitehouse, PhD 19:57

I agree. I feel that so strongly and I, I think it's all the voices like you're chiming in right now, sharing, like this is relatable and, and even to touch on it's not a failure if your child has anaphylaxis. Right? You listed the fears and I think that's another thing that people get stuck on, they can't get past, I made a mistake." It might not have been a mistake. Things just happen unfortunately. So sharing our experience I think is really validating around that. Is it something you're comfortable sharing?

Vivian Hernandez-Trujillo, MD 20:23

Absolutely. I mean, one of my daughters, read the in incorrect label at school and she had a reaction. I'm not really critical or judgmental because what I say is we're all human. Like it can happen to any of us. We hold ourselves to a standard. Our aim is always to protect, but at the end of the day, there is human error there and we're gonna make mistakes,

Amanda Whitehouse, PhD 20:45

but

Vivian Hernandez-Trujillo, MD 20:46

we have to forgive ourselves for that. That's why I am a big advocate about even when they're little, let's say an 18 month old Olivia, my daughter, teaching her to say no peanuts, no nuts.

Amanda Whitehouse, PhD 20:58

You

Vivian Hernandez-Trujillo, MD 20:58

can teach little ones as they grow to be their best advocate, right? Because it takes multiple layers. It's not just a parent or just a grandparent or just the family member. It truly is all of us. So whenever you have a party or you are with other people and there's food, it's asking does anyone here have food allergy? Does anyone

Amanda Whitehouse, PhD 21:18

have a particular

Vivian Hernandez-Trujillo, MD 21:19

need. It may not even be food allergy, it may be a gluten intolerance or something else. Right. So it's just being respectful that not everyone can eat every food. And then you hear the stories about, well, they were at their friend's house and the mom was just being nice. Well, the poor person did not do that on purpose. Right? So I think it's just keeping in mind and forgiving yourself, like errors may happen, if something happens, then being prepared and being able to treat it if it does.

Amanda Whitehouse, PhD 21:46

You used language earlier when you were talking about that, that I love. You are empowered to use it. You have something that you can use that will make you or your child feel better. I wanted to throw in there too. You're talking about when kids are so young, it's great to be talking about it and they can be learning and practicing. I will tell you, all of our trainer devices have been in the kids' medical play toy kit since they were little, and they'd be chasing each other around the house, you know, trying to inject epinephrine. But they know how these things work. It's just been so normal to have it around and for them to hold it and see it and be familiar with it, which then gives them the confidence, I know what this is. When I feel it in my pocket, I feel empowered. I know it's with me rather than being afraid of it.

Vivian Hernandez-Trujillo, MD 22:26

Exactly, exactly. The hesitancy can be there, but yes, if, unfortunately, if you ever have to use it, it's just a reminder: this helped and, and it does empower you for the next event should it happen.

Amanda Whitehouse, PhD 22:40

Another thing that contributes I think, to some of that fear and hesitation is that there can be some side effects from any epinephrine use. Can you talk us through that so people are prepared, they know what to expect and if they do experience that they know that it's normal and that it's not necessarily a problem.

Vivian Hernandez-Trujillo, MD 22:56

Absolutely. So any medication obviously has side effects. The most common side effects and the ones that I generally talk about with my patients are like an increased heart rate, sometimes palpitations, feeling a little bit of that adrenaline rush, which goes with epinephrine. Sometimes you can get some shaking and that can all be normal. But generally those subside

Amanda Whitehouse, PhD 23:15

over

Vivian Hernandez-Trujillo, MD 23:16

time and, and there, there's no long term side effects from them.

Amanda Whitehouse, PhD 23:20

One of the things that I've noticed that it might be helpful for you to comment on that in the conversations I have with my clients is those physical symptoms feel like anxiety. So they'll kind of confuse side effects from the epinephrine with, with feeling more anxious after the administration, which also makes sense given the situation. But I think it's validating to know that that's can be just a physiological reaction to the medication and that it will subside.

Vivian Hernandez-Trujillo, MD 23:44

Absolutely. And actually that happened with my daughter, so she was already anxious. But I will say as soon as she got the medication, she did say, she felt her heart racing a little bit, so it's interesting. I'm glad you actually brought that up, because some of this may seem like anxiety, but absolutely it could be a normal side effect of the medication and to be expected.

Amanda Whitehouse, PhD 24:04

Is there more that you want families to know about that practical side of making sure that it's with you all the time, storage issues. I don't know if you wanna touch on those specifically with AUVIQ.

Vivian Hernandez-Trujillo, MD 24:13

Keeping it just out of extreme, temperatures, extreme heat, and, and I live in. In South Florida where it can get very hot. So I just say always carry it with you. Don't leave it in the car because it gets too hot. And just remembering to carry two devices at all times, there's a reason that it's dispensed as a two pack. That's just important to remind people. And I told you, like for myself, because there's three of us, I can be carrying up to six devices at a time, but that's the right thing to do if I'm trying to protect three people because we have the same allergen. So.

Amanda Whitehouse, PhD 24:43

Right.

Vivian Hernandez-Trujillo, MD 24:44

If there was an accident and we all eat the same thing, then that could actually happen.

Amanda Whitehouse, PhD 24:49

You could potentially all react, yeah, which is a scary thought, but a good point. I think sometimes people don't think that far down the line with it. I know you can't give individual advice, but it's a conversation for people to have with their doctor. But there's that question and that fear of, if I have to give a second epi. So you mentioned carrying two, but can you give us some general information about when that might be a need that people have?

Vivian Hernandez-Trujillo, MD 25:13

That's a great question actually. We do, we do talk about that. So I generally tell people after five to 10 minutes, if you're not better or you're getting a recurrence of symptoms or you're getting worse, I would absolutely use the second dose. And at that point, obviously it would be definitely a reason to, to seek immediate emergency care, going to the closest emergency room or calling 9 1 1.

Amanda Whitehouse, PhD 25:34

Right. So you've given us a lot of information, but can we do kind of an overview then, as people are going into these conversations with their physicians, and having these shared decision making conversations, what mindset and what questions do you want people taking to their own doctors?

Vivian Hernandez-Trujillo, MD 25:50

Okay, so the first thing I'll say is you need to have a good relationship with, with whoever's taking care of you, right? So if you feel that you're not with the right person, I really encourage you, find someone that you feel comfortable with, because developing that relationship and that trust and that communication is key because there is no such thing as a little question or a dumb question. No, every question is important. And sometimes, you know, we may be sitting in a visit. And I can't remember everything to talk about. Well, that question may trigger something important that I was supposed to say. So just always remember, you know, be prepared. I encourage families. Write down your questions, you know, whether it's when to use it or how to use it. I can tell you training is important. We review frequently signs and symptoms. We may review at every visit, it's just going to depend because some patients may have already had a reaction. They're very well aware. Others may need that reminder, and that's okay. If you need to review it at every follow-up visit, I encourage you to do so and writing down your questions really, because at the end of the day, this can be overwhelming, but the more information empowers you, having the medication that will treat, and the standard treatment for anaphylaxis is epinephrine. So being prepared to treat, these are all things that empower us and they give us that control that we've been talking about today.

Amanda Whitehouse, PhD 27:11

Perfectly said. Thank you for sharing that. If you could leave families with a key takeaway about epinephrine preparedness, what would it be?

Vivian Hernandez-Trujillo, MD 27:20

Have an open conversation with your physician. Understanding how important your role is as a caregiver or as a parent. For the infants and toddlers, again, there is an FDA approved dose that's available AUVIQ for the youngest children, and just remembering the importance of carrying the device at all times. Being prepared,

Amanda Whitehouse, PhD 27:43

and

Vivian Hernandez-Trujillo, MD 27:43

just remembering that you are empowered and, and you're part of a community where you can get a lot of support and information.

Amanda Whitehouse, PhD 27:50

Yes, and thank you for being a part of that. For those who aren't familiar with AUVIQ or who may want more information where would they find that?

Vivian Hernandez-Trujillo, MD 27:58

They can go to auviq.com and that there, there's a lot of different resources available to families and to the medical team as well. And I encourage you to look at that.

Amanda Whitehouse, PhD 28:08

Perfect, and I'll put all of those in the show notes for people who want a little extra help finding them so that they can check it out and talk to their doctors about it.

Vivian Hernandez-Trujillo, MD 28:14

Perfect.

Amanda Whitehouse, PhD 28:15

Thank you so much for being here to share your personal and your professional experiences. It's so helpful to all of us.

Vivian Hernandez-Trujillo, MD 28:21

Thank you for the opportunity. Your work is very important and I do share with patients and I will continue to share with patients, I, I appreciate it. Thank you so much.

Speaker 28:36

One of the themes that you'll hear me keep coming back to this season is that choice without support and information can feel overwhelming. Our epinephrine is probably the most important and the best example of that. New options are exciting, but they can also leave families feeling unsure, second guessing themselves, or afraid of doing things wrong. What Dr. Hernandez reminds us of in this conversation, both as a physician, a food allergy patient and a food allergy mom, is that confidence isn't about perfection. It's about familiarity. It's about repetition, and it's about trusting yourself in moments that matter. Before we wrap up, here are a few steps you can take after listening. Number one, if you're not familiar with AUVIQ, check out the website. It's auvi-q.com or auvi-q.com. There's a link in the notes and you'll find a lot of information there, including the AUVIQ training video and other helpful information. Number two, revisit the fundamentals of anaphylaxis and epinephrine use if you're not completely confident about it. I'm linking two previous episodes with Dr. Mike Pistiner, who was a very popular guest talking to us about the updated guidelines for infant and toddler anaphylaxis and demonstrating using epinephrine in babies and toddlers. These episodes pair perfectly with today's conversation. Number three. Remember that what matters the most about your epinephrine device is familiarity. Whatever device you carry, make sure it is one that you are comfortable enough to carry all the time. Practice with it, and review the steps when you're calm. Confidence doesn't come from having the best device. It comes from knowing your option inside out.

Amanda Whitehouse, PhD 30:18

the content of this podcast is for informational and educational purposes only, and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. If you have any questions about your own medical experience or mental health needs, please consult a professional. I'm Dr. Amanda Whitehouse. Thanks for joining me. And until we chat again, remember don't feed the fear.