Fun With Epi-pens

This was a letter sent to Dr. Krista by one of our patients. Her son, E, has a severe nut allergy that was diagnosed about 6 years ago. Recently he had an exposure. Her story is incredibly educational both for parents of children with severe food allergies as well as their friends and relatives. It is published here with her permission.

Friends of kids with nut allergies,

We had an allergy scare last night and learned a lot that I thought I would share as we had to use an Epi pen on E last night for only the 2nd time in 6 years.

We were at a friends’ home around the corner for dinner, and I think E felt so comfortable being back in Reno and with his friends that his guard was down. I was there, but not aware that ice cream was served and after the year of food vigilante we’ve had with all of our travels, I would have said that I was sure he would not eat anything without checking either the label, with me, or both. While our friends knew of his allergy, no one knew the ice cream had nuts in it.

He had taken only a few bites of the ice cream when I walked out and saw what he was eating and checked the package to see that it had nuts. It had been less than 2 minutes since he began eating and his tongue and mouth were itchy and he appeared just the slightest bit swollen. I gave him 3 children’s Benedryl right away and an Epi pen within another minute and we headed straight for the ER. While we were prepared and all is now fine, here is what I learned last night.

  1. I was sure that after seeing how cautious I always am, and have tried to teach him to be, that he would never eat anything without checking. However, he is 7 and really wanted to have ice cream with the kids so opted not to ask and instead to try and sneak away with it.
  2. Leaving the Epi pen decision up to him would not have been a good decision. He claimed that his tongue was itchy but that he didn’t need an Epi pen. I didn’t realize how freaked of the needle he was and despite his worsening allergic reaction, he was scared and screamed and bolted so fast when he realized what was happening and that I was going to give him a shot. He ran away and kicked so hard I needed a friend to grab him and hold him down while I did the injection.
  3. Always carry 2 Epi pens. While we were at the hospital in less than 15 minutes after his exposure and the Epi pen injection, I was close to giving him a 2nd Epi pen as his symptoms were oral and not seeming to subside. Thankfully we were just turning into the hospital so I decided to wait. If we had been any further away, I would have needed to use a 2nd Epi.
  4. Always go straight to the hospital after using the Epi. At the hospital, in addition to the Benedryl I’d given him, they gave him Pepcid which I’d never heard about for allergies. Apparently Pepcid works similar to Benedryl, but blocks separate and different histamines that can arise in an allergic reaction, so the ER doc told us that it’s best to have both on hand always and it is fine to give both together. Talk to your doc about this. Even nearly 2 hours after exposure his mouth started to swell a bit more and he was given a steroid treatment and kept for another hour to be watched. After 3 hours we were released, but I learned that it’s possible to have another reaction anytime up to 48 hours later as all of the medicine in him dissipates, though this is much less likely, so it’s important to keep a close watch once you go home.

E’s first reaction to nuts was at age 1 1/2 and we were caught unaware of his allergy and the whole experience and use of an Epi pen at the ER was an ER blur. This time I was much more educated and learned so much about how incredible epinephrine really is and how amazingly it works – WHEN USED QUICKLY.

Finally, I know the policy at E’s school is to keep his medicine (Benedryl and Epi pen) in the nurse’s office. I now realize that for a serious allergy, this is crazy. The nurse is far away and it would likely take 5 minutes to get to her office, locate his medicine and get to him. While he carries another Epi pen in his backpack and/or with him at all times, I’ve now seen that he is not yet able to make the decision for himself when to administer it, and I don’t have confidence that he would opt to give himself the shot. Please, if you have younger ones, make sure the teacher is well versed in the situation, how to use the Epi pen and how important it is to do very quickly if they’ve been exposed and are having an oral reaction.

On another note, given that we had just been to our allergist and the question of when to switch from Epi Pen Jr to adult strength Epi Pen came up. Epi Pens say to switch to the adult strength at 66 pounds. E is only 59 pounds, but his allergist and a friend had recommended just 2 weeks ago that we switch to adult strength, which we did. I had this switch confirmed by 3 docs and nurses last night at the hospital – just by looking at him they all said use the adult Epi as the potential side effects of a stronger dose of epinipherine are so much less harmful than not enough.

E is fine this morning, just slightly exhausted from the night and ready to practice reading labels!

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