Family Health

When to give an EpiPen to your child: Taking out the guesswork in a life-threatening situation.

As of the writing, my daughter is now 18 months old, and I have already discovered five foods that she is allergic to: egg, peanut, sesame seeds, green peas and fish.

The first time Kara, my daughter, had an allergic reaction was when I introduced a scrambled egg to her one morning for breakfast. She was eight months old back then. After a few minutes of feeding her, she suddenly vomits everything she ingested. Puffy eyes and hives followed.

When we met the allergologist, Kara underwent an allergy skin test for confirmation. The specialist added the peanuts in the test because he usually sees in the clinics that these two types of food come together. Patients who tested positive on one also shows the same result on the other, most of the times.

True enough, my daughter showed a positive result on both. She is allergic to eggs and peanuts – confirmed. Hence, the doctor has prescribed me three Ep-Pen Jr, one for our home, one for my in-laws’ house and one for Kara’s diaper bag.

Food Allergy in Children
Photo by Kelly Sikkema on Unsplash

Food Allergy

For a person to present with food allergies, he or she is possibly predisposed to develop the atopic disease. According to JAMA Pediatrics, atopic diseases are a group of conditions linked by a shared underlying problem with the immune system. The common thing between these diseases is that they are IgE-mediated allergies, wherein the allergens are usually harmless.

Examples of childhood atopic diseases are asthma, allergic rhinitis, atopic dermatitis and food allergy. In the United States, there are eight common food allergens: milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish.

In severe cases, anaphylaxis may ensue. Anaphylaxis is a severe allergic reaction that may lead to death. It’s onset is so fast that immediate recognition and action to treat are necessary. Hence, persons with a food allergy must always have an available EpiPen anywhere and anytime.

EpiPen

EpiPen is an injectable medication for severe allergic reactions. It contains a drug called Epinephrine that will save a life during an emergency situation. Let’s say the person who had an allergic reaction is experiencing swelling of the throat, which then makes it hard for him/her to breathe;
this autoinjector will reverse the condition in just a few minutes!

If EpiPen was prescribed to your kid, make sure to get a training kit with you. The training kit will guide and give a hands-on experience on how to administer the medication properly. Make sure everyone who will watch over the kid is familiar with the procedure!

Discovering my daughter’s allergies

I looked upon the internet what alternatives to peanut butter I can give my daughter. Then when I went to a specialty grocery store, I found a sesame seed spread, which is listed in one of the peanut butter spread alternatives.

The next morning, I scooped a minute amount of spread using a teaspoon and let my daughter taste it. The tip of the teaspoon touched her lips, and she ingested whatever is on it.

Within a minute, she started vomiting until there is no longer stomach content she can expel. She started showing redness around her mouth and later on, red patches became raised above the skin. The rashes eventually spread to her chest, and she keeps on scratching these patches.

It was heartbreaking to see her suffering from the food I gave her. She did not show any signs of airway obstruction, so I decided to give her Benadryl immediately – as prescribed by our family doctor. We went straight to the urgent care to have her assessed and for necessary medical management.

One day, I cooked frozen green peas in butter and served it to Kara for her lunch. She enjoyed it a lot, so I gave it again after 3 days. On the second time, while in the middle of self-feeding with her green peas, I noticed that she keeps on scratching her hands. In just a few seconds, her hands become red, swollen and warm.

I stopped the feeding and went to look for her Benadryl. When I went back to her, I saw rashes around her mouth. I immediately gave her a dose of Benadryl, and within 2 minutes, I saw some relief on her itchiness. The redness and swelling of her fingers took some time to get off.

In summer 2019, my family and I, together with my husband’s older brother, went to downtown Toronto to stroll around. We bought meals from a seafood take-out store and ate on a different level of the building. I had a grilled red snapper and shared it with Kara. She loved it so much that she finished a considerable portion.

There was also a day that my mother-in-law cooked Tilapia for her. She seemed okay feeding on her own with this type of fish.

Recently, my mother-in-law baked a Pampano for dinner. I gave Kara a plate with shredded fish on it. Surprisingly, she showed similar signs and symptoms when she ate the green peas. I was really shocked knowing that she safely consume fish previously.

Managing the food allergy

Strict avoidance of food

Just like what you’ll hear from the doctor’s clinic, a particular food allergen should not be present in your household once a family member is diagnosed to be allergic to it.

Also, watch out for cross-contamination. It may not be visible in the naked eye, but it can cause allergic reactions, too. Cross-contamination may happen from food to food (nuts even if taken off on top of salad will still have remnants on it), food to object (utensils, dishes) and food to saliva (from people and pets).

Communicating with people who prepares your food

Your family could be having dinner in a restaurant, or your child may be eating out at a cafeteria with friends. In any situation, you or your child must be able to inform the food handlers about the food allergy. In this way, you lessen the risk of a possible allergic reaction.

Recognition of the signs and symptoms

Aside from the parents, the caregiver and educator must know what the signs and symptoms of an allergic reaction are. These include the following:

  • itchiness inside and outside the mouth
  • swelling of lips
  • shortness of breath
  • difficulty of breathing
  • cough
  • high pitch whistling sound
  • nausea and vomiting
  • diarrhea
  • flushing
  • red itchy bumps on skin
  • swelling around the eyes
  • stomachache
  • fainting/collapse

Availability of Epinephrine autoinjector

I always have an EpiPen JR in my daughter’s diaper bag. There is also one in our house and another one in my in-law’s house.

Making sure that this life-saving medication is always at hand when needed should be a priority of all parents with kids that have a food allergy.

In school, it would be great for parents to provide written instruction to the school staff or teacher. The written instruction will detail what the parents want the teacher to do should an allergic reaction takes place inside or outside the classroom. Doing this will empower the educator in taking care of your child’s medical needs.

So when do you give an EpiPen?

Within minutes to several hours of ingesting a food allergen, signs and symptoms will be very visible. Here’s a guide that you can follow to identify if it is already time to inject the EpiPen:

S/S A
generalized hives
itchiness or flushing
swollen lips
swollen tongue
swollen uvula

S/S B
crampy abdominal pain
vomiting

S/S C
difficulty of breathing
wheezing/high pitch whistling sound while breathing

S/S D
syncope/fainting
incontinence or involuntary loss of large or small amounts of urine
hypotonia/collapse

From the list above, if two or more categories are present, then it is likely that there is an exposure to an allergen and the EpiPen should then be given.

Example scenarios would be:

  1. generalized hives (S/S A) + persistent vomiting (S/S B) = give EpiPen
  2. swollen lips (S/S A) + difficulty of breathing (S/S C) = give EpiPen
  3. abdominal pain (S/S B) followed by collapse (S/S D) = give EpiPen
  4. itchiness (S/S A) + abdominal pain (S/S B) followed by wheezing (S/S C) = give EpiPen

All of the items written above are merely recommendations based on the diagnostic criteria I have read regarding anaphylaxis. It is best to consult your doctor when it comes to your child’s case.

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