Recent head-line grabbing news horrified families everywhere–a 15-year-old girl died from an allergic reaction to peanuts. Most were shocked that something as small as a kiss from someone who had eaten peanuts could cause such a severe outcome. But it did. It has left many reeling, trying to figure out how to prevent similar tragedies in the future.
It is rare to have a severe allergic reaction to a kiss, but it happens. For highly allergic people, it takes only a small amount–a trace–to cause one. There have been reactions to airborne traces–not from the smell, but from the protein being discharged in the air. Think of being in a room (or on an airplane) when many bags of peanuts are being opened. The dust from opening those vacuum sealed packs in a closed environment can provoke a reaction. Skin contact, where milk is spilled on an open wound or a child touches a surface with peanut residue, and then puts his or her fingers in the mouth, has caused reactions. Again, these are not common, but they do occur. So how much does it take? And how do you treat it if a reaction occurs?
There are so many questions people have about allergies: what are they, where do they come from, why are they on the rise (they are, dramatically), who is at risk for developing allergies, what are the most common allergens, what makes some foods more allergenic than others, what tests are there to find out what someone may be allergic to, at what age can you be tested (infancy), can allergies be ‘outgrown’, can they come back, why are some reactions mild and others severe, is there a cure (not yet), how can reactions be avoided, what is anaphylaxis, how are the symptoms recognized, how are they treated? Great questions! It would take several articles to answer them with any depth. For now, we’ll address how to treat an allergic reaction.
Our son is severely allergic to dairy, eggs and peanuts. We cannot speak for all children with food allergies, but perhaps some of our experiences from years of dealing with allergic reactions can be helpful to others. First, a few disclaimers: not all food allergies are severe; not all allergic reactions are severe; symptoms vary from individual to individual and even from time to time with the same person. (I’m a parent, not a medical professional.) Check with your physician or allergist if you have any questions–this is not medical advice.
Whether you are a parent, a teen with allergies, a relative, friend, neighbor, or teacher, it is important to know the signs of an allergic reaction called anaphylaxis. Sometimes, the first allergic reaction occurs in someone who did not know they were allergic. Recognizing the symptoms, and reacting quickly, can save a life.
What is anaphylaxis?
Anaphylaxis is a sudden, severe, potentially fatal, systemic allergic reaction that can involve various areas of the body (such as the skin, respiratory tract, gastrointestinal tract, and cardiovascular system). Symptoms occur within minutes to two hours after contact with the allergy-causing substance, but in rare instances may occur up to four hours later. Anaphylactic reactions can be mild to life-threatening.
An anaphylactic reaction may begin with a tingling sensation, itching, or metallic taste in the mouth. Other symptoms can include hives, a sensation of warmth, asthma symptoms, swelling of the mouth and throat area, difficulty breathing, vomiting, diarrhea, cramping, a drop in blood pressure, and loss of consciousness. These symptoms may begin in as little as five to 15 minutes to up to two hours after exposure to the allergen, but life-threatening reactions may progress over hours.
In the U.S., food-induced anaphylaxis is believed to cause about 30,000 trips to the emergency room and between 150 to 200 deaths each year. Individuals who are allergic to foods and have asthma are believed to be at a higher risk for developing an anaphylactic reaction. (source: The Food Allergy & Anaphylaxis Network)
How is an anaphylactic reaction treated?
The answer to this depends on the reaction, and often this is where things go terribly wrong. The medication of choice is epinephrine, available by prescription as EpiPen, EpiPen Jr. (for children under 66 pounds), and Twinject. It should be given quickly, not an hour or two later. This little wonder drug can save a life, but people often hesitate to use it immediately for many reasons. Some fear shots, some fear using it if not needed can cause harm, some–most–misread the symptoms and treat with other medications, wasting precious time.
After giving epinephrine, the person needs to go to the emergency room, where they will be given steroids. That is critical. Monitoring by medical professionals is necessary, even when symptoms appear to improve.
If I’d written this article last year, my perspective might have been different than it is today. Our son is 11 years old now. We were proud of our track record, especially with his list of severe allergies. After all, how many times a day do we eat? Three meals, snacks, parties, holidays. OK, we eat continually. Food is everywhere. We used epinephrine on him only once in those 11 years–that is until recently. We had two back-to-back accidents within the past three months that threw everything we thought we knew out the window.
When I read accounts of children who died because the EpiPen wasn’t given immediately, I wondered how that could happen. Why would anyone hesitate? After all, it’s easy to use, the needle is hidden, it barely hurts, it does no harm if used when not needed (caution is advised for certain heart conditions. It helps severe asthma attacks and it can save a life. Now I get it. Now, we have our own tales of near misses to share.
Our son has asthma. Each time he was exposed to an allergen in the past, he had a sudden, severe asthma attack. Mind you, those exposures were mostly caused by his allergens being cooked in the same room, not by ingestion. The two times as an infant he got a sip of milk, he also threw up violently, immediately. Each of those incidents was turned around with antihistamines and albuterol. When he was 7, a cheese slice touched his food. He didn’t eat the cheese slice–it just touched his food. Sudden asthma attack. Albuterol and antihistamines barely made a dent this time. We rushed him to the doctor where they gave him a shot of epinephrine and steroids. We had an EpiPen with us–we didn’t use it because we were looking for more than asthma. Big mistake. We were lucky his symptoms turned around.
Flash forward five years, with no reactions in-between. We wondered if he might be outgrowing his allergies. He outgrew several by age 5. Maybe the allergy tests are wrong? That turned out to be wishful thinking. A few months ago, we gave our son a new product. Dairy/egg/peanut free, or so the ingredients indicated. He took a few bites, then left the room. Being the paranoid, overprotective, cautious type, I followed him. He took a few sips of water, and complained that his throat was bothering him. So was his stomach. That was all, nothing more. No asthma, no noticeable swelling, no throwing up.
I got that sickening feeling only a parent raising a child with food allergies can understand. I got out the product and reread the label about a dozen times–nothing. No allergens. But he was not behaving right. Where was his asthma? It had always been our early warning sign before. This time, his symptoms were different. So, being an educated person I gave him the EpiPen anyway, right? Wrong. But we did take him to the ER. At the hospital, they looked at me like I had a second head. The child didn’t appear to be in much distress, no asthma, blood pressure was fine, he was moaning and sighing and his voice was funny. I handed them a copy of his emergency allergy plan, and explained our history.
So they gave him the shot right away, right? Wrong. Although I asked about it several times,why didn’t I just give him the shot I had in my purse? They took our son in the back where some doctors and nurses pondered their next move. Ever get the feeling you were watching an accident in slow motion?
Suddenly, our child’s symptoms exploded. He threw up violently, filling five containers, getting it all over him and a few of those around him. His throat closed. They ran for the epipen, and injected him immediately. They put in IVs and started steroids, more epinephrine, and antihistamines. He was traumatized, but his symptoms improved and he fell asleep while we stayed there for hours monitoring him.
We contacted the manufacturer later, to find out what might have been in the food that wasn’t on the label. They happily told us their plant was peanut free. Yes, but what about dairy or egg? No, no, we’re dairy free too. Egg? Oh, egg is everywhere. High probability there was egg cross-contamination. Is that a problem? Unfortunately, yes, since our son is severely allergic to eggs. It seems many people, including some manufacturers, don’t understand that other food allergies can be just as severe as peanut.
That takes us to this Thanksgiving. The extended family gathered around dinner. My son took a few bites, got a funny look on his face, and said he wasn’t hungry. That nervous feeling started to grip my stomach. He said his throat felt funny, but he had only eaten some corn and potatoes. I ran into the kitchen rechecking all the labels. Nothing. His upper lip was starting to swell. This time, I told him, we’re going to use the EpiPen. He looked at me like all kids do when you tell them they’re going to get a shot. Then, to my surprise, he asked me to hand it to him. He wanted to do it himself. He did it flawlessly, holding it in place for the slow 10-second count, with a big smile on his face.
We went to the hospital. This time, no drama, no IV’s. They gave him steroid pills he could swallow, and monitored him for a few hours. That was it. Because we (he) acted quickly this time, he was spared more trauma and misery. We left after a few hours and rejoined our family. It turned out there were two batches of potatoes, one with milk, the other without.
The lesson in all of this? Take food allergies seriously. Do all you can to prevent a reaction. Read labels and avoid cross-contamination. Even with all this, accidents will happen. Act quickly. Use the EpiPen immediately. As our son recently proved, it’s so simple to use, even a child can do it.
For additional information:
The Food Allergy & Anaphylaxis Network, www.foodallergy.org. 800-929-4040
EpiPen – www.epipen.com – has an online video showing the proper way to use the EpiPen
Twinject – www.twinject.com – has an online video showing the proper way to use the Twinject
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