Can you help me straighten some things out?

This is one of the many problems that are faced by parents and teachers when caring for the food allergic child.
I think your allergist should be able to give you some good advice on this, if you have been advised to always use an anti histamine first , and use epi-pens if child is not responding then tell the school staff exactly that.
However on a differant note, allergen rubbed in to the eye can cause an anaphylactic reaction. Swelling , esp facial swelling should always be regarded as a serious symptom. There is no harm in taking a child to the hospital to be monintered for a while , as a stronger reaction may sometimes occour hours later.
Its clear that you need medical advice so that you can be sure that you and your sons teachers are fully informed on the management of allegy.
I wish you good luck and point out that so far I am still encountering some problems with my sons school, and its a total pain in the whatsit!!!!
bye sarah

This is a great question, one that I am trying to figure out an answer to also.

Could the school nurse always monitor your childs blood pressure after giving benadryl until you arrive? Or is this not safe?? I will be asking my allergist for alot of guidance here. I hope others on this board can share their thoughts on this too. Thanks,

Jill

williamsmummy,

I would ask my allergist, but she has already given her "list" to the school - pretty generic, IMO. I have given my "list" as well, but think it could use some focus. It's just so hard to explain to them - when you live with it 24/7 it becomes second nature. I want to refine our "list" (of symptoms and their treatments) to something more user-friendly. Don't know if that's possible.

There are some cut-and-dry scenarios, but some aren't so easy. Like the swelling I mentioned above. I've never dealt with that, so I really don't know what I would do. If it was the ONLY symptom, I would probably just Benadryl and watch, but I don't know, so I don't know what to tell the school in that situation. I'm pretty sure the allergist's "list" says to Epi if 2 or more symptoms are present. I'll have to double-check.

We have already met with the school several times and think we have things spelled out pretty well, but these kinds of questions pop into my head from time to time, and throw me into a second-guessing frenzy.

Jill,

As for the nurse... she is barely ever there, so she will be of very little help. As a matter of fact, I think the most crucial person in the equation is going to be the secretary. She is the one who will make the call home and monitor my child until I get there. Good luck to you in your endeavor, too!

This is such a tough thing as I wrestle with this myself. I mean you don't want to be in a situation where someone questions giving our children epipens/ER trips everyday.

Our nurse is full time so any situation in which a reaction is suspected, he will be escorted to the nurse for observation. The nurse and other VIP's will have his prior reaction history which includes hives, but these were hives like no other. I have never seen a person's body progess into hives like Ryan's did last January when he ate Kellogg's cereal. That's not to say the hives in the future won't be mild, but as I told my mother, his past reactions have been quick with physical symptoms that stand out--profuse vomiting, severe hives, mild to moderate wheezing.

This probably isn't much help at all, but perhaps there isn't really an answer. Just educate people the best we can with whatever information we can provide. I don't know...

Here's what we came up with last night:

** SIGNS OF AN ALLERGIC REACTION**

Mouth: Minor: itching, tingling
Major: swelling of tongue, swelling of lips or mouth, difficulty speaking or swallowing, excessive salivating or drooling

Throat: Minor: light annoying cough
Major: itching or tightness in the throat, hoarseness, difficulty breathing, excessive throat clearing

Nose: Minor: sneezing, sniffling, runny nose

Eyes: Minor: itchy, watering
Major: swelling around the eyes

Skin: Minor: itchy rash, hives, eczema flare-up, generalized flushing of the skin
Major: swelling extremities

Gut: Minor: nausea, abdominal cramps
Major: nausea, diarrhea, vomiting

Lung: Major: shortness of breath, coughing, wheezing, labored or shallow breathing,

Heart: Major: weak pulse, dizziness, low blood pressure, rapid heartbeat

Behavior: Major: weakness, sleepiness, sense of impending doom,loss of consciousness

** The severity of symptoms can change quickly and can potentially progress to a life-threatening situation. Allergic reactions are very rapid. Continual observation is necessary.

**ACTION FOR UNCONFIRMED EXPOSURES**
1. Observe, checking for symptoms, for two hours.

** ACTION FOR MINOR REACTIONS**
1. Give medication: Liquid Benadryl Dose: 2 tsp Route: orally Frequency: every four hours
2. Call emergency contact.
3. Observe under supervision for 1-2 hours.

** ACTION FOR MAJOR REACTION**
1. Give medication: Liquid Benadryl Dose: 2 tsp Route: orally
Administer EpiPen Jr.
2. Call 911 (rescue squad) request advanced life support and epinephrine.
3. Call emergency contact.

*****************************************

What do you think? (This is done on a chart so it's a lot easier to read/understand.) I know everyone's plan is different, but does this generally make sense to you?

Thanks for any input. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

[This message has been edited by Lam (edited August 20, 2002).]

Lam --

Just a quick thought. What about deleting "Allergic reactions are very rapid"? My thought is that leaving out that sentence might ensure that someone will watch a bit longer/more carefully in an uncertain situation (while they are getting ready to "call" it) if they are keeping the other two sentences ("Can change quickly...Continual observation is necessary) in mind, rather than thinking that, if it isn't happening fast, it may not be happening.

Just my .02. Let us know how it goes!

--Sue

Sue,

Thanks for pointing that out and for responding so quickly!!

Those few sentences were taken directly from the paper our allergist provided to us for our school (the one I said was "pretty generic"). What we did was blend our "long" list with her "generic" one. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]

I agree, that sentence could be misleading. Thanks again! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Under Action for Major Reaction, I would list GIVE EPI PEN first, before benadryl and put it in bold. I want people to know that despite all of the information on the chart, the most important thing to get correct and remember is the epi pen. Thanks so much for posting, I am going to use all of it!

Jill

Jill,

"Eagle Eyes!!" Thanks for catching that!! I can't believe we didn't!!

Again, this was on the paper from the allergist's - IN THAT ORDER. I agree - Epi should be given first in a major reaction.

Another thing (that we DID catch) on the paper from the allergist: "swelling of lips or mouth" was under Minor. We didn't agree, so we moved it to Major on our revision.

This paper will be used as the "alert" paper for subs and the info sheet for those who need it on a day-to-day basis at school. It will also show our son's name, etc., note his allergies, and have his picture on it. And our phone numbers are listed after "call emergency contact".

Thanks so much!! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

[This message has been edited by Lam (edited August 20, 2002).]

Our allergist recommends the benadryl-before-the-epi protocol, unless of course our daughter is unconscious. I believe the thinking is that since the reaction is being caused by a massive release of histamines, that to get something into the system to stop them is imperative. Of course the epi is followed just minutes (if not seconds) later, to help counteract the effects of all that histamine.

[This message has been edited by KWest (edited August 20, 2002).]

That is great Lam! My son has cold urticaria and often has a few hives on his face and hands after playing outside in the fall, winter and spring. I have always wondered how approach this problem. I am hoping with his daily dose of Zyrtec that this is not going to be an issue this fall.

As someone mentioned, it seems that every allergists' protocol for suspected ingestion is different. My allergist recommends giving the epi with any of the other symptoms ALOMG with sneezing. My son's iniital (and only) reaction started out with profuse sneezing followed by vomiting, hives, and throat constriction. My allergists' opinion is that giving the epi after a suspected ingestion would be better than not giving it and going straight to anaphylaxis. We are just starting public school, so we'll see how this works. That was the plan at my day care as well, and they never had to administer the epi. Of course, if the epi becomes excessive, we'll have to look at again. Go figure!

Stay Safe.

Raising. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Raising.

i'm a bit confused because our former allergist said, "benadryl before epi". our new pediatric allergist firmly says, "epi and then benadryl. period."

joeybeth -

Our final copy reads with the Epi first, then the Benadryl.

For our situation, that makes better sense to me because our son will be wearing the Epi on his person, while the Benadryl will be in the nurse's office.