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Haven\'t posted in awhile, 11 y/o son had reaction at school today!

18 replies [Last post]
By Cindia on Sat, 05-05-07, 04:43

Hello,

I haven't posted here in a long time. My 11 y/o son Steven had a reaction at school today. His class table group got the highest score so his teacher rewarded the kids with donuts. He ordered a maple bar. After taking the first bite, he thought that it tasted spicy. But, thought that it might be cinnamon. The next bite he had an immediate sensation of a tightening jaw, stomach ache and itchy throat. He tells the teacher who sends him to the nurse.

The nurse gave him 2 teaspoons of benadryl then called our house. As I was in the shower, I didn't hear the phone ring. I discovered later that the message she left was, "this is the school nurse, please call me back." That's it!

She ended up reaching my husband at work. He tells me that Steven had a possible peanut reaction and that he spoke with the nurse and that he was given benadryl and sent back to class. My heart sinks. I ask him the details and when he mentioned the itchy throat, I panicked and said I was going to the school to check him out. (We live around the corner).

When I get there, the nurse calls the teacher and asks him to come to the office again. I examine him. He says his throat still hurts. I call his pediatrician who is not available but his nurse says that Steven should be okay if there is no swelling in the throat. I check the Epi for the expiration date and ask the nurse if she thinks the epi should have been given. The second my son hears this, he freaks and says "I feel fine." I still don't feel comfortable. I call his allergist who is booked for the day but squeezes me in immediately.

By the time we get to the allergist, Steven is sleepy from the Benadryl but otherwise seems fine. The allergist says that the nurse did the right thing. That itchiness can occur inside or outside the body. Benadryl was appropriate and Epi not needed unless he was coughing, having trouble breathing, light-headed, vomiting. She tells us to watch him overnight and continue giving benadryl every 4 hours until tomorrow.
She ordered another Ige/rast blood test for next week. The last one he had was when he was 6 years ago.

I am feeling better. Get home. The pediatrician calls. He apologizes and says that his own office staff should have immediately given him the message. Also that the school nurse was wrong and anytime there is itchiness in the throat, to give the Epi immediately. He said there is more harm in undertreating than overtreating. He also said that hindsight is 20/20 and that now he is okay so it seems like the right decision was made not to give the epi. He also said however, that no one can tell how it might have progressed.

I'm not sure what to do, or who to believe. It seems like the responses up and down the chain were not to expectations. When I heard about the throat being involved, I thought he should have been given the epi. His 2 previous reactions have never involved the throat and he has never been administered the Epi-pen.

I'm looking for comments. Anyone game?

Thanks!
Cindia

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By Peanut Militia on Sat, 05-05-07, 05:43

How soon did she send him back to class? Does he have an Epi in the classroom? I would be hot mad they sent him back with his throat still itching. It sounds like it has been awhile since your son has had a 'bad' reaction.

It is easy for kids to get lax when they have forgotten what an anaphalactic reaction feels like. Isn't there a video on the signs he could watch to help him remember how it could end?

I have always been told if my daughter has injested something with peanuts to use Epi and ask questions later. She is very sensitive--perhaps that is why your allergist wants to IgE test. How comfortable are you with this allergist?

Sorry I answered with questions. I am just trying to help you think through--I know I always overthink things after my daughter has a reaction-I am glad he is O.K. now!!!

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By Cindia on Sat, 05-05-07, 05:56

Hello P,M,

I'm fine with more questions.
"How soon did she send him back to class?" He injested the donut at about 9:15. He was in the nurses office getting benadryl at about 9:25. He was back in class about 10:00.
"Does he have an Epi in the classroom?" No.
My son has not had a reaction since 2002 when he was 6 years old.
The allergist he saw today was part of a "group" and we had not seen her before.
Definitely there has been a loosening of comfort zones over the years. We had even been toying with the possibility that he had outgrown it.
I am upset, but I too could have given him the epi-pen when I got to the school shortly after 10:00 when I was having my doubts.
I don't know about any videos regarding reactions but the whole family is in for a "re-education." After his tests and speaking with his doctors again, I plan to have a meeting with the school nurse.

Thanks for your input. I hope I answered everything.
Cindia

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By Peg541 on Sat, 05-05-07, 06:13

I try to think of itchiness in the throat as hives. Hives are big bumps. Any big bumps in the throat can close off the airway. Therefore I'd use the epi.

For sure it was a known ingestion. Might as well go all the way and use the epi. You have an allergic child with a known ingestion. Using the epi would be second nature in that instance.

We live we learn. That's why we are here. You are right to go over it all with your family. Set down some stiff guidelines and let your son know the epi is his friend not someting to be afraid of.

One thing that bothers me about your story is all of the people that gave you advice. Honestly all the stuff we write and experience here and it all starts with "give the epi."

It is just such a big step giving an injection, you are really admitting something is wrong and maybe reluctant to go down that path.

But the best thing you can do is be safe because PA can be so bad QUICKLY.

I'd rather we all trusted our own instincts and never had to call allergists or pediatricians. That's what we are teaching our kids anyway. Trust your own instincts. They are just as good as a doctor's, especially when the doctor is at the other end of a phone and you are there with your son.

And I hate to ask but why was he eating school donuts in the first place? I don't mean to be confrontational and it may sound that way but this is how we all learn. My son would kill to eat a donut from a donut store. We went in one recently (he's not even comfortable going inside) and there were the peanut covered donuts right there in the display case. One pair of tongs served all types of donuts not to mention those peanuts falling off onto everything.

Good luck. Nice to see you back but sorry it had to be this way. I'm glad your son is OK but he should know he got off easy this time.

Peg

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By Cindia on Sat, 05-05-07, 06:44

Hi Peg (Waving Hi!)
I think you are so spot on with your reply! The biggest issue that is underlying this whole thing is DENIAL! It started out so well...Since the first grade I have packed his lunch everyday. I used to pack treats for his teacher to dole out. That stopped about 3rd grade. Now he is in 5th. He only vaguely remembers his last reaction which was not anaphylactic. Our comfort zones got stretched Waaay out. He has eaten donuts many times in the past with no problems. Like I said, we were even starting to think he had possibly outgrown it.

All a BIG, BIG, mistake! Believe me, I could have just not admitted to all that I have written here, for fear of looking foolish. I don't believe this helps anyone. I know there are others out there in our similar situation and I want them to learn from our mistakes.

ANd you are right. That epi is scary. I have many in the house, at school, in my purse. I have never practiced with an expired one. What's the use of just carrying them around? They go perfectly with my uncharged cell-phone in my purse.

Time to get serious. I am just now coming down from the stress of the day and just am feeling so scared. I feel like crying.

You are right about trusting my own instincts. I should have listened to my self. There were also many thoughts racing through my head at the time. "I must be over-reacting. He is back in class. If I use the epi, I'll have to call 911 and that will be embarrassing and cause a scene. She is a nurse, so she must be right. The principal will think I am hysterical." What also complicates this is I just started as a substitute teacher at my son's school. So the principal is my boss.
I'm just rambling now.

Sorry,
Cindia

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By lakeswimr on Sat, 05-05-07, 13:15

I'm not a doctor but I totally disagree with your nurse and allergist! For *us* itchy throat is an automatic epi injection. Throat hurting is ambiguous but if that meant any *tightness* then it would also be an automatic epi injection.

Also, and very importantly, this incident brings out that your son's school is doing potentially dangerous things. A child who might be having a reaction should not be sent to the nurse or sent back to class. I hope he didn't walk to and from the nurse alone but I don't want my child moving during a reaction because this can speed any reaction.

Also, you must have a clear emergency plan. According to that plan what steps should have been given? The nurse should *not* have to call you but should refer to the plan. If anything she should call the allergist but shouldn't be calling you.

A 6 year old can't necessarily communicate clearly what they are feeling in their throat. Is the nurse *sure* your son didn't have any throat swelling? What caused the pain in his throat?

Our emergency plan calls for the epi if DS has many other symptoms besides those you listed.

I agree with your ped. And I am glad he sees how serious it was that he didn't get the message immediately. In the future I would insist on speaking to the doctor immediately because it was a potentially life-threatening situation.

Reactions can vary a lot. my son has had reactions where he had symptoms that previously weren't there. Past reactions don't predict future ones.

I personally might want to talk with the allergist in person to go over the ermgency plan to be sure I knew it and then would re-train the classroom teacher and nurse.

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By lakeswimr on Sat, 05-05-07, 13:23

I just read your replies to others and I'm sorry. It is hard to face the reality of FAs. It sounds like you are struggling with accepting this reality now. try not to beat yourself up.

I agree with the other posters and the pedistrician. Also, I don't like your school's policy of sending him to the nurse. The classroom teacher should have his epi (he should be wearning them on him) and should refer to the emergency plan and administer if necessary. Children can die walking to the nurse or get much, much worse. Walking during a reaction can speed it. I would at minimum want the nurse to come to *him*.

Also, the nurse should *never* call you to ask what to do. She should refer to a clear emergency plan. Does she have your son's emergency plan? Is it clear of the symptoms for which to administer the epi? Our son's plan calls for the epi for an itchy throat. I might shop around for a new allergist or at least go in and review your son's emergency plan so you are clear when the epi should be given and so you can make his teacher and nurse clear. The amount of fooling around time involved in this incident was dangerous, IMO, had this reaction been more serious (and there is no way to tell once a reaction starts--most of the most serious reactions start with minor symptoms at least at first.)

I would also *not* let him eat things made in places where they make things with nuts. REactions can vary from exposure to exposure so just because he has eaten something fine for years doesn't make it safe. Donoughts are usually made with things that have peanuts and nuts and so aren't safe. I'm sorry. That makes your son different than others and makes more work for you but it will protect your child. (((((hugs))))) I know how having dashed hopes feels.

Best wishes.

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By Greenlady on Sat, 05-05-07, 14:05

Thank you, thank you for sharing your story. I think loosening of comfort zones as kids get older is a common problem and by sharing your story you may have saved another child.

So often, the stories of fatalities seem to be adolescents who had had a reaction since they were toddlers.

So glad that your son was one of the lucky ones. Give him a hug for us!

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By cynde on Sat, 05-05-07, 14:31

Hi Cindia, sorry to hear about your sons reaction, I hope you are both feeling better.

Our DS had a reaction recently and we did the same thing, second guessing whether to use epi or not. I spoke to the pediatric allergist (after the fact) and he gave me great guidelines, for anyone with a known history of anaphylaxis:

WHEN TO ADMINISTER EPI-PEN

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By Peg541 on Sat, 05-05-07, 14:44

Thanks for the reply Cindia.

Every night I sleep with a doctor. I know what he knows, some of it anyway. He had NO training in food allergies.

My research for the last 17 years and my teaching my son make me and of course my son the MOST EXPERIENCED and EDUCATED people in this house re: Food allergies.

Doctor or not my husband is just a regular guy and food allergies are not his field. So you go ahead and trust yourself. And give your son the power and knowledge to trust himself because we are not here forever.

You go ahead and cry and be scared but remember at least you don't have a three year old to work with. Your son is 10 and more than ready to assume the responsibility of his allergies. He'll be fine.

So it's like starting from scratch but you'll be fine.

Peg

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By Corvallis Mom on Sat, 05-05-07, 15:09

Cindia, I am so sorry-- how frightening!

I agree with so much of what has already been said.... but clearly, from my own recent experience.... do as I [i]say[/i] and not as I [i]do[/i] [img]http://uumor.pair.com/nutalle2/peanutallergy/rolleyes.gif[/img]

In any case, I am so glad that your son is okay.

It is hard when they don't have a recent memory of a big reaction to keep them scared straight. So if there is a silver lining, maybe it is this-- your son will now enter adolescence with a clear memory of just how little it takes. If you can use this incident to re-educate everyone well, the timing couldn't be much better. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

And you (like us) will have to squarely face the mental barriers to using epi and move past that fear of 'embarrassment' or whatever it is that stops us in that moment.

{{hugs}} again.

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By McCobbre on Sat, 05-05-07, 15:56

Quote:Originally posted by cynde:
[b]Hi Cindia, sorry to hear about your sons reaction, I hope you are both feeling better.

Our DS had a reaction recently and we did the same thing, second guessing whether to use epi or not. I spoke to the pediatric allergist (after the fact) and he gave me great guidelines, for anyone with a known history of anaphylaxis:

WHEN TO ADMINISTER EPI-PEN

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By Peg541 on Sat, 05-05-07, 16:14

McCobbre we used to spend whole summers at the movies. I used my son's PA to get us all to stop eating movie food. So good and so expensive.

I explained to him that if he was eating in the dark he could pull anything out of that candy box and eat it. You never know when a rogue peanut gets into your jujubees!

It saved us tons of money, made a good habit and kept DS safe.

I miss movie popcorn but it is so much better not mindlessly eating like I had been.

Peg

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By on Sat, 05-05-07, 16:32

Cindia, I'm so sorry to hear that your son had a reaction. I hope he's okay to-day.

I personally think when you're actually dealing with "the situation" - even though you know everything you know and your gut is telling you one thing (or not), there are sometimes mitigating factors that we allow to affect how we deal with the reaction. I think you had a lot of that going on and I'd like to say not to be too hard on yourself. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

When my son had his last reaction (at age 7, anaphylactic), he was also sent back to class by the principal. Then he threw up (which your guy didn't) and the principal called me and told me she was walking Jesse home (we lived across the street then).

I didn't know then that it wasn't okay for him to be walking around. I learned that after I posted the story here. Also, what we didn't do was administer the EpiPen and that was a strange one because the reaction halted itself without the use of an Epi (even at the hospital) and of course, I had to post about it here to ask how that was possible.

As far as the donut - had your son eaten donuts from this place before? We haven't found a "safe" donut shop since moving "back home" three years ago, but my son has also eaten donuts in shops that I knew were peanut free. So, I don't automatically think, OMG, he ate a donut and that's so not okay, KWIM?

If YOU feel that you have relaxed your comfort zone, only you and your family know that. What you'd need to do is examine how you think you've loosened or changed it and discuss how you're changing it back (or even making it stricter) and why.

It's funny (not comical funny), but in the last three years, I had let Jesse eat two "may contain tree nut" products. Then, at Christmas time this year, he decided he was eating a bag of Hershey's Kisses with "may contain trace almonds". I wasn't okay with it and actually wasn't okay with the two times that he ate the "may contain tree nut" products at his Grandmother's home. But, Jess was PA only.

Posted about that here and the conclusion we came to (Jesse and I) was that before I could allow the change in our comfort zone, he would have to be re-tested for tree nuts.
And guess what? He's TNA!

I think it's particularly scary for us to read about reactions of children at your son's age (same age as my son) - particularly if they haven't had one for awhile, because we start to worry if they're becoming daring and if they might become another PA statistic.

My biggest concern doesn't lie with your family and how you'll treat this reaction. It lies with the school and why the nurse sent your son back to class so soon. I think he should have been watched like a hawk.

The only reason I would think (and now know thanks to cynde - cynde, good to see you btw [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img] ) to Epi because of an itchy throat inside is because of something that happened with my daughter a few years back. She was stung by a bee right on her lip and we decided to take her to emerg because after speaking with the pharmacist (across the street from us), he said that it could affect her airways if the swelling progressed inside.

So, to me, like someone else posted, if it's hives making the throat itchy inside, they could restrict the airways.

Anyway, sorry you had to come back and post 'cus of this, but I'm really really glad you did.

[[[[[BIG HUGS TO YOU AND YOUR SON}}}}}

Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

------------------
There but for the Grace of God, go I.

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By alliedhealth on Sat, 05-05-07, 18:58

I have just heard Dr. Burks speak on this exact topic- he said there is variability among allergists on this but based on his research and conservative approach:

Benadryl ok only if very few hives on face alone, no significant other symptoms

Epipen first if: 1. any systemic symptoms, or
2.hives progress/ increase in number or on any other part of the body- or

3.any GI (vomiting and/or stomach pain) or

4. respiratory (cough, voice change, wheezing) symptoms.
Then (after epi-pen)benadryl and to MD, watch for 4 hours

He reiterated epipen very safe in children, much better to overtreat than undertreat especially with potential outcomes.

So sounds like he had GI signs and respiratory=epi-pen to what I can see

Not intended in place of medical advice board certified allergist- for informational purposes only

[This message has been edited by alliedhealth (edited May 05, 2007).]

[This message has been edited by alliedhealth (edited May 05, 2007).]

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By lmw on Sun, 05-06-07, 03:42

These incidents make me worry.

DD has had an itchy throat as her main symptom for both her PA and TNA reactions. Benedryl seemed to work, although she did have continuing symptoms the next day.

We have never seriously considered using the epi at these times, her last reaction was mild but her most serious to date, maybe if we HAD given it, it would have shortened the length of the reaction.

I can see me as one of those waiting for a really clear sign that it's epi time - I just hope it's not too late at that time!

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By saknjmom on Sun, 05-06-07, 13:16

I am very sorry your son had this reaction and I'm glad he's okay.
I have a question about how you all deal with a non compliant child....we added this detail to his IHP this year.
Your son said, no I'm okay when the epi pen was mentioned...
Does anyone have information or permission for "force" if a child is non compliant to receive the epi pen?
My son just turned 9, he's 4'9" and weighs about 90 pounds. He could be difficult to handle physically if he fought receiving the epi pen.
We gave permission to physically restrain him if he will not cooperate with epi injection.

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By Cindia on Mon, 05-07-07, 07:35

Thanks to all who responded. I really needed the support and cyberhugs and the kick in the A$$. I read all the replies and will try to answer all the questions raised.

Cindy, I asked my son about eating these donuts before and he said that he had them once before as a reward. He thought it would be okay if they didn't have peanuts sprinkled on them and no one else ordered peanut topped donuts. Now he swears to me that he will not eat these mystery baked itmes again. His teacher sent a brief e-mail to me saying that from now on he will offer homework passes and other non-food rewards to be on the safe side.

The issue of non-compliance and restraint for epi-pen use is something that had never even crossed my mind. I will bring this up with the family and doctor and school.

Also, my son was escorted to the nurses office with another student. It did not occur to me either about the walking part. Yet another issue to think about.

That's it for now.

Thanks to everyone!
Cindia

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By that'smetrying on Mon, 05-07-07, 18:57

Hey Cindia, hope you are feeling better...two things to think about, 1. the nurse should come to your child, not the other way around.

2. My son is 7 and 75 pounds, his doc recommends 4tsp Benedryl for hives and slight tingly feelings followed up by 3 tsp of Prelone steroid. Just a thought that you son's benedryl dosages may need to be changed.

Hope you and your ds are feeling better!

------------------
mom to Ari(7) - severe nut allergies, asthma, you name it - and Maya (9), mild excema

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