#255340 - 04/29/08 01:04 AM
Could use some reaction feedback...
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KSLaru
Registered: 03/28/08
Posts: 65
Loc: MO
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Tonight we made our first trip to the ER and I'm needing some moral support.
Here's the scoop:DD walked around the block with a neighbor girl, and when they got back to the neighbor's house, they disappeared inside. I was with my other daughter and the neighbor's father outside. They were about to eat, and I wasn't going to let DD stay for dinner. The father goes in to get DD, and about 10 minutes later she comes out. I immediately notice her cheeks are very red and hot. We get home and have her wash hands and face with soap and water, but the redness continues and now her throat is feeling itchy and tongue feels "funny". She says she didn't eat anything or put anything in her mouth, only used the bathroom and washed hands. We give Benadryl, but then I grab our new action plan, which I haven't had a chance to go over with DH yet. Based on it, we should give epi, but I'm hesitant even though I think we should. DH doesn't want to...wants to stick with Benadryl like usual and wait. 40 minutes later, cheeks are still pretty flushed and tongue still feels funny, so we gave another teaspoon of Benadryl (3 total now). 20 minutes later, DD is so sleepy and I don't want her to sleep, so I offer dinner. She eats some, but then says she feels like she is going to be sick. That does it for me and I want to take her to the ER, plus give the epi. DH doesn't want to do epi because she is "looking better" and didn't eat any PN. Then I remember the blood pressure issues with anaphylaxis and DD's sleepiness and insist on going to ER. I almost pulled over on the way to give the epi because she was nodding off so much. We were quickly seen in the ER and all her vital signs were normal, and of course she looks good with no symptoms due to all the Benadryl. We stayed 4 hours, but by hour 3 her cheeks were starting to flush again, sneezing, itchy eyes and patches of skin. We were given a steroid there, and are to follow up in the AM with our allergist. Now DD is okay.
Here's my issue - the action plan is supposed to take all this guesswork out of it, but I still am nervous about giving the epi! At least this time we made it to the ER, but the doc there said we were okay to not give the epi since she was "fine". Of course that reinforces DH position, even though it does not agree with the allergist. It also doesn't help with my not wanting to "overreact." DH plans to talk with the allergist for more explanation.
I guess I just need to vent to folks who go through this. How have the rest of you handled these situations? With the info I have now, I don't like the whole "wait and see" scenario, but since it's what we have done before and been okay, I can see we will have trouble jumping right to the epi. This is also going to be the plan for school, so if we get a call from school and we question the plan, that will defeat the whole purpose! My head is just swimming with concerns now since she reacted this way to who knows what amount of PN that she didn't even eat!
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#255356 - 04/29/08 03:07 PM
Re: Could use some reaction feedback...
[Re: KSLaru]
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Krusty Krab
Registered: 04/20/07
Posts: 210
Loc: Planktontown, USA
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Let me start by saying how sorry I am that your DD had a reaction. How very scary for your family, and for her. I'm glad she is alright.
I immediately notice her cheeks are very red and hot. We get home and have her wash hands and face with soap and water, but the redness continues and now her throat is feeling itchy and tongue feels "funny".
Cutaneous symptoms, possible swelling going on.
40 minutes later, cheeks are still pretty flushed and tongue still feels funny
Cutaneous and possible swelling continues after 40 minutes and benedryl.
She eats some, but then says she feels like she is going to be sick.
Gastrointestinal symptoms.
What you have described above is considered anaphylaxis. This was most definitley an epinephrine worthy reaction. I understand that it may be unsettling to have to give a shot to your child. However, reactions like these can cross over to the point of no return very, very quickly. I'm going to give you my honest opinion. You should have epi'd her. Period. Your daugther needed it. Children do die from well intended parents or caregiver who use the wait and see approach, and I assume you know that. Please take time to re-read articles and stories of those who did not receive a timely injection of epinephrine. And remember that you are modeling behaviors for your daughter. None of us here (i assume) would ever want our children to utilize the wait-and-see approach if they were old enough to be on their own. It is always better to give the epi when in doubt. always.
Then I remember the blood pressure issues with anaphylaxis and DD's sleepiness and insist on going to ER.
Yes.
We stayed 4 hours, but by hour 3 her cheeks were starting to flush again, sneezing, itchy eyes and patches of skin.
possible biphasic reaction
but the doc there said we were okay to not give the epi since she was "fine".
ER docs are NOTORIOUS, IMO, for bad allergy advice. What awful advice he gave you. In fact, I'd call the head of the hospital suggesting a review of the importance of timely epinephrine.
It also doesn't help with my not wanting to "overreact."
KS, you have got to stop thinking that you are overreacting. You are your daughters only lifeline. She's counting on you and your DH. That jab is a 10 second event... living without your daughter is forever. KWIM? Of course I know you understand what I'm saying, although it might not be what you're wanting to hear. I'm sorry that your DD had such a scary reaction. Putting all of this in perspective can be hard, but I encourage you to work through this and my hope for you is that your future decisions favor agressive actions in regards to treating anaphylaxis. Of course, this is just my honest opinion of the events.
Hang in there KS. It's not easy. I'm so glad your family took her to the hospital, and that she is alright. I'm sorry if my post seemed too bold, it's scary for me to read these reaction stories.
_________________________
I'm not a doctor, see your own for advice.
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#255358 - 04/29/08 03:24 PM
Re: Could use some reaction feedback...
[Re: KSLaru]
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SkyMom
Registered: 10/27/01
Posts: 459
Loc: Canada
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I am also sorry to hear about your dd's reaction and your family's ordeal. I totally agree with Krusty Krab on this one. I hope your dd is feeling better today.
Edited by SkyMom (04/29/08 03:26 PM)
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#255361 - 04/29/08 05:09 PM
Re: Could use some reaction feedback...
[Re: SkyMom]
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nutty1
Registered: 02/24/08
Posts: 56
Loc: IL
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I also agree with Krusty.. Although, I can understand your hesitation. I am a nurse, and I give intramuscular injections to people on a DAILY basis. The thought of having to give my son an injection with the epi-pen causes me anxiety, and I hope that its something I never have to do. Although my brain knows that giving epi is the right thing to do when necessary or when in doubt, I have this thought in my head that if I ever have to give him the epi (he's 5 years old), that I'm going to have to have 1 or 2 people hold him down while I stick this needle into his muscle and hold it for 10 seconds, and that this is going to be a very emotionally traumatic thing for him to endure. Now, I realize that it may be necessary, and maybe it won't be as bad as I have created this scenario in my head, but I can understand your hesitation. The fact that I am hesitant (being a nurse that gives a lot of injections), I would imagine that not ever having given someone a shot would just compound your hesitation.
Another thing that you mentioned that I wondered about was you giving 3 DOSES of Benadryl?? That is a lot of Benadryl! I don't think that people realize how VERY sedating Benadryl actually is. Benadryl, aka Diphenhydramine, is the dominating ingedient in most over the counter sleep aids- Tylenol PM, etc. Another way of looking at it is that these sleep aids are just Benadryl with another name slapped on it. I would never give my child 3 doses of Benadryl, in fact, I don't think I would even give 2 doses, I would go right to the epi after I if symptoms came back.
Krusty, are you an MD? RN?
Edited by nutty1 (04/29/08 07:00 PM)
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#255376 - 04/29/08 11:41 PM
Re: Could use some reaction feedback...
[Re: nutty1]
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KSLaru
Registered: 03/28/08
Posts: 65
Loc: MO
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Thanks for everyone's input. You all mentioned things that were in my head at the moment. I knew we should give the epi and was ready to do it, even though I was nervous about it. DH says he understands everything about the allergy, but I don't think he truely does. He thinks since we have been fine before, we would be fine this time. I know past reaction does not predict future reactions, and that timeliness of epi administration is linked to positive outcomes. I tried to explain that, but until he reads that from someone other than me, I don't think it will really sink in.
That being said, we saw our allergist today for follow up and he said we should have given the epi as well, based on symptoms even if we didn't know what triggered the reaction. PN is the only thing DD reacts to like this, so it's a given to me. He validated the info each of you have offered and what I also knew to be true.
nutty1, DD is about to turn 5, and based on her reaction when I mentioned giving the epi, I would probably need someone to hold her down as well! She was pretty anxious all around since she had never been to the ER before. She's been in the hospital with me plenty of times since I work there, but for some reason she thought I was going to leave her there! :( You could see the relief in her face when I told her I would never do that! At least now she's had that experience and won't be as scared next time. As for the Benadryl, based on DDs weight, a dose is 2 teaspoons, so we only gave her 1 and 1/2 "doses" vs 3 "doses". I appreciate your concern.
Krusty, your input was not harsh at all - just the truth. I know I wasn't overreacting, but sometimes you start to wonder when questioned, KWIM? Everything you mentioned reflects my thinking at the moment that I couldn't get DH to understand. As for the ER Doc, I agree he did give bad advice and I'm glad DH wasn't there to hear what he said!
I would like to think this would have gone better if I had a chance to go over the new action plan with DH before an actual incident.
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#255384 - 04/30/08 09:34 AM
Re: Could use some reaction feedback...
[Re: KSLaru]
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Krusty Krab
Registered: 04/20/07
Posts: 210
Loc: Planktontown, USA
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As for the Benadryl, based on DDs weight, a dose is 2 teaspoons, so we only gave her 1 and 1/2 "doses" vs 3 "doses".
I wondered this too. Thank you for pointing it out.
And no nuttty1, I'm not an RN or MD.
I would like to think this would have gone better if I had a chance to go over the new action plan with DH before an actual incident.
I'm sure you're right. Reactions are scary, no matter what.
_________________________
I'm not a doctor, see your own for advice.
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#255426 - 04/30/08 11:07 PM
Re: Could use some reaction feedback...
[Re: Krusty Krab]
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cristym
Registered: 11/19/07
Posts: 150
Loc: Pennsylvania
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I will never forget my Drs response when I asked about knowing when to use the epi pen.
"Use the epi pen and call 911 any time there is known or suspected exposure to Peanuts or Tree Nuts. Do not wait, by the time you are sure that you need the epi pen, it may be too late."
Edited by cristym (04/30/08 11:10 PM)
Edit Reason: spelling error
_________________________
Cristy
DS 9 PA, TNA, Oral Allergy Syndrome
DD 3 PA, TNA
DD 3 no known food allergies reflux and eczema
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#255523 - 05/04/08 04:13 PM
Re: Could use some reaction feedback...
[Re: KSLaru]
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KSLaru
Registered: 03/28/08
Posts: 65
Loc: MO
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I just wanted to update. I talked with the neighbor girl's parents, and they didn't have anything with peanuts to eat last Monday night when all this occurred. I should say, as far as they know. The father even said they don't usually eat peanuts and rarely eat PB. I do know they have candy around, though. He did mention they had a party 2-3 weeks ago, and I think he hinted that maybe there were some nuts at the party.
Here's my theory - if they had nuts (again, I'm not for sure), maybe someone rinsed their hands w/out soap and dried them on the bathroom towel. It sounds a little far out to me, but since all DD did was go in the house, use the BR and wash hands; and upon returning to my home (5 houses away) she was already red and puffy on her cheeks. And I have to remember, this is the same kid who reacted when getting her hair cut and the stylist had eaten nuts earlier but "knew she had washed her hands."
Does anyone else get reactions like this? From this hard to imagine minute amount of PN protein? It honestly makes me quite nervous to visit friends' homes. I'm really surprised she hasn't reacted from carts at the grocery store or Target before since she seems so sensitive. Our allergist asked if I thought it could be anything else because he wasn't really sure if it was PN, but she doesn't react like this to anything else.
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#255525 - 05/04/08 05:02 PM
Re: Could use some reaction feedback...
[Re: KSLaru]
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Krusty Krab
Registered: 04/20/07
Posts: 210
Loc: Planktontown, USA
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The father even said they don't usually eat peanuts and rarely eat PB.
Well we all know how difficult it is to keep a nut free home. It takes alot of label reading and even a phone call or two. So his statement doesn't mean much to me.
I don't think that this necessarily changes anything as far as how you manage the allergy. You're carrying epis and benadryl no matter if you go to a friends house or the grocery store. Of course the nature of the allergy, possibly more sensitive than most, might make you pause.
What did the allergist leave you with? A big 'I don't know." or "Let's test for other allergies."??
One last thought, could it have been the soap?
_________________________
I'm not a doctor, see your own for advice.
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#255611 - 05/08/08 12:48 AM
Re: Could use some reaction feedback...
[Re: Krusty Krab]
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KSLaru
Registered: 03/28/08
Posts: 65
Loc: MO
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I agree, I won't change anything as far as how we manage the allergy. I now ALWAYS have Benadryl and epis with me. I say "now" because before talking with Chris and doing additional reading, the only time I wouldn't take them was on my work days since preschool has all the meds and we live about 10 minutes away. If I had a concern, the meds would be there and the hospital is across the street. I make no exception now.
As for the allergist, he seemed that he didn't really know. He did ask if we gave the epi, and I had to admit no. He did agree with my idea that even if we don't know what caused the reaction, if the symptoms are present we should go with the plan. I got the feeling he thought maybe it was pollen related, and he mentioned possibly skin prick tests for that if DD didn't respond to Claritin or Zyrtec.
I hadn't really thought about the soap. I don't remember what they have, but DD doesn't usually have issues with that kind of stuff. Of course things can always change.
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