use/not use epi

I have told school and daycare personnel that when in doubt, use the epi-pen (have said the same thing about the benadryl for lesser reactions.... itchy eyes, one or two hives). I have stressed that the epi-pen won't hurt him, but to delay treatment may kill him (my son).

i have asked for written instructions from my allergist on when to use both. based on my conversation with the nurse, i am afraid to give them to my school. as i read this i am just getting madder and madder. i am making an appointment with another allergist in the am, i tried to ask her what will happen if i use it and i am unsure.. she said well unless he is having trouble breathing..just give him benadryl. thanks for taking the time to post this. it is very helpful information. julie
i assume that after we give him the epi that he then goes to the er no matter what?

Epinepherine increases the heart rate, so you should always go to the ER after administering it.
Also, one shot may not be enough to completely avoid the reaction, so it is important to go to the ER where the medical staff can keep an eye on the reaction, heart rate, etc.

Gwen

[This message has been edited by Gwen Thornberry (edited March 10, 2000).]

Just a note that the GPS that Canada refers to is probably a typo for CPS: Compendium of Pharmaceuticals and Specialties. It is a listing of all pharmaceuticals and specialties licensed for use in Canada. There are similar pharmacopeias in use in the US. In Canada, all doctors, hospitals, pharmacies and public libraries should have the CPS.

I've been told that in a reaction you should always give the epipen then go to the ER. Perhaps this is because my daughter has already had an anaphylactic reaction. The doctor advised against Benedryl as treatment since it could alleviate the symptoms, but then the anaphylaxis could return with a vengence very quickly. I was also told that the heart rate would speed up, but in children (under 18) this is not terrible dangerous. I guess it can pose a danger to adults. Not medical advise to others...this could just be for my situation since we have already dealt with anaphylaxis.

Kathryn, thanks for picking up on the typo!
I should always double check my typing. I made that post so readers, especially new parents relasize that they probably don't know enough about the epi-pen because they forgot to ask, an heavens knows the allergists don't exactly tell youeverything you need to know. Some allergists are also out of date with their own knowledge of what should be done during a reaction. It is always best to check with the allergists. Read the CPS if you really want to know why epi can be a problem for adults, ot heart patients.

Thanks for this information. The part that is really disturbing is that Benadryl will cover up and then full blown ana could come on. Didn't know that. For us, it is a difficult situation. My son has a reaction nearly everyday. Some seem quite serious, but I have never used the epi. I am a bit desensitized. I hope I never have a situation where I should have used it but waited too long.

andrea

Hello everyone! The subject of epi-pen is a very serious one. I myself was not sure of when to use this for my son. My doctor told me how to use it. But failed to explain the specifics of when it is necessary. Not until I becamed trained as an Emt did I understand the whole of it. My suggestion is to anyone who may be required to help administer an epi call your doctor and get specific directons as to the signs and symptons to be aware of and when to administer. Doctors sometimes assume that you know because you don't ask. That is not always the case.

My son had a reaction last night (we're not sure to what). He started with a few hives and grandma (he's staying at my parent's house for a few days because of a chest cold) gave him Benadryl (our standard for hives), but the reaction just got worse. She paged me and I had her take him to ER where he ended up getting a shot of adrenline. My new rule based on what happened is that within 20 minutes, Benadryl is not helping... Epi-Pen him. And one of our other rules is that any time we have to use the Epi-Pen, he gets a trip to the hospital! Quesion... when is it anaplyactic and when is just a bad reaction???

My son and I got back from his allergiest yesterday (he got a RAST test-still waiting for results).

I asked about the use of his epi pen.

I was told that the epi pen injected in the outer thigh will not go through a pair of jeans or sweat pants. Only very light-weight summer pants.

I have never needed to admister an "epi" and I would like to hear from other parents who have and whether or not it went easily through their clothes.

[This message has been edited by Lola J (edited March 23, 2000).]

It went through a pair of jeans on my son. My allergist said the needle is very sharp, and as long as you jab hard enough, it will work.

[This message has been edited by kristene (edited March 23, 2000).]

Epi question is a difficult one for those of us who have not experienced an anaphylactic attack to date. In regards to Benadryl, we've been told not to use it for this since it may "mask" or hide some symptoms as opposed to solving the problem. Sort of like a painkiller soothing the pain temporarily. However, you don't want to hide any symptons that can be deadly. You want to know about all symptons in order to determine your course of action in event of an attack.

I wrote about this on another board here and was pooh poohed, since so many have been told to use Benadryl by their doctors or allergists...but I don't think i would ever use it for this kind of allergy...don't want to hide any symptoms...only common sense to me. And just cause many many others are doing it doesn't make it correct!
Hoping never to have to use the epi!

I think of Benedryl as part of the treatment, part of what is needed to control the reaction. My son's latest reaction (1st anaphylactic for us) was not "masked" by the Benedryl. It was a serious reaction that couldn't be stopped with just the Benedryl, so we used the Epi and went to the ER. I don't agree with the "masking" theory. I see the Benedryl as part of the treatment process. (No "pooh-poohing" intended!)

[This message has been edited by Tammy James (edited March 27, 2000).]

When I asked our allergist about using Benedryl he said to think of it as a wooden table on the train tracks trying to stop the train. Luckily we haven't had to use either but do worry which one I would choose and whether or not it would be the right choice. I think it would be easier if there were hard and fast rules about this and each doctor were consistent.
MIchelle

Hi Everyone-
About the Epi pen and when to use it...
Here's my experience...
Just this past Friday, March 17th I went in for allergy testing to see just what was in those girl scout cookies that set me off a few weeks prior. Since I had to change my PCP in order to get a referral to an allergist and I had been getting allergy shots through my PCP's clinic- I decided to just go for it and get re-tested on all my other allergies at the same time. So this was not only food but pollins, dogs, cats etc. Well we started testing and the scratch test on my arms didn't reveal much so they went to the next step which is the bubble under the skin test on my upper arm. Well- I went into anaphylactic shock on the test! They said my face went white then greyish and they couldn't get a blood pressure. I didn't feel much of anything except that my arm was itching under my armpit and the skin on my neck was starting to itch. I didn't feel any of the tongue swelling or have any of the coughing I had with those cookies. They came at me with a huge needle of epinephrine in my arm and made me take 3 prednizones. They also called 911 and when the ambulance got there they gave me an IV of
solu medrol (another prednizone). They also gave me more epinephrine because I began to choke after they had me in the ambulance but before we rolled out of the parking lot. They also gave me IV benadryl (Huge dose). After that I passed out- The benadryl is powerful in IV form. So anyways- they had to change hospitals in-route because I was in such bad shape and go to a closer one then they had told my Dad origionally. (My poor Dad got to the hospital only to have to turn around and head to a different one when he found out I wasn't there.) So here's what I think...
It was different for me both times. The second time it came on almost in more of a stealth like fashion- I was totally unaware and actually thought the nurses and doctors were overreacting to my whealt on my arm. My senses were fogged due to the drop in blood pressure and I couldn't really think straight. I do remember that my mouth felt really dry and that's supposed to be something to watch for. I've been concerned because we never were able to find out what set me off even on the test yet since they had to end it so quickly. The cat prick was what set me off on Friday. They just drew blood a couple days ago for a Cap Rast that they're sending to the Mayo Clinic in Rochester N.Y. and I'm told it will be 2-3 weeks before we know on the food in those cookies. Peanuts? Choc? Who knows! My allergist told me when I asked- Since she prescribed three epi pens to me- She said that if I feel anything weird enough to make me even question if I'm having a reaction or not- to go ahead and use the epi pen and call 911. She said it only really buys you about 10 to 15 min max and since it took them two shots on me that I need to be right on top of it. The pharmacist told me to keep one of my prescription strength benadryls inside the case of the epipen and take one right when I shoot myself. I've also heard that drinking the elixer even works faster. About masking...(not to poo, poo the issue either) but I'm sure that if I hadn't gotten the benadryl down when I did with the girl scout cookies I don't think I'd be here today since I didn't have an epi pen yet at the time and the elixer took the swelling right down in my tongue and throat also bought time for the actual pills to take effect. Alone- I don't know if it would have worked- since I already had a claritin and sudafed in my system when I had the reaction. I hope this helps. Colleen [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

I had also read about Benadryl "masking" the symptoms, so when my son had a reaction to an unknown substance at school three weeks ago, I asked the doctor at Children's Hospital in D.C. We had used both the epi and benadryl before taking him to the hospital. The doctor there advised to use both, especially if we believe there may have been a peanut exposure, and then immediately head to the hospital. There is a danger of secondary reactions occurring, so maybe that is what people are referring to when they say it "masks" the symptoms? We will continue to use both, if it should occur in the future.

Hey folks, first off, the "pooh poohing" was just a little humour to have a little fun with this serious topic.
Secondly, we have never had any reaction to date and my opinions were stated based on speculation of how we might react in a situation.
But let me make one thing clear.
1) If one does not have an epi, and only has benadryl, then i understand using it.
2) If one has both and decides to use both the epi and the benadryl, then i understand using it.
3) If however one has both, and has the intention of only using the benadryl (and assuming syptoms clear up with this) do not follow up with a visit to the emergency, then i strongly disagree using the benadryl.

My intended course of action would either be to use nothing (perhaps if there was one or visible small hives or similar) and then visit the emergency room as a follow up, or use epi and visit emergency room.
Again, I fear that if i used the benedryl on my 4 yr old and the couple of hives etc. went away, they may come back with a vengence later whereby time might be more important.
And i wouldnt want to "mask" any symptoms or simply temporarily clear the symptoms.

Anyway this is my opinion, and I welcome any information or logic to counter this. Please educate me if i'm wrong in my view and i'll change it! After all, we're just trying to keep our kids safe right!
Stay safe!

This is for Redtruck...
I totally agree!!! I was at the allergist office today and asked her point blank about this topic. She said- Use the epi pen- It'll save your life!!! She said if you want to use the benadryl- that's ok too- but the epi pen is what will save your life and to use it first and immediately call 911 for a trip to the E.R. from your friendly paramedics. She didn't think the masking was a problem probably because she's assuming you're following her directions of having 911 take over from there and that they'll be able to give you more epi if need be etc. Colleen [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Our allergist said any time breathing difficulty is present - use the epi-pen. He also said the Benadryl should be given also.

This a topic I was very concerned about when we went to the allergist with my daughter after her reaction at 14 months. I was told to use Benadryl if it appears to be a mild reaction; i.e. a few hives. However, if there is any kind of "disfiguring swelling" (my daughter had extreme swelling of her lips and face) use the epipen right away. I was told if you wait until there is actual breathing difficulty it could be too late. I guess the bottom line is if there is any question, use the epipen. My daughter has not had a second reaction so I have not been in a situation where I had to decide, and I am sure it is a scary prospect to use the epipen, but when your child's life might be at stake I don't think any of us want to take any chances.

That is interesting, thanks for the advice you received. My daughter experiences breathing difficulties immediately, so I am confused again. I would hope breathing difficulties does not mean it is too late. We live 25 minutes away from a hospital. I also have read many times that epi-pens last 15 minutes, but my allergist said it could last only 5 minutes. Has anyone else received that information?

REgarding the "Masking" effects of Benadryl - my understanding is that this refers to the sedating properties of Benadryl. If you give the Benadryl, and the patient starts acting sluggish/sleepy/lethargic - however you want to describe it - it may be difficult to determine whether they're just getting sleepy from the Benadryl or becoming disoriented, etc. from the drop in blood pressure that signals anaphylactic shock.

Shawn,
That is my biggest question with Brett's first reaction. He was close to bed time so I know he was tired, then I gave him the benadryl and then when we were on the way to the hospital, he was acting very sleepy. He didn't act that way once we got to the hospital, but I still wonder if he had a drop in blood pressure. They took it when we got there and didn't say it was low.