When should I use the Epi pen?

You're going to find that there is not one answer to this question.

Where my PA son is concerned, I follow exactly what his pediatric allergist told us. At the first sign of a reaction, in Wade's case it was hives and facial swelling, we are to administer the epi, call 911 and administer Benadril. His reasoning for the prompt action is that given the nature of peanut allergy, no one can tell if the reaction will be severe, prescious time may be lost waiting for a reaction to progress, things can go from mild to severe in a matter of minutes. Giving the epi early can save a life.

Now, this is what we do, but others may have different opinions. Hope this helped some.

Regards,

Katiee (Wade's mom)

My allergists written instructions (form letter type) for Philip are:

If child experiences mild symptoms of:
- several hives
- itchy skin

Give (dosage) of Benadryl. Stay with child and watch for more serious symptoms.

Symptoms that progress can cause a life threatening reaction: Severe allergic reaction
- Hives spreading over body
- Wheezing, difficulty swallowing/breathing, swelling (face/neck), tingling/swelling of tongue
- Vomiting
- Signs of shock (extreme paleness/grey color, clammy skin, etc.), loss of consciousness.

Treatment:

1. Give Epipen Immediately
2. Call 9-1-1 Immediately
3. Get to emergency room

He also said that a severe reaction could involve only one of the symptoms listed above or multiple symptoms.

As for Philip - he didn't vomit, I assume it's because the peanut protein wasn't ingested but was absorbed by his mucus membranes around his eyes and nose. His reaction included major hives and facial swelling but no mouth, tongue or throat swelling; major rhinitus; general distress - couldn't stop crying; severe drooling.

As an aside - if you ever need to use the epipen and call 9-1-1 be sure to tell the dispatcher to have the ambulance carry epinephrine (possible anaphylactic reaction). Only 11 states have ambulances that carry this med as a matter of course. The rest of the states emergency response ambulances need to be asked to bring it when necessary.

Hope this helps clarify things for you somewhat.

I thought I would post a copy of Cayley's Emergency Plan, which I laminated and gave to her Nursery School. The laminated card sits beside her EpiPen and Benadryl:

~~~~~~~~~~~~

CAYLEY

This whole issue is rather confusing to me as well. We have been instructed to administer the Epi-Pen at the earliest possible signs of a reaction (no matter what those signs are) and then call 911. I'm sure I would do just that if I knew for sure that Ryan was exposed to a Peanut or Tree Nut. But that's not always the case. Reactions can occur when it's hard/impossible to discover the source.

Do I administer the Epi-Pen immediately even if I can't identify any reason why Ryan might have a scratchy throat or a rash? I feel I would be reluctant to do so. I just don't like the idea of sticking him with a needle when I'm not sure he needs it. I'm not queasy about it. It just goes against my nature.

At the beginning I too was confused by the medical community.

After Philip's initial ANA reaction and treatment the hospital sent us home with a prescription for steroids and a recommendation to avoid peanut butter (not peanuts), the sun and chlorine. His first reaction happened after my daughter's swim lesson so they really weren't sure what caused his reaction. They didn't even recommend that I contact his doctor for follow-up, which I did immediately anyway.

His pediatrician prescribed an epi-pen as soon as she heard of his reaction (prior to our appt.) and told me to pick it up at the pharmacy ASAP. She took the allergy seriously and during out appt. she too said use the epipen at the first signs of a problem. She gave me the needed referral to see an allergist.

The allergist wouldn't see us for 2 weeks as he wanted Philip's system to stabilize and expel all unwanted substances. When we did meet with him, prior to administering any tests he spent about an hour just talking to us about what happened, how he was treated at the ER, did we have an epi - he reinforced how to administer it properly. And he wouldn't go further in our discussions until I actually showed him that I was carrying the epipen with me right then. Then he said where is your Benadryl?

I was taken aback - nobody had mentioned Benadryl prior to this. He went into a lengthy discussion about using Benadryl for minor reactions and the various ways these could manifest themselves. While I was comforted by the Benadryl, and having had to use it on several occassions - it's like a miracle drug it works so fast, I too worried about delaying use of the epipen and perhaps not using it quickly enough to help when needed.

Basically it all comes down to ingestion for Philip. For my own mind I've reconciled myself to administer the epipen if there is a known ingestion of any peanut product and Philip is displaying any symptoms no matter how slight.

For contact reactions the Benadryl clears him up quickly as well as washing the allergen off his skin as soon as possible.

None of us want to be in a situation where we wait too long. But we also don't want to subject our kids to unnecessary pokes of a needle and rushing to the ER. This is such a judgement call and one that you learn your own comfort level as you gain experience with how your child reacts to different things. I know how Philip reacts to contact, a teacher or babysitter won't and may use the epi on him. I would rather have them be safe and err on the side of caution then have them delay and put him at risk.

You may want to visit a thread entitled "My Symptoms in Graphic Detail" - you'll need to search for it, I've forgotten where it's filed. I learned a lot about the throat and digestive tract reactions from that - things I was particularly concerned about because Philip couldn't tell me what was happening 18 mos. ago. Kinda gross, but really sobering and educational.

You'll find your comfort zone over time, but never let your guard down. It is well documented that reactions vary each time, usually increasing in severity with each subsequent exposure.

Philip's Mom - That was a Fantastic post. You communicated what I was trying to get at much better than I did. I feel more clear now after reading what you wrote on what I am going to do. If there's a reaction to a known ingestion, I am going with the Epi-Pen, if I'm not sure, Benadryl first and on stand-by with the Epi.

PhilipsMom: I thought you did an incredibly good job in your explanation also. I already have a comfort zone with all of this, but I just thought you really explained it well! Way 'ta go!