Explaining ana. reactions VS minor reactions (to a different allergen)

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I'm in the process of gathering information to present to the principal of the school my daughter will be attending next year. One question I had is: when listing your child's symptoms, how do you explain to a teacher the difference between the beginning of an anaphylactic reaction and a minor reaction to another allergen?

For instance, my daughter is anaphylactic to peanut, but also has minor allergies to egg and dairy.

If she comes into contact with egg, for instance, and just has a couple of hives, would I expect that they administer the epi pen?

I struggle with this myself as a parent, but since I know her allergy and symptoms best, I would just make a judgement call at the time.

So far, I've told her preschool that if she just says 'My tongue is itchy' or has a couple of hives and it goes no further, they don't need to administer the epipen yet, but to monitor her closely. I've also told them that if gets any more serious than that, to go ahead and give the epipen, and there are no negative ramifications if they give the epipen when they didn't really need to.

In her last (and only serious) reaction so far, she had hives right away, was crying uncontrollably (presumably because of severe anxiety or tightness in the chest), vomited twice and had her upper lip swell up a bit.

Any advice on this?

So far at home, she hasn't had many small reactions, but when she has, it was always been attributed to cross contamination of dairy or egg. At school, I don't know if she would be watched closely enough for them to know what she is reacting to. The school is peanut/nut-free (allows may contains) and they have good policies in place to prevent cross contamination.

On Oct 18, 2008

I dont think you have to give details of what level the allergies are.

when dealing with schools, list the known allergies, and then list the symtoms and then get a docs treatment plan, or a step by step guide . Can understant why you wouldnt want an mild reaction = a epi pen with out need. So education on symptoms and allergy is more important for other careers of allergic children.

did the immuneolgist tell you that your child would only ever have mild reactions to certain foods?

just curious, as from my understanding of allergies is that in the 'right' circumstances a previous mild reaction has no link to further mild reactions. It all depends on state of health of person before ingestion, and the amount ingested.

On Oct 19, 2008

My daughter has two food allergy action plans at school. One for peanut and one for her other food allergies (soy, peas, beans, other legumes)(sadly it looks like we are about to add a couple more things to this list soon)

Her reactions are different depending on the allergen and quantity/concentration, but any of them could become anaphylactic.

Basically the peanut plan goes to the epi-pen immediately (because her sensitivity is high and her reactions severe)

The other plan allows use of Benadryl first and adds epi-pen if her symptoms progress.

The tricky part is if she starts itching/rashing for unknown reasons... could it be cross contamination? contact? what was the allergen? is it just environmental? a new allergy? For this type of reaction I have allowed the nurse to give her Benadryl and monitor her closely. She also calls me so I can give her advice or come to see her myself when possible.

Some would consider the latter too risky, but it is working for us right now. If we didn't allow the use of Benadryl first for reactions other than known peanut, she would be going to the hospital by ambulance (as that is required following use of the epi-pen)about once per week.

Good luck to you as you start your school journey. We are about to cross that bridge into middle school, and I must say my anxiety is once again on the rise.

On Oct 19, 2008

Originally Posted By: williamsmummy

did the immuneolgist tell you that your child would only ever have mild reactions to certain foods?

Well, when we went to the allergist 18 months ago, he did a rast test for peanut and egg because she had had previous anaphylactic reactions to both. He only did a scratch test for milk and in fact, told me it was negative. However, although she can eat yoghurt and cheese with no problems, she was getting an itchy tongue from ice cream (which was peanut and egg free) until about 12 months ago. We haven't tried her on any milk, butter, or ice cream since then.

She did get a couple of hives from eating a part of burger that had touched my DH's burger with mayo the other week.

According to the allergist, her rast for peanut is 93, but for egg, it's only 11, which is allergic, but not anaphylactic, as he said 20 is anaphylactic, I think.

On Oct 19, 2008

Originally Posted By: 4mykids

My daughter has two food allergy action plans at school. One for peanut and one for her other food allergies (soy, peas, beans, other legumes)(sadly it looks like we are about to add a couple more things to this list soon)

Her reactions are different depending on the allergen and quantity/concentration, but any of them could become anaphylactic.

Basically the peanut plan goes to the epi-pen immediately (because her sensitivity is high and her reactions severe)

The other plan allows use of Benadryl first and adds epi-pen if her symptoms progress.

The tricky part is if she starts itching/rashing for unknown reasons... could it be cross contamination? contact? what was the allergen? is it just environmental? a new allergy? For this type of reaction I have allowed the nurse to give her Benadryl and monitor her closely. She also calls me so I can give her advice or come to see her myself when possible.

Some would consider the latter too risky, but it is working for us right now. If we didn't allow the use of Benadryl first for reactions other than known peanut, she would be going to the hospital by ambulance (as that is required following use of the epi-pen)about once per week.

Good luck to you as you start your school journey. We are about to cross that bridge into middle school, and I must say my anxiety is once again on the rise.

Thanks. This is really helpful. I totally hear you about avoiding the epi pen if it's just a minor reaction, especially with the hospital visit! I think here, you just have to 'seek medical attention', which could mean going to a clinic, and not necessarily going to the hospital via ambulance. Good luck with your transition to middle school!

On Oct 19, 2008

Your daughter's reactions to dairy sound similar to my daughter's soy reactions. She had skin tested negative then years later had 4 days of hives which we tracked down to a cereal cross contaminated with soy, she then skin tested positive and food challenged positive to soy.

Now if we slip up on soy (easy to do) she has itchy/burning tongue and throat and some swelling/blistering of her lips. Plus itching, red-circled eyes at times. Her allergist has started calling this "mild anaphylaxis" and encourages us to become more cautious.

She later started having reactions, identical to the soy reactions, to peas/lentils/chickpeas/certain beans/possibly sunflower seeds.

Then out of the blue she recently started itching and rashing all over her face after eating corn. Different than any of her other reactions. The first time was at school. Unfortunately they waited longer than they should have to give her Benadryl because they thought it was excema. (To their credit, another child was in the midst of a grand mal seizure.) But she was OK. And after two more identical reactions following corn I put it all together and beleive she has a new allergy. (The second time she had the reaction at school she got Benadryl right away)

Regarding medical follow-up after epi-pen... our Food Allergy Action Plan includes instructions to call the rescue squad, take the used epi-pen with you to the Emergency Room and remain at the ER for 4 hours for observation. I think that is the standard instruction in the US.

When my daughter had an accidental peanut ingestion (that's a whole huge story in itself) and used the epi-pen, she had continued treatment in the ambulance with I-V Benadryl, I-V steroids in the ER and was admitted to the hospital for 24 hours while they continued the I-V steroids and fluids.

On Oct 22, 2008

Yikes! I'm afraid of my kids developing more allergies. I guess time will tell. Good luck.

On Oct 25, 2008

Your allergist is wrong about the 20 being ana and lower not. DS had ana to egg ingestion and his RAST was 2.4 at the time. Even some who test *negative* have ana reactions. neg tests are only 90% accurate.

Originally Posted By: Alison's Mom

Well, when we went to the allergist 18 months ago, he did a rast test for peanut and egg because she had had previous anaphylactic reactions to both. He only did a scratch test for milk and in fact, told me it was negative. However, although she can eat yoghurt and cheese with no problems, she was getting an itchy tongue from ice cream (which was peanut and egg free) until about 12 months ago. We haven't tried her on any milk, butter, or ice cream since then.

Originally Posted By: williamsmummy

did the immuneolgist tell you that your child would only ever have mild reactions to certain foods?

She did get a couple of hives from eating a part of burger that had touched my DH's burger with mayo the other week.

According to the allergist, her rast for peanut is 93, but for egg, it's only 11, which is allergic, but not anaphylactic, as he said 20 is anaphylactic, I think.

On Oct 25, 2008

I think separating out milk or any allergens from others can be lead to problems. We seldom for sure know that a given food caused an *accidental* ingestion of an allergen. Because that it would be best in my non-medical opinion to have an emergency plan that didn't say anything about which allergen. A good emergency plan treats mild symptoms (regardless of cause) differently than systemic ones. If your child suddenly starts having systemic reactions to milk (which is possible) you want the emergency plan to cover them as well!

A good plan wouldn't cause a child to go to the ER regularly and needlessly. It would clearly tell people when to give the epi and when to monitor, etc. If you don't have a clear plan I'd print out the one from FAAN and bring it to your allergist to fill out. If your allergist won't provide this I'd find a new board certified one who will.

On Oct 25, 2008

I definitely understand your point, Lakeswimmer. The two plans I use for my daughter are the Food Allergy Action Plans from FAAN (which are very good plans) signed by her physician.

The way we use them differently is by when the epi-pen is used as you progress down the checklist of symptoms. Her peanut plan has epi checked on ALL symptoms. In fact the first line is altered so that if she has a known peanut ingestion the epi is to be administered even if symptoms are not present. (Because by golly they WILL be present) The reason for this is because my daughter's reactions to peanut are so severe and immediately anaphylactic.

Her other allergen plan has antihistamine only checked on the first three: ingested but no symptoms, mouth tingling/swelling, and rash/hives. Then adds epi on the rest which includes use of epi for multiple system symptoms.

My son's plan (he is also PA) looks more like her "other" plan because his reactions are mild, if he reacts at all, but he needs a plan for treatment on the chance that he might one day have a bad reaction.

I feel strongly that this is the best way to handle my daughter's situation since she has multiple food allergies of varying severity. But of course every child is unique and needs a plan under the direction of a physician that suits his/her situation.

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