questions that the \"Wait and See\" post has brought up for me

Posted on: Wed, 06/14/2006 - 11:03am
mama2sym's picture
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Joined: 04/19/2006 - 09:00

This is something that I can't seem to find an answer to -- I mean an answer that helps me really understand when to give the epi. I know there is no ONE answer, but I can't seem to find MY answer, so please help!

DD#2's (15 mos old, 10 mos at the time) only exposure to PN began with coughing and runny nose, progressed to swelling eyelids and purple splotches on her face, then repeated vomiting. I know now (didn't know then) that she was in anaphylaxis. By the time I got dressed and got her to the doc's office (we live only a few city blocks away, so this is about 20-30 mins after ingestion), all symptoms had subsided but for some eyelid swelling.

I was told that next time the reaction is like that to give epi and call 911 for an ER visit. But I'm confused because all her symptoms subsided. So I should administer epi next time, because the symptoms may NOT subside like they did last time, is that it?

Oh, and btw, our allergist is from the "Never give benadryl" side of things.

Thanks for any help.

mama2sym

Posted on: Wed, 06/14/2006 - 11:14am
Daisy's picture
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Joined: 01/16/2006 - 09:00

Please see the following chart.
It is listed on the main board as
"Anaphylaxis Symptoms and Grading Chart"
[url="http://pediatrics.aappublications.org/cgi/content/full/111/6/S2/1601/T2"]http://pediatrics.aappublications.org/cgi/content/full/111/6/S2/1601/T2[/url]
It is one of my favorite charts. I have unusual allergy symptoms (usually start as GI), so I keep a laminated copy in my purse.
BTW, most Docs want you to use the Epi first, then give liquid Benadryl to neutralize histamine already in the system. But the Epi(and 911) is the most important part for multi-system or serious reactions. (Some Docs advocate Benadryl only for mild hives. But always follow *your* Doc's advise. Other suggestions may be discussed with your Doc, but only *he/she* knows your child's unique situation.)
Daisy

Posted on: Wed, 06/14/2006 - 11:29am
mama2sym's picture
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Joined: 04/19/2006 - 09:00

Daisy, thanks for your response. I've read this chart a million times, yet I still get confused. I think what confuses me is that my dd's symptoms subsided within 20-30 mins, and I guess I am afraid to administer the epi if the symptoms ultimately subside in a few minutes. That's why the "wait and see" post affected me so much.
mama2sym

Posted on: Wed, 06/14/2006 - 11:32am
Peg541's picture
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Joined: 12/29/2002 - 09:00

mama2sym I believe the situation is that your body builds antibodies up the first time you encounter an allergen. The first encounter might not be so bad and might pass quickly but once that happens the body is manufacturing antibodies to FIGHT this foreign invader THE NEXT TIME.
So the next time, second time you encounter the allergen your body GOES AT IT FULL FORCE because it recognizes it as something bad. It's the full force attack that causes anaphylaxis. Your immune system is in overdrive.
Like Penicillin. You can get one shot and do fine but its the second shot that causes the problems.
And the theroy goes that each successive reaction comes faster and in a more dramatic manner.
When my son was tested at age 5 his arm blew up with a streak up his arm. The allergist said "he must have eaten peanuts before" He had one bite of a pBJ that he immediately spit out months before. I also think he may have had a reaction at age 2 or so but treated it like croup because I had no idea he had FAs and have no memory of what he had been eating. He's 21 now.
And the allergist said "do not let him get skin tested again because he will have a big reaction he is so sensitized."
I am trying to be as accurate as my nursing education lets me be. If anyone has anyting to add please feel free. This is what I know and what we live by.
So yes, next time your child has an exposure please do epi pen, benadryl and 911. Wait and see kills more kids all the time.
Peg

Posted on: Wed, 06/14/2006 - 11:47am
Daisy's picture
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Joined: 01/16/2006 - 09:00

Yes to everything Peg said! As always, well put. Like the analogy to penicillin allergy.
Just to add, I am an adult. I had GI allergy as a child Undiagnosed, but classic symptoms. I was diagnosed w/ FA after spending my teens and 20's w/ IBS. I *never* had an episode involving any respiratory symptoms or cardiovascular symptoms until I was in my late thirties. It has rapidly progressed from there to resp/cardio/and GI symptoms to tiny amts (such as "processed in a facility that also processes shellfish").
Each successive reaction can be different depending upon several factors including the type of exposure (skin contact vs ingestion), amt of allergen, and allergen burden (ie: already reactive like in pollen season). Some reactions may be worse, some may be hives only. But these are not predictable. That is why following a guideline is so important. You just never know...
Don't be worried; be informed!
Daisy

Posted on: Wed, 06/14/2006 - 11:50am
lilpig99's picture
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Joined: 12/22/2005 - 09:00

Just to put things in perspective. Of course, you know how your DS's reaction went....everything ended up subsiding on its own. But in my opinion, it sounded as if it was quite an intense reaction this time...even if he wasn't wheezing or vomitting or such. I think you will mull this over and then get to the point where you just realize that if he should have another reaction along those lines...with a known ingestion of the allergen or not...you will just give the epi. Please remember, the epi will not hurt him. It is designed to save his life...when you're sons next reaction happens, (lets hope it never comes) it very well could be severe and immediate...I've read subsequent reactions tend to be worse than the previous.
Everyones reactions are different and while it can be hard on us parents to 'give our kids an injection', it really is JUST a medicine (albeit life saving)...I don't think we'd feel such the need to 'wait and see' if this medicine were not in the form of an injection.
But I *do* think you will get to the point of just resigning yourself to the fact that you will just give the epi (and benedryl) and leave for the ER. With lots of vigilance in reading labels, and such....one hopes to never need the epi.
Much luck to you as you walk the FA path....and hugs too!

Posted on: Wed, 06/14/2006 - 1:11pm
luvmyboys's picture
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Joined: 05/25/2006 - 09:00

My ds recovered on his own from his first anaphylactic episode too. I read recently this is more likely to happen with very young children...their bodies are able to handle it better. However, there is almost no risk to the epi and there is a huge risk to wait and see. Vomiting is a VERY bad sign. I would always give epi if there was vomiting and any other sign however slight or suspicion of ingestion. 2 systems=anaphylaxis...give the epi.
Luvmyboys

Posted on: Wed, 06/14/2006 - 1:39pm
Anonymous's picture
Anonymous (not verified)

What is the reason you think you should not give the epi? Is there a fear of something?
If a person needs the epi and does not get it, the result can be fatal.
If a person does not need the epi and does get it, the result is usually a hyper kid.

Posted on: Wed, 06/14/2006 - 2:00pm
Corvallis Mom's picture
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Joined: 05/22/2001 - 09:00

My understanding from conversations I've had [i]in confidence[/i] on the subject of anaphylaxis and pharmacology... is pretty scary, to be blunt.
Anaphylaxis resolves on its own fairly frequently... IF the person can be adequately brought through it alive.
Some people will die when they anaphylax and there is apparently very little that can really be done if this is happening. This is somewhat rare, BTW.
Epinephrine is all we have to get us to the pros who can bag you and get an IV into you. Use it.
My daughter has had TWO anaphylaxis incidents that resolved with nothing more than high doses of diphenhydramine... and the first one, probably not even that, really... she was recovering by the time they gave it.
But knowing what I bothered to find out after the last one-- I will [i]never[/i] hesitate again.

Posted on: Wed, 06/14/2006 - 2:58pm
Overwhelmed's picture
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Joined: 03/31/2006 - 09:00

Just heard from my Drs. mouth yesterday after my almost 5 yo daughter had an immediate anaphylactic reaction during an egg food challenge....
Hives only...benadryl
ANYTHING MORE...epi and 911
Still hoping to outgrow this!

Posted on: Wed, 06/14/2006 - 10:21pm
mommyofmatt's picture
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Joined: 03/12/2004 - 09:00

I've struggled with this myself in the past...and hopefully I won't ever again.
My ds had 2 reactions that I felt were borderline reason for epi...I chose to give Benadryl and look at the clock. I'm NOT saying this is the way to go, just what I did.
Once things calmed down, I realized I could only see what was going on on the surface of his body. I didn't have any way to check his blood pressure or assess his breathing other than observing. The breathing and the blood pressure, those are potentially 2 of the most fatal symptoms.
If your dd's body is telling you that she's in anaphylaxis with 2 or more body systems reacting, it's best to listen. Waiting too long to treat properly has resulted in deaths.
And I think delayed epi use may result in the need for prolonged hospital stays and extreme discomfort as the body tries to recover and multiple drugs/lifesaving techniques are used.
The quicker the epi is used, the quicker the recovery is as I understand it.
Try to erase that image of her recovering on her own. That image is not going to help you do what you need to do to potentially save her life. The epi is a good thing.
You asked a great question though, I'm sure many others have thought the same way. Meg
[This message has been edited by mommyofmatt (edited June 15, 2006).]

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