When would u give EPI? Ingestion, inhalation, touch...

Posted on: Sat, 07/10/2004 - 10:48am
Danielle's picture
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Two allergists said to me that if I think my 3 year old has ingested a may contain and hasn't exhibited symptoms to give the EPI no matter what. She had her first and only reaction when I shoved a bite of peanut butter in her mouth when she was almost 2. That was about 18 months ago (knock on wood) Prior to that, during the same month she had had a few bites of peanut butter cookie and hated it. She had pneumonia and RSV at the time and I was trying to fatten her up since she had lost so much weight. I will always believe that her immune system was in really bad shape at that time and that is one of the reasone she reacted to the peanut butter. She had to have the epi at the ER after 2 doses of beni and a dose of steroid. What I know now she should have had the EPI at the beginning when we arrived and the hives would never have progressed like they did. Anyway, she had really bad hives but the Dr's never heard any breathing problems. She skin tested pos 18 months ago and CAP RAST tested level 2 last year. I am extremely vigilant about everything and we don't have any may contains in the house including creams and cosmetics. I just wonder if we were at the park and I knew she stuck her hand in peanut butter should I give the epi????? We have had 2 instances when she was in the room with peanuts and peanut butter ( a lot of it) without my knowledge. One of these was actually in an allergist office when a 1 pound bag of peanuts with shells was brought back to me and I ran to the bag and closed it and the peanut dust was overwhelming. She did not react but I didn't know anything back then or I would have thrown a fit at the nurse. Anway, I was just wondering what you were instructed to do and what you would do as a parent.... Touch, ingestion, Inhalation.....

Posted on: Sat, 07/10/2004 - 11:50am
Carefulmom's picture
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That is a tough one to answer. I`m sure you`ll get lots of different answers. If I knew my dd ingested a real peanut product, I would use Epi. As far as may contains, she ate an ice cream that was a may contain for 2 years, but it did not state that it was a may contain, as many ice creams don`t, so I did not know. For 2 years she ate it probably 50-100 times without symptoms. Then she ate it and had a reaction, so I called the company, and that is how I found out it was on shared equipment with peanuts and not stated. The reaction was fairly mild. So while I would never buy it again, and I really chewed out the owner of the company for not stating it was a may contain, I personally would not use epi if dd ingested a may contain and if she seemed fine. But if she had any symptoms at all, even a hive, after eating a may contain I would use it. None of us knowingly give our pa kids may contains, so the situation will probably never happen. Meaning we won`t know it is a may contain until our child has a reaction and we call the company afterwards and find out it was a may contain and not stated.
About contact, we were at a bday party and there was a pinata. Dd got a bit of something that looked like pb from a candy on her finger. We IMMEDIATELY washed it for about 2 or 3 minutes literally. She was fine, no epi. By the way, my dd`s cap rast is class 4, so she is probably more severe than yours. Another time she accidentally touched a Snicker`s wrapper (meaning the inside of the wrapper, the candy had been eaten). I held her arm so her hand could not get to her mouth, walked her to a bathroom at least 2 or 3 minutes away, and she washed her hands for 1 or 2 minutes. No symptoms at all.
About inhalation, I guess that depends on how much and if there are symptoms. Dd`s 504 says when the cafeteria serves pb, she cannot sit in cafeteria (she eats only our food, no cafeteria food, but all the kids eat lunch in the cafeteria, whether they bring or buy). Well, one day the menu got changed at the last minute. The printed menu that went home to the parents said one thing, but after lunch we found out they had served pb. Dd sits at a peanut free table, but there were about 100 kids in the cafeteria at the other tables eating pb. Nothing happened, no symptoms at all. So I personally would not use epi for inhalation unless symptoms. But if inhalation and any symptoms at all, even one hive, I would use it. By the way, I am not saying I would use it for 1 hive if no exposure. One day last year I picked her up from day camp and she had one hive. I kept checking her, nothing else happened, and I did not use it. We never figured out where that came from. Her friend had eaten pb, but dd had seen her friend wash her hands.

Posted on: Sat, 07/10/2004 - 2:19pm
Anonymous's picture
Anonymous (not verified)

Danielle, sorry, I still don't know how to quote or copy and paste after all these years, so you'll see bits of your posts and then my answers or questions or comments.
Okay, so you've been a member long enough and have enough posts to know that there are two schools of thought re Epi-pen use regardless. One is that you give your child Benadryl and then wait to see if the Epi-pen is required. I am of the Epi-pen only school of thought but only because my son has had three anaphylactic reactions. Having said that, there is even some leeway, for me, personally, when I'm dealing with a PA reaction with my son.
Two allergists said to me that if I think my 3 year old has ingested a may contain and hasn't exhibited symptoms to give the EPI no matter what.
Okay. I don't understand why an allergist, never mind two, would say this. The Epi-pen is for an anaphylactic reaction which involves two body systems (there are some really *good* definitions posted on the board, if you need help finding them, let me know).
A "may contain" product has a 1 in 5 chance of actually containing a peanut product (or trace thereof) so there is only a 1 in 5 chance of a reaction. Why would you Epi with only a 1 in 5 chance of reaction and then you don't even know if it's going to be anaphylactic or not because you never know what the next reaction is going to be?
For example, my son had two anaphylactic reactions after his first reaction so when he had his fourth reaction, I was quite prepared for it to be anaphylactic. It wasn't. It was a two hive only reaction to cross-contamination. So why would I subject his body to an Epi-pen when he was not having an anaphylactic reaction? What he did get that night was a dose of Benadryl.
She had her first and only reaction when I shoved a bite of peanut butter in her mouth when she was almost 2. That was about 18 months ago (knock on wood) Prior to that, during the same month she had had a few bites of peanut butter cookie and hated it. She had pneumonia and RSV at the time and I was trying to fatten her up since she had lost so much weight. I will always believe that her immune system was in really bad shape at that time and that is one of the reasone she reacted to the peanut butter. She had to have the epi at the ER after 2 doses of beni and a dose of steroid. What I know now she should have had the EPI at the beginning when we arrived and the hives would never have progressed like they did. Anyway, she had really bad hives but the Dr's never heard any breathing problems. She skin tested pos 18 months ago and CAP RAST tested level 2 last year.
Were there any other symptoms besides hives when you went to emerg that time? When the Epi was finally administered? You also do not have to have breathing problems to be having an anaphylactic reaction. Again, only two body systems have to be involved, and although it does usually include the lungs/airways, particularly for children with asthma, it isn't always the case.
My PA son has asthma. When he had his last reaction, anaphylactic, he went to the office because he felt as though he needed his asthma puffers. I think his chest was constricted but he didn't know the difference between his chest being constricted and needing his asthma puffers. When we did get him to the E.R., his breathing was checked and it was okay. But his reaction was still anaphylactic because more than two body systems were involved.
Interestingly enough, the reaction halted itself and an Epi-pen was not required.
I am extremely vigilant about everything and we don't have any may contains in the house including creams and cosmetics. I just wonder if we were at the park and I knew she stuck her hand in peanut butter should I give the epi?????
If you were at the park and your daughter stuck her hand in peanut butter, wouldn't you wash it off first and then see if she showed any symptoms of having a reaction? Again, it is my understanding that an Epi-pen is for an anaphylactic reaction. If your daughter stuck her hand in pb at the park and didn't have an anaphylactic reaction, but did have some symptoms, some Benadryl would be in order and careful watching for a bi-phasic reaction, but not the Epi-pen just because she stuck her hand in pb.
We have had 2 instances when she was in the room with peanuts and peanut butter ( a lot of it) without my knowledge. One of these was actually in an allergist office when a 1 pound bag of peanuts with shells was brought back to me and I ran to the bag and closed it and the peanut dust was overwhelming. She did not react but I didn't know anything back then or I would have thrown a fit at the nurse. Anway, I was just wondering what you were instructed to do and what you would do as a parent.... Touch, ingestion, Inhalation.....
Just recently, posted about when we came back from March break, we were on the bus and someone was eating peanuts at the back where we were seated. I could smell the smell overwhelmingly. I quickly ushered both of my children to the front of the bus. My son obviously inhaled some of the peanut fumes because I certainly did, but he did not display any symptoms, so I did not give him the Epi-pen. I just watched him closely for the rest of the bus ride to make sure that he did not develop any symptoms.
There are many people that do have anaphylactic reactions upon inhalation, contact, certainly ingestion. It is when you have an anaphylactic reaction that the Epi-pen is required.
Hopefully that helped, not clear though. I was given NO instructions whatsoever when my son was diagnosed and I did learn the hard way, but only if he is having an anaphylactic reaction would I administer the Epi-pen.
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
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Posted on: Sat, 07/10/2004 - 2:46pm
California Mom's picture
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I thoroughly agree with Cindy (ATM). I will go even further and say I think it would be utterly ridiculous to use the epipen if a child ingested a may contain but had no symptoms. If there were symptoms, certainly. But no symptoms? Definitely not. Another way of looking at what Cindy said is that there would be an 80% chance that the "may contain" item did [b]not[/b] contain peanuts.
I am confident that you will know to use the epi if your daughter should (God forbid) have another reaction.
What was this about a nurse bringing you a bag of peanuts at the allergist's office?! That sounds like quite a story. [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img]
Good luck!
Miriam

Posted on: Sat, 07/10/2004 - 5:29pm
Anonymous's picture
Anonymous (not verified)

California Mom, thank-you, I don't think I've ever been "thoroughly agreed with" before. I know I have thoroughly agreed with other people and even lately have started to post that rather than go into babble speak, but I have never had someone say that about me. Thank-you. [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
(Cindy who is awake due to much traffic on her street, both car and foot wise [img]http://uumor.pair.com/nutalle2/peanutallergy/rolleyes.gif[/img] )
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
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Posted on: Sat, 07/10/2004 - 7:04pm
k9ruby's picture
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Joined: 03/25/2004 - 09:00

This is what we were told to go by:
hives/redness/itchiness V.minor swelling= Mild reaction=BIG DOSE OF ANTIHISTIMINE and WATCH!
Major swelling, throat/mouth/tounge/lip swelling,= ANAPHYLAXIS=Epi+999
this is our own allegists opinion.

Posted on: Sun, 07/11/2004 - 1:08am
California Mom's picture
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Joined: 07/14/2000 - 09:00

Cindy, I quite often thoroughly agree with you!
[img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img] Miriam

Posted on: Sun, 07/11/2004 - 1:24pm
rebekahc's picture
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Joined: 12/02/1999 - 09:00

For ingesting a may contain with NO symptoms I personally would not give epi but would just watch very closely. For contact - airborn or otherwise - with NO symptoms, again no epi. For contact without ingestion but developing symptoms I would watch VERY closely and give epi if symptoms seemed to be progressing at all. For ingesting known peanuts (ie a bite of pb cookie or something) I WOULD give epi regardless of any symptoms.
DS has had plenty of reactions involving 2 body systems that although anaphylactic by definition I did not consider to be "life threatening". He has had 6 major anaphylactic reactions. Of those 6 he received epi for 4 of them.
I'm pretty sure you'll be able to tell when your DD needs the epi, but I'll write DS's experiences here for you as an example.
Reaction 1 - mystery reaction at mall - had epi in my purse but too scared to use it. Rushed to ER 5 minutes away instead. They gave him benadryl and steroids but no epi!! I didn't know better, but the next day at the allergist she "read me the riot act" and said we were lucky DS survived. I also believe she called the ER staff and gave them what-for for so poorly mismanaging DS (they never even checked his breathing or oxygen levels). Symptoms: squeaky voice from swollen vocal cords, snot pouring from nose and mouth, hives covering body, limp/lethargic, very junky coughing, sense of doom.
Reaction 2 - at allergy office after getting his usual allergy shots. Became very lethargic and said his chest hurt. I carried him to the nurse who said, "Well he doesn't look very bad but let's take him into the treatment room and see. I'm sure he won't need epi or anything." She left to tell the doctor DS's symptoms and literally came running back and gave him epi. Apparently the chest pain was one of those don't mess around symptoms especially when combined with the lethargy.
Reaction 3 - Ate one pistacio and began hives, squeaky voice, snot, etc. like first reaction. I immediately gave epi and drove to ER. He was fine by the time the doctor saw him. Doctor said, "Congratulations, Mom, you saved his life." Sent us home right away with no monitoring or anything. [img]http://uumor.pair.com/nutalle2/peanutallergy/mad.gif[/img]
Reaction 4 - DS was in ER for asthma and developed a fever. They wanted to give him Motrin, but I said we were avoiding it since DH is allergic to it. His fever went up more, so they gave it to him anyway. He was already on benadryl and IV steroids for the asthma but he had a major reaction to the Motrin anyway. They gave him epi. Over the next 3 days while in the hospital on oxygen, just before he was due to get his next dose of steroids, the Motrin reaction would start again. The steroids were just holding it at bay. They did not give him more epi or benadryl though.
Reaction 5 - mystery reaction to chocolate covered pretzels from a manufacturer I had checked out - hives, snot, squeaky voice, etc. Allergist had told us for his next reaction to call her at home, so I did. She felt that since it was flu season and he probably wouldn't get adequate care in the ER anyway that I should just give him the epi and monitor him at home. If epi didn't work or whatever to then call 911. She said to give the epi and call her back in 5 minutes. Before I could give him the epi, he vomited. Immediately his symptoms started to improve. She called me back in 3 minutes because she didn't want to wait for me to call. I told her his symptoms were improving after the vomiting. She called every 10 minutes for the next hour and then checked with us several more times duing the night.
Reaction 6 - mystery reaction to milk - just squeaky voice and a few hives. I consider the squeaky voice critical though because if his vocal cords are swelling it could compromise his airway. Gave benadryl and epi. Monitered pulse and respiration at home and by phone with the doctor.
After all his reactions he required some kind of steroids or benadryl every 4 hours for several days afterward.
Hope that was somewhat helpful.
Rebekah
[This message has been edited by rebekahc (edited July 11, 2004).]

Posted on: Sun, 07/11/2004 - 1:48pm
Carefulmom's picture
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Our allergist told us if two or more organ systems involved to give Epi and not wait for "life threatening". The reason is that if you wait until "life threatening", by then the blood pressure may have dropped and therefore, the epi will sit in the thigh and not work. That is why Nathan died. He tells us this on every visit. I used epi for hives and wheezing, no trouble breathing at all, and he told me I did exactly the right thing.

Posted on: Sun, 07/11/2004 - 11:34pm
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Joined: 04/02/2003 - 09:00

This topic is so hard, but i do believe that any one of us would do what we felt was right for the situation.
I don't think we can set in stone yes EPI or no EPI without being in the situation.
I personally feel that i would do what is appropriate for the symptoms, situation etc. Reactions are typically sudden and pretty immediate after exposure. I do think that symptoms will speak for themselves.
I am not saying to wait around for anaphalais to get into full swing, but if there are no symptoms, then i don't see any reason to give the epi. I would probably give EPI at the hives stage though if i knew for certain that he had touched or eaten peanuts.
If my child touched PB, i would wash him while watching for a reaction. I would proceed as necessary. Same for ingesting and airborne.
I think that it is wrong to subject a child to the EPI and all of the trauma if it is not needed. Also, each person has different levels of sensitivity. We have been on the airplane with PBJ sandwiches being served. My son had hives, which i believe were from contact. I gave benadryl and watched him during the entire flight. He was okay. I am not saying that going into anaphalaxis is better, only that we should proceed as the symptoms direct us.
Think about childbirth--most of us said no drugs, or yes painkillers, no cutting, no this no that. But, sometimes circumstances and the situation help to make the choice and decisions. How many of us changed our preconceived notion of what we were going to do during labor?
Same thing with setting the EPI plan in stone. I say always be prepared with the proper medications, educate your child about making decisions about eating, educate others who are in the presence and care for your child.
I hope that none of us are in that situation and can keep our kids reaction free!
[This message has been edited by saknjmom (edited July 12, 2004).]

Posted on: Mon, 07/12/2004 - 11:07am
Scooby's picture
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I have an aquaintance with a PA child. She regularly eats may contains and other foods which some of us would never dare, i.e. bakery items, chocolate, Chinese buffet [img]http://uumor.pair.com/nutalle2/peanutallergy/eek.gif[/img], etc. Has not had a reaction that I know of, other than her initial ingestion and another major contact rxn (pn smeared on her face). So just because it is may contain, it doesn't necessarily mean there is pn in the product or that it will cause a rxn.
My DS has had several contact reactions to one of his other allergens, not pn, but just as dangerous. Some were very mild, just a spot or red mark on his skin. Cleared immediately with hydrocortisone. That was back when his excema was bad. The only major skin reaction caused localized hives which quickly responded to a dose of Benadryl.
His school plan states Benadryl for known contact or suspected ingestion / epi for known ingestion. I would hesitate to give epi without "any" symptoms.
DS has been in many situations where pn is present. A lot depends on sensitivity. DS's rast is very high, but he doesn't have a problem being in a non-pn free environment at school. Another situation where just because pn could be in the environment doesn't mean your child will react. I would never consider giving my DS epi just because he was in a room with peanuts. That is, unless he showed some sign of reaction.
Hope that helps and you can relax a little!

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