Allergy Actions

call the dr back. i'm sure you're not the first persontot leave there with questions that popped into your head there after the appt.

I would suggest making a list of questions and call your allergist back. I would even suggest faxing the list and give them a day or two to prepare your answers. Ask them to put together an allergy action plan which should detail the symptoms of a reaction, what you should administer, and when.

There is a good book about food allergies by Steven Sicherer of Mt. Sinai hospital and it helped me understand allergies a lot more.

good luck.

Hi S.,

It's a matter of degree ... you use the Epi pen when the reaction is severe. The biggest thing you worry about is anaphylactic shock and the throat swelling closed. If the baby starts wheezing and gurgling, there is probably edema in the throat and you should give the epi pen to reduce the swelling and let him breathe. If he stops making sound altogether, it means the airways are already swollen closed so he's not breathing (give the Epi pen immediately, of course). If the baby gets hives but is breathing fine, you can use the benadryl.

Do be aware that allergies can change over time. Just because he ate a peanut last month and only got hives doesn't mean he'll only get hives from eating one this month, so you need to watch very diligently to make sure the treatment is appropriate. Allergies can also get better over time, but of course we worry much more if they're getting worse than if they're getting better.

Good luck!

Hi S.,

My daughter was diagnosed with a peanut allergy at about 18 months as well. The answer to your question depends on how severe your son's allergy is and what he consumed. My daughter once reacted when my mom accidentally gave her toast with jelly, and her jar of jelly had been contaminated from a knife that was once also used in the peanut butter. In that instance she was treated with just Benedryl. (she had small hives around her mouth but was acting fine). I know that she has a severe allergy to peanuts so if I saw her eat a handful of nuts I would be prepared to give her the Epi right away, so I guess other than those 2 extremes it is really hard to say! If there is any wheezing or throat discomfort (the throat can swell and close!) then go for the Epi immediately. If it's just hives, start with Benedryl and watch very closely with Epi in hand. My daughter's allergist told me giving the Epi is always the safe way to go when in doubt, it can't hurt and is guaranteed to help, but not giving the Epi quickly enough can definitely hurt! It's such a scary thing. You learn to live with it though and as your child gets older it will be easier to keep him away from the danger foods. I hear in about 5 years it will be common practice to treat kids w/ nut allergies by giving them very small doses of nuts over a period of time which will make their bodies able to tolerate nuts so I hope this allergy will not be with us forever! If your son is not allergic to soy you may want to substitute soynut butter. My daughter loves it and it's convenient like peanut butter. It's in the organic section by the natural peanut butters. I've heard of "sun butter" also, but I'm not sure how it tastes. Anyway, we call is just "soy butter" so it doesn't sound like peanut butter in the slightest! We also have a separate jelly jar just for her, with her name written all over it. When we go to a birthday party we bring her something safe to eat since bakery cakes are not safe usually since they are made near nuts even if they do not contain nuts. That includes Dunkin Donuts and places like that too, even the bagels! You just have to read, read, read the ingredients like a crazy lady! : ) Good luck to you!

Hi S.,

I agree completely with everything the first poster said. I have two little boys with multiple food allergies, and I second everything she wrote. We have also experienced something similar to her child's jam jar contamination, but in my son's case he had full-blown anaphylaxis. Make a list of all your questions, and call your allergist back and ask to speak to her!

Something Dana didn't mention, which is kind of a side note, is that our allergist told us that food items that are processed in a facility that share equipment, etc., actually can have a contamination rate of up to 60 percent. Really scary!

Something else to think about is the other adults in your son's life--your husband, grandparents, baby sitters--anyone who might care for him in your absence. Not only do you need to know what to do and when, but they need to be comfortable using the epipen in an emergency as well. My boys both started school within the last year, and that brings a whole new list of concerns when you start to release them to other people.

Three things that have not been mentioned yet:
(1) you should go to a specialist, not your regular pediatrician. Specialists are so much more knowledgeable about their field. I got much more complete information when I went to a specialist. We go to Dr. James Fagin in Great Neck, part of Schneider's Children's Hospital. He is an Allergist & Immunologist, and deals w/childhood asthma also. I'm sure there's a lot of other great drs too, don't know where you live

(2) Have the specialist do blood tests to find out what other foods your son is allergic to (if anything). The blood test only tests for the most common allergens, but it's still worth it.

(3) If you use the Epipen, you use it first, then immediately call 911. I've heard from more than one source that you want the ambulance to come to you, not drive to the hospital yourself, because they can get to you more quickly, and because when you to to the hospital in an ambulance you are first priority. If you drive in, you don't get priority. You have to tell them you need the ambulance to bring an Epipen, in case your child needs another dose. Apparently, only about 1/4 of ambulances in NY have Epipens (is that stupid, or what?).

Benedryll is for a localized reaction - meaning he might have slightly puffy eyes, a slight rash in one little area, lips or other simple sign of allergy. The epi pen is for SEVERE symptoms. Trouble breathing, full body rash, severely puffy eyes. Mainly if there is trouble breathing or he is so swollen/rash that he might be having trouble breath. OR if you give benedryll and his symptoms worsen. If you are uncertain call and talk to your allergist again. My allergist said the reaction has to be severe enough for the epi pen and if it is and the epi pen is used to go RIGHT to the ER. So for me, I kind of figure the epi pen is for a very severe reaction - one that I might already plan on taking him to the ER for - the point of the epi pen is during that type of reaction to buy yourself some time to actually GET to the ER.

Hi S.,

My 21-month-old daughter has a shellfish allergy. (We discovered this because of cross-contamination of food we purchased from a restaurant.) She received an epi-pen after her official diagnosis. Her allergist told us to only administer the epi-pen if she has trouble breathing. If her face swells (like it did during her initial reaction), we can give her Benadryl.

I hope this helps.

A little about me:

WAHM of a 9-year-old son and 21-month old daughter. My husband and I have been married for almost 13 years.

Hi S.,
We discoved my son was allergic to tree nuts and peanuts at 1. It is scary when they are that little. My son had a few other allergies as well and this is what his pediatrician and allergist both suggested... when we saw hives on his skin give Benedryl and continue to watch for signs of anaphylaxis. If we began to see those signs give epi-pen. HOWEVER, if we saw him eat a nut give Epi-pen right away and call 911. He told us "no one ever died from an epi-pen so better safe than sorry" There are varying degrees of allergies too so I would confirm with your allergist what to do and when to administer the epi-pen based on your sons severity. You shoudl write down all of you questions and call the allergist back.. It can be very overwhelming when you are there. I'm sure he wouldnt mind answering your questions now that you have had time to digest all of this.
A great website is www.foodallergy.org You can find great recipes and tips there. One thing I read there and none of the doctors told me was to check my lotions and soaps. Many have almond oil in them. Sure enough, I had several which contained this in it and got rid of them right away. You should also check out Cherrybrook Kitchen mixes. The are nut free and you can get them in Stop and Shop. They make really good cake mixes and cookies. I always make these whenever we go to a party so I know my son will have somehting that the other kids are eating too. They are so good that everyone eats them and doesnt even know the difference! Hope this helps.
Danielle

Hi S..

My son has peanut/tree nut allergies as well. The answer to your question (atleast... according to my allergist) is not to give the Benadryl at all. Reason being... Benadryl has no LIFE SAVING abilities. All it will do is mask the fact that something serious may be happening, and by the time you realize it (because the Benadryl will have masked the earlier warning signs), it may be too late. My son ate a peanut butter cup once. He was about 2 years old. We gave him Benadryl and waited for something to happen. About half an hour later, he started violently vomiting, at which point we headed to the ER. He was not having problems breathing, so I didn't give him the epi-pen (although I was ready with it, obviously). Speaking to the allergist AND the pediatrician after the fact, both said I should have given the epi-pen, even though there was no problem with his breathing. And when I mentioned to the allergist that it was so weird he hadn't had any reaction (no hives, etc) until the violent vomitting, he said... "no, of course he didn't. You gave him Benadryl which masked any of those early warning signs you may have had." Of course after the fact, it seems perfectly logical. I hope this helps... =)

Hi S.,
You've gotten great advice from everyone. I have a couple of things to add:
Both of my girls have nut allergies, requiring an epi-pen for each. My 5 yr. old has tree nut (cashew, walnut and pistachio), while my younger 3 yr. old has peanut and Brazil nut allergies. We just stay away from ALL nuts here ~ except each other :) What I was told by our pharmacist was that if you ever need to administer the epi-pen, chances are you will have to give two doses, about 20-30 minutes apart. I was never made aware of this by our pediatrician OR the allergist! So I carry the Epi-Pen Jr. Twin pack for EACH child! Also, when your first epi-pen expires, instead of throwing it out, use it to practice injecting it into a grapefruit. It will make you (and every other caregiver to your child) more comfortable to know the feeling should you ever have to administer it for real. Just remember to hold it in for the 10 seconds after sticking it... I was so nervous that I stuck it and then pulled it out and it sprayed all over!

One thing to be diligent about is to constantly reinforce allergy education to your son. We've constantly told our daughters (from the day of diagnosis) they that are allergic to nuts... "can't have that, it has nuts"... "Why can't you have nut? Because you are allergic to nuts and will get very sick"... "we have to check to see if that has nuts," etc. They are never too young to learn about it and you'd be amazed at how quickly they pick up on that and remember to ask for themselves once they start talking. I remember my daughter at 2.5 years old used to go up to people and relatives at parties and ask, "does this have nuts?" It's SOOO IMPORTANT for them to be aware and always ask before they take any food that YOU do not prepare for them!

To follow up on what Lindsey B said, allergic reactions intensify each time the child injests the food item. If he only had a mild reaction to a nut the first time, the reaction could be worse should there be a next time.

Also adding to Dana G.'s response: another DELICIOUS alternative to "Peanut Butter" is "Sun Butter". It is made from sunflower seeds and has the exact same texture as peanut butter. My girls both LOVE it and I am so grateful to the friend who introduced us to it!

Best of luck to you and your family :)

My daughter has multiple food allergies, and she is always within reach of an epi-pen and benadryl (the single-dose packages of children's benadrul are great for carrying around). We keep one epi-pen at her daycare and I carry a twin-set of epipens in the diaper bag...because sometimes the first injection doesn't work. Supposedly, it should work within moments of the injection. And, although we have never used it, I understand that it is only to be used if she can't breathe and the situation is truly life-threatening (gasping for air and lips/face turning blue/white). One injection should buy you about 20 minutes to get to an emergency room. We would give the injection through her clothes (because you can't spare the 5 seconds to remove them) and then immediately call 911. Otherwise, give benadryl and monitor closely for the rest of the day, because another reaction can happen later.

I read somewhere that if other adults don't think you are being neurotic about keeping your allergic child free from his/her allergens, then you are not doing enough to keep your child safe. The book by Linda Coss, "How To Manage Your Child's Life-Threatening Food Allergies" is good.

Good luck!

You have gotten a lot of good advice. I always assumed with my child that if there was no swelling around the mouth or throat that is was not anaphylaxis. However, our son reacted once with itchy eyes, stuffy nose and vomiting (no swelling lips or throat). I gave him Benadryl and he did okay (luckily). Our allergist later told me that when more than one body system reacts, it is anaphylaxis and he would have given the epi-pen. We now have a form from the allergist that we use for school, camp, etc. that is very helpful to me. It is called an Authorization of Emergency Treatment and it has a list of symptoms and which medications to give if the symptoms are present. I keep it with our epi-pen and benadryl. You should ask your allergist for specific guidelines and also check out www.faan.org, a great non-profit website with resources for dealing with allergies.