Lessons From a Teen Food Allergy Tragedy
RW: We reassure them that it’s incredibly safe, and even if you get a dose you didn’t really need, it is not a problem. So it’s better to give it if there’s any doubt rather than not give it. Every study has shown that it’s dramatically underused, even in highly educated populations, and there are a lot of reasons for it. In some it’s fear of the needle, in some it’s fear of the drug.
There’s a misconception about danger with the drug, which is actually still held very strongly by a lot of emergency-room physicians, so even in the setting of the emergency room, epinephrine is dramatically underused. But 80 percent of the time, one dose of epinephrine will completely reverse an allergic reaction, and it is very safe.
AL: Do people need to go to the hospital every time they take epinephrine?
RW: You do, and one of the big misconceptions is that most people think you’re going to the hospital because you’ve just given your child a dangerous drug. But the reason you’re going to the hospital is because you’re having an allergic reaction that required epinephrine, and you need to have your allergic reaction further evaluated and monitored. We want them to stay at the hospital, typically for a four-hour observation period, because the reaction can look like it’s resolved and then come back two hours later. It’s not because of the epinephrine.
If 100 people took their EpiPens right now accidentally, and they didn’t really need it, we would say, “Stay at home, you’re fine.” The medication is not a worry at all.
AL: One parent e-mailed to say: “Besides food allergies, my child has highly sensitive skin. If I gave her the auto-injector every time she had a hive, it would be once or twice a week.” How do you differentiate between a localized reaction and a systemic reaction?
RW: Every symptom needs to be interpreted and treated in the context of the situation. So if those hives showed up in a situation where the parent is quite confident there was no ingestion of a problem food, we would treat them as a very benign condition. If hives showed up with a child at a birthday party or at a family picnic where there’s lots of food around, and the child’s been out of the parent’s sight, then you have to assume that there’s been a food exposure, and treat that possible reaction more aggressively.
AL: Parents are also struggling with how to talk with their kids about the potential dangers of their conditions, and cases like Natalie’s. What do you advise?
RW: My feeling is there’s no benefit to talking about death in the preschool- or school-age years. When the child is literally a year old, the message is that foods can make you sick and you need to be careful. And then it becomes a little more specific: you can’t eat anything that I don’t approve or provide for you, because it can make you sick.
As the child becomes late school-age, early adolescence, then talking about fatality is completely appropriate. So depending on the maturity of the child, that’s when they’re 10, 11, 12. All it will do to a 6-year-old is upset them. They can’t conceptualize that to a point that there’s any value to it.
AL: When speaking to adolescents, do you do it in a way that doesn’t scare them?
RW: An element of fear is actually part of the message and is appropriate – and the message is typically given to that 11- or 12-year-old in the context of them taking more responsibility for carrying their epinephrine. So there’s a gradual transfer of responsibility from the parent to the child.
The message is, “If you don’t have it with you, you could die.” And that is an important part of the reason why they need to be convinced to have the medicine with them all the time.
Next: Interview with Dr. Susan Waserman