Q: My 5-year-old is newly diagnosed with anaphylaxis to soy and peanut. I’m a little nervous about when to use the auto-injector. If a reaction occurs, how do I know if the symptoms are serious enough to use it? e.g. would he need to be wheezing?
Dr. Sharma: Dealing with a new diagnosis of a food allergy in your child can be highly stressful. It may initially seem over-whelming to learn how to keep your child safe and manage reactions, but educating yourself on some key medical facts and preparing an emergency plan are important first steps.
First, you should know that epinephrine, the drug in the auto-injector, is a very safe medication. In the vast majority of cases, any risk of side effects is far outweighed by the benefits of using it promptly
In the case of a severe allergic reaction to a food allergen, it is essential that epinephrine be administered quickly. A delay in epinephrine is one of the key factors identified in food allergy fatalities.
In general, epinephrine should be administered promptly if your child has any one of the following symptoms: trouble breathing, tightness in the throat, feeling faint, obstructive swelling of the lips and/or tongue, or many hives over the body.
Aside from those symptoms, epinephrine is also indicated if there is a combination of symptoms from two or more different parts of the body, such as hives and vomiting. So, to address your specific question, your son does not need to have wheezing to require treatment with epinephrine.
Work with your child’s allergist to devise a written food allergy action plan (also called a food allergy and anaphylaxis emergency care plan) that describes the appropriate treatment of an allergic reaction depending on the specific symptoms observed.
This plan can then be provided to your child’s school, child-care providers and family members who may serve as caregivers, so that they are all prepared in the event of a serious reaction. FARE (Food Allergy Research & Education) has a food allergy action plan template  that may be downloaded and completed by you and your allergist.
Dr. Sharma is an allergist, clinical researcher and assistant professor of pediatrics. He is Clinical Chief of the Division of Allergy and Immunology at Children’s National Health System in Washington, D.C. and Director of the Food Allergy Program. Questions submitted below will be considered for answer in the magazine.