Q: Recently my mother was babysitting my son, who is 3 years old and peanut-allergic. She called me distressed; she had given my son a cookie she’d baked and he’d broken out in some hives on his face and began rubbing his nose. But what really made her think something was wrong was that he was suddenly very fussy, cranky and wouldn’t engage. (Unusual, since he’s a most happy child.) I told her: use the auto-injector, and it made him fine in minutes. Can fussiness be a sign of an allergic reaction? Did we over-react in giving epinephrine?
Dr. Sicherer: You made the right decision. Epinephrine is a safe, potentially life-saving medication. Therefore, giving it when there could be some doubt about the need is never an over-reaction.
Often, in your absence, erring on the side of instructing a caretaker who is less experienced to go ahead and inject is reasonable, even when it might not be the same decision you would make if you were observing your son first-hand.
Here, your child apparently ate a suspicious food, already had hives and itching, and experienced a change in behavior. Young children may have discomfort that they cannot adequately verbalize. They may not be able to specify stomach pain, throat discomfort or other ill feelings.
During allergic reactions, some young children stop playing and become suddenly quiet, some may appear fussy and cry and become agitated, and others may point to areas of their body that are bothering them.
Children may also describe symptoms in “their” terms, for example, “there are bugs in my ears” for itchy ears, or words such as “burns”, “hurts”, or “stuck” for mouth or throat symptoms.
You may notice a young child scratching at their tongue, or preferring a fetal position. Like any allergic reaction, it is important to consider the big picture, the exposure, and symptoms, to decide on treatment.
Speak to your allergist to review when and how to administer epinephrine and always review these issues with those who will be caring for your child.
Dr. Scott Sicherer is Chief of the Division of Allergy and Immunology of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in New York. Together with Dr. Hemant Sharma, Associate Chief of the Division of Allergy and Immunology at Children’s National Medical Center in Washington, he writes “The Food Allergy Experts” column in the U.S. Edition of Allergic Living magazine. Questions submitted below will be considered for answer in the magazine.