Q: I’m a single mom and my teenager with multiple food allergies is alone in our apartment before I get home from work (about 6 p.m.). Any suggestions for what she should do if she finds herself having a reaction while on her own?
Dr. Sharma: Putting a plan in place for managing anaphylaxis is critical in all settings, and is especially important for teenagers like your daughter who might find themselves alone during a reaction.
Be certain to prepare a written anaphylaxis action plan with her allergist, and have the allergist review it with her in detail. Later, you can also frequently review it with her.
The plan should clearly list all symptoms of anaphylaxis so she can quickly recognize if she is having a reaction. It should also describe the actions to take to manage anaphylaxis – most importantly, immediate treatment with epinephrine. Your daughter should understand that a delay in administering epinephrine increases chances of a serious, potentially fatal reaction.
If she has a history of anaphylaxis, the allergist may recommend treatment with epinephrine if one of her food allergens was definitely or possibly consumed, even if there are no obvious symptoms. After treatment with epinephrine, she needs to know to call an ambulance, so she can be observed in the emergency department.
A 2012 study evaluated when to transfer the responsibilities of anaphylaxis management to teens. The survey included 88 pediatric allergists, and most expected patients would be able to do the following by 12 to 14 years old:
• recognize the need for epinephrine (88 percent),
• learn to self-inject epinephrine (84 percent),
• and be able to self-inject epinephrine (78 percent).
Those surveyed felt that a child’s readiness to take these steps depended on his or her medical history, level of maturity, and ability to demonstrate auto-injector technique. So it is also wise to have your daughter practice and demonstrate auto-injector use with her 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.