Talking Allergies

My little baby girl had another bad allergic reaction yesterday. We noticed after dinner she was breathing funny, and then her voice started to change, and she would not speak to us. There were no swelling around the mouth or hives so we observed for a couple minutes, but it wasn't getting any better, she was starting to struggle, it was so scary!!! But my little girl is just so awesome, she was still playing and smiling, while having difficulty breathing. Anyways... we gave her some Benadryl (as recommended by her doctor) and called 911, and we had her Epipen shot in our hands in case it would get worse again! Then it was a little surreal when 3 firemen walked in our home started to check her, and gave her some oxygen, but all her vitals were good at that point. After that 2 EMTs showed up with the Ambulance, lights flashing and everything! They checked her, and said the Benadryl must've kicked in, because she was breathing almost normally (and we noticed too). She was still a little raspy, and the EMTs suggested to bring her in to the hospital to make sure everything was okay. My husband and I decided we'd bring her in ourselves, but then her breathing got worse a little, so we flagged them in the street and they gave DH and Anne a fast ride to the Children's Hospital. I followed by car, but lost them around the corner. It was so hard knowing that in that Ambulance were my baby daughter and DH!

When we got to the hospital her bottom lip and tongue had started swelling... OMG, I was so scared, but I knew that at the hospital if something worse was going to happen, she'd be taken care of. By the time we went to triage, the reaction was pretty much over... Finally!!! We waited for her to be checked and she was fine, and the doc said with her history of allergies, it's most probably something she ate. He also told us it wasn't anaphylactic, because a dose of Benadryl would not have helped in that case. His opinion is that it was a 'bad' allergic reaction, nothing more, nothing less... Aside from being a little tired, she was fine this morning...

Now, the parental guilt trip is kicking in, because we couldn't keep her safe in our own home! What did she lay her hands on? Was it the mushrooms (new food) she had for dinner? (She'd had some on Saturday without problems, but she ate more yesterday.) Were we negligent and missed crumbs on the floor? Did she touch something in the kitchen without us noticing (she walks now, and we let her move around so we can't always see what she's doing)? Was it something in the air instead? ARRGGHH... Needless to say, the floors have been cleaned today, and ALL her toys are getting a good wash tonight! Now, I'm nervous in my own home...

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Me - Kim - No allergies
DH Ben - 31 - Allergic to nuts and peanuts, lots of environmental allergies.
DD Anne - 4 - Asthma. Allergic to dairy, eggs, mustard, kiwi, peanuts, wheat and barley... for now...
DS Francois - 1 - No allergies so far...

Kim, the most common place for a reaction to occur is at home because that is where we eat most of our food and spend a great deal of time. Don't be too hard on yourself. Right now she is OK. That is good.

I don't know how Dr's determine what is an anaphylaxic reaction and what is concidered a bad allergic reaction.

I would suggest that if her airway is affected next time, you just give the Epi-Pen. You can't believe how fast it stops the symptons from getting worse.

Bottom line, I'm glad she's OK.

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb

Kim -- I'm sorry that your little one had a reaction.
My son's first (and only) anaphylactic reaction happened in our home too, after dinner. Our home is free of his allergens and we're still unsure of what exactly caused it. My guess is that he got residual amounts on him while we were out and they somehow made their way into his mouth, but it's still a mystery.


I just wanted to say that I've been told by my son's allergist that Benedryl will not help with breathing issues. We questioned his allergist because when my son was around 18 months (and we were still discovering allergies) he was exposed to dogs and cats and became quite wheezy -- we gave him Benedryl thinking that that would help him and it didn't improve his breathing at all. I agree with Susan -- if your daughter ever has difficulty breathing again and you suspect an allergic reaction, go directly for the Epi Pen.
Don't be hard on yourself -- I was too, immediately after my son's reaction and now I have the perspective that sometimes these things happen. Our kids don't live in plastic bubbles and we all do our best to keep them safe. Focus on how well you handled the situation and that she's doing fine . Use the experience to see how you might do things differently (after my son's reaction we started carrying wipes with us everywhere and used them when hand washing wasn't possible) -- you'll start to feel better once some time has passed.

First, hope you're feeling a little better.

My suggestion would be to get an appt. soon with your allergist. It could be an allergy - I'd work up a list of all ingreds. she'd eaten in the dinner, in case there are some the allergist wants to test for.

I'm no doctor, but one thing your allergist might suggest is the histamine levels in mushrooms. They can cause allergy-like symptoms in some people. See this: http://www.michiganallergy.com/food_and_histamine.shtml

Any way, glad you went to the hospital and, as Susan suggests, from what Dr. Waserman and other experts say, I wouldn't hold back with the auto-injector if you really think you're witnessing an allergic reaction. As for a "bad allergic reaction" – most allergists wouldn't call it bad unless it was anaphylaxis.

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Allergic to soy, peanut, shellfish, penicillin

Thanks for all the encouragement, it helps a little!

I didn't know that about mushrooms, I'll definitely talk to my allergist about them. But I'll stay away from them in the meantime! We have an appointement for January, which is the earliest we could get in...

This is the second time she's had a similar reaction... Last time I said, "Next time : EpiPen", but this time my husband wanted to wait and see and I was a nervous wreck and quite emotional so I wasn't able to convince him we should use it, but we did call 911. She could still breathe and make sounds (although it was labored), and was playing and smiling. And everything did get better after the Benadryl, so I'm pretty sure it helped her.
I did have the Epi in my hands ready to go until the EMTs showed up...
The doctor at the ER (not an allergist), and the EMTs before him told me it wasn't an 'EpiPen case'... well, what is then??? Some swelling came later, but the breathing was fine then... I'm a mom, not a doctor, and emotions come into play, and my husband and I have different approaches in emergency situations... He's more calm and collected, but maybe a little too much? I don't know...

I'm defnitely going to bring it up with my allergist the next time we see her. In the meantime, I hope and pray it doesn't happen again.

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Me - Kim - No allergies
DH Ben - 31 - Allergic to nuts and peanuts, lots of environmental allergies.
DD Anne - 4 - Asthma. Allergic to dairy, eggs, mustard, kiwi, peanuts, wheat and barley... for now...
DS Francois - 1 - No allergies so far...

Hi Kim,

For peace of mind, I would urge you to get that appt. sooner than later. It's important for you and your husband to be on the same page on treatment/what kind. in case (God forbid) of another reaction.

You want to be ready, and just because you had the stronger emotional reaction, doesn't mean you were over-reacting.

Re Emerg doctors/EMTs: The new consensus guidelines that the CSACI (the nat'l allergists' group) put out are fairly conservative and lean in favour of assuming it's anaphylaxis and using the auto-injector if there are one or more clear symptoms after eating. See a video with Dr. Susan Waserman here https://www.epipen.ca/EN/signandsymptoms.html on the EpiPen site. She's the former pres. of the CSACI.

I think the EMT guidelines haven't caught up yet with what the allergists have to say. In fact, I raised this in a workshop at the CSACI conference in September. I think the allergists need to be offering direction to the Emerg doctors. I hope they will. Not to sound holier than thou, I once went to Emerg when having a reaction that appeared to be anaphylaxis - holding my EpiPen. They gave me a big shot of Benadryl and a high dose of Prednisone (and a prescription for the latter).

I don't think that was what an allergist would have done. But it's true that once you're at a hospital, they are pretty on top of things should a reaction start to get worse. Bottom line: I still say sort out your emergency preparations with your allergist; I don't think you want any hesitation or difference of opinion in an emergency that involves your dear little girl.

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Allergic to soy, peanut, shellfish, penicillin

This is a typical reaction to an anaphylaxic reaction. Every fiber in your body desperately wants to believe that it is not anaphylaxis. You do not want to think that your child can die or that you may have fed them something and you most likely will have checked and rechecked before even giving the food so... how can it be? But it could be and it probably is and the fastest and therefore safest medication is epinephrene.

Do not wait until the reaction gets to a certain size before administering the medication-as soon as a reactiuon is suspected give the Epi-Pen and call 911.

You can do no harm in acting quickly, the same cannot be said for waiting.

This is something that I have learned over time and from personal experience as well as from speaking to others.

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb

How scary for you. I'm glad to hear everything turned out ok.

Both of DD's reactions happened in our home with food I gave her. As Susan said, most food ( especially of allergic children) is eaten at home and provided by a parent. Try not to feel guilty about it.

You may find yourself in a weird space for a few weeks. I did both times. I would hear a siren and burst into tears on the sidewalk. It was almost like going through some sort of post-traumatic stress.

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daughter: 6 years tree nuts, peanuts

Hi Kim,

Like everyone else, I'm glad to hear that your daughter is okay. And hugs to you for what you had to go through with her last night!

It's a little tough when people in the medical field seem to minimize an allergic reaction. One of the paramedics who came when I called for ds's reaction to whole egg basically pooh-poohed it as a dislike of egg that caused ds to throw up violently, etc. Agh. B/c ds was doing all right by then, I kept my mouth shut and then got him to the pediatrician's office. Thankfully, she was clear, and said it was an ana. reaction.

Anyway... glad your dd is ok. Take care of yourself, and try to let go of some of the guilt (I know, easier said than done!).

Marla

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*Son, 5 years old: Asperger's, allergic to eggs, peanuts, and mustard seed (outgrew dairy and soy)
*Son, 23 months old
*Hubby: allergic to cats and trees (non-specified types)
*Self: allergic to penicillin

kdufour, I'm sorry to hear of your frightening experience with your daughter - thank goodness she's okay!!!! Don't be too hard on yourself, it is very frightening to be in that situation. The first few times our son was in that situation, we also did not use the Epipen, and it took a long time for his symptoms to diminish - even though we went to the hospital. They did not use the Epipen in the hospital; rather, they gave high doses of Benadryl followed by Prednisone. Since that time, I have needed to use the Epipen twice (once when he was 3.5 yrs old while in the grocery store (he reacted to something on the grocery cart handle), and once at a friend's house when he was 5.5 yrs old), and within 5 minutes, our son was completely symptom free!! It was truly incredible to see how quickly the Epipen relieved his symptoms. Of course, we still called 911 and went to the hospital. In our son's case, he did not need any further treatment, and his symptoms did not return. He was simply observed in the hospital for several hours. As much as I don't relish ever using the Epipen again, I would not hesitate. It could save your child's life... that's all that runs through my mind if I see a reaction... the Epipen could save my child's life. That's all that matters. They say "seconds count", so it's best not to hesitate.

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14 yr old daughter: no health issues
11 yr old son: allergic to peanuts, tree nuts, eggs, fish, sesame, sunflower, mustard, poppy seeds, green peas, some fruits, instructed to avoid all other legumes (except soy & green beans), pollen, cats, horses

I'm very sorry that happened and *very* glad your child is OK now. I hope in the same situation you will give the epi pen without any hesitation. The #1 reason people die from anaphylaxis is not getting the epi pen quickly enough. Breathing problems as a food allergy reaction are *always* an indication to give the epi pen. If a food allergy is going to be life-threatening Benadryl will not stop it. Benadryl does not in itself have life-saving capabilities. I hope you have a clear emergency plan in hand so you don't have to guess what to do. *ALL* food allergy emergency plans would say to give the epi for breathing problems due to a food reaction.

Also, we should *always* go to the ER after such a reaction as a good % of reactions are 'bi-phasic' meaning that a 2nd, often more deadly and swifter moving reaction, comes up to 4-6 or even more hours after the initial reaction. That is why it is very important to go to the ER via ambulance and stay there and be monitored for at least 4 hours. You don't want to be driving if your child starts having an even worse reaction because it wouldn't be safe for you or your child. The paramedics should have insisted on taking you themselves and the fact that they didn't and didn't seem to insist she even *go* to the ER means that in the future you need to be ready to advocate and insist by showing your emergency plan signed by your allergist stating she is to go to the ER via ambulance in such a case.

There is a huge learning curve and I'm learning, too. I say all this but I'm saying it to myself, too, with no judgement to you or anyone else. Very best wishes!

Also, request that the Doctor treating you or your child write a prescription to replace the auto-injector you used prior to calling 911.
As lakeswimr said, there could be a bi-phasic reaction and you want to be fully stocked withyour usual number of auto-injectors if that haqppened.
Get it filled on the way home.

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb

My allergist was saying that at emergency wards, they do not always follow protocol and give epinephrine, and at the CSACI conference in Edmonton, Dr. Estelle Simons, said the same thing, so it seems to be a concern amongst allergists. My allergist said that often, they will just give an anti-histimine and cortisteroids, and not epinehrine. This leads to protracted anaphylaxis, and he sees people a few days after their emergency ward visit who are still suffering from this. That is not good.

Epinephrine is the only drug which will stop the mast cells from degranulating so it is really important to get it if you are having anaphylaxis. The other drugs will stop symptoms and minimize damage to your organs, but epinephrine will stop the reaction itself. So if you have anaphylaxis, and the hospital does not give you epinephrine, it does not mean that your reaction was so mild you didn't need it, it just means that the emergency ward doctors are not up on their stuff. Apparently, that is not so rare as you would think. There is a study they did in the US and the rate at which people were let go from emergency without a referral to an allergist, an Rx for epinephrine, or getting epiniephrine in response to anaphylaxis was really scary. I will try to find the study.

http://www.touchbriefings.com/pdf/2452/ACF215.pdf


Ewww, this is even worse then I thought. It says that only 12% got epinephrine. This is actually really good reading.

I don't know what we can do to stop this, but it may be a good idea to phone your allergist ASAP after a reaction, to make sure you are okay , or carry an emergency plan that your allergist has signed, so that the emergency ward will follow it.

I am really glad your little baby is okay, and I agree with the other mom's who are saying it is very hard to get a handle on what to do, but an epipen will not cause any long term bad effects, and I have given myself a shot, and it hardly hurt. When my son was little I had to give him a shot, and I hit it really hard into his leg, and that hurt him. He limped for about a week, but I was scared that if I didn't do it hard enough, it would not work. You don't need to use very much pressure to have the auto-injector go off. If you have an expired one, try giving it through a paper cup, so you can see how little pressure is needed. Some people suggest using oranges, but it is hard to tell how little pressure is needed to give it to the orange. If you turn a paper cup upside down, and discharge the auto-injector through that, it hardly dents the cup.

Anti-histimines will stop skin symptoms such as hives and itching, but not more serious breathing or internal organ symptoms, so it is not recommended to use anti-histimines to try to stop anaphylaxis.

Sometimes, people will not be sure that the kid is having anaphylaxis, so they will wait until symptoms progress, but it is better to give the auto-injector, even if you are wrong. One allergist said the best thing, I thought, when they were all debating when to give the auto-injector. He said "If you KNOW or SUSPECT that the person has been exposed to his allergen, give the auto-injector." It is very confusing to figure it all out. I still am confused about quite a bit of it. But here is what I have figured out over the years - I hope it helps.

When my son was 11 months old, I fed him 1/4 of a peanut butter cookie. I don't think he even ate that much, as he immediately started drooling, and crying. He got hives around his mouth within a few minutes, had scratched his neck bloody in about 15 minutes, was as red as the reddest sunburn, and swollen all over, screaming, within about 30 minutes, was wheezing and with a racing heart by the time the ambulance got there about 45 minutes after I had fed him the cookie. He got a shot of adreneline in the ambulance. He tested positive to peanut 3 months later at his allergist appointment. I think his bump was about 3.
When he was 3 1/2 we made a mistake and he was given a baked good with peanuts in it. Within 10 seconds of taking one bite, he was screaming and his mouth was swelling. He said later that his stomach immediately went into a cramp. I gave him the Epipen right away, and the anaphylaxis did not progress.
When he was 6, he shared a granola bar in school and it had peanut in it. Within 10 minutes, ears and mouth started swelling, and he confessed what had happened to his teacher, and they gave him his Epipen. The ambulance was there 6 minutes after it was called, and so were we. His breathing was not compromised, and he was mostly scared. He went to the hospital and was given anti-histimine and cortisteroids. His mouth was swollen for two days.
When my son has skin prick tests, he tests at 3 or 4 sized bumps.
I got my son the blood test that tests the # of IgE's in his blood. He tested at 17.9. That was on the cusp between severe, and very severe, and it said that if he was exposed to peanut he would have a 95% chance of having an anaphylactic reaction. That was helpful information to me as we know that if he ever got any peanut in him, we would just give him an auto-injector without waiting for even one symptom, cos there was a really big chance that he was going to react, it was just a matter of time, so might as well give him the Epipen, head for the hospital (by ambulance), and hang out and wait to see what happens.
The blood test that tests the # of IgE's in the blood is helpful and so are the skin prick tests, but there is no way of telling how severe a reaction will be. The number of mast cells the person has, their general health, # of IgE's, asthma, what part of the cycle you are in for females, how much of the allergen, and how it got into the body all play a role in the severity. There are probably things I have forgotten that play a role, too.

Sorry I write such long posts. I am avoiding cleaning the kitchen.
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Interesting article Pamela Lee. I just sent it to my mother and the staff at CHEO.

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Moderator
Daughter: asthma, allergies to egg, milk, peanuts, tree nuts, most legumes (not soy) & penicillin. Developing hayfever type allergies.
Husband: no allergies
Me: allergies to some tree that flowers in May
Cat: allergic to beef, pork and lamb