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PostPosted: Wed Jan 20, 2010 12:58 am 
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Joined: Tue Jun 26, 2007 2:45 pm
Posts: 790
Location: Vancouver, BC
My kids are between them, severely allergic to peanuts and tree nuts, along with some other milder allergies. They had what I strongly believe to be a contact reaction at a birthday party once where there were no peanuts/nuts served, but likely a lot of residue on toys, as the family ate nuts frequently. When I spoke to my allergist about this, he suggested pre-dosing with benadryl if we go to their house again, and I'm wondering if this would be wise prior to a flight where there may be residue on seats, etc?

We have flown WJ to Maui twice with no incident, but then they don't serve P/TN on their flights, and they had leather seats that were easy to wipe down. On Thursday, we are flying to Toronto on AC , which I'm not happy about, but DH booked it without asking me first, and they do serve TN in exec class (we are in Econ). I phoned their medical line this morning and was told their allergies are in the file, but we would have to tell the FA upon boarding as they don't have access to the files. She also suggested having the kids sit on a blanket so there would be less exposure to the seat itselt which could have residue. She said the seats are fabric and not as easy to clean.

So, given that we are bringing our own food and will inspect and wipe down all wipe-able surfaces during preboarding, and the kids know not to eat things off the floor, I think the chances of them having a major reaction through ingestion would be slim, but there would be a pretty likely chance of contact reactions from residue. I will request a buffer zone of at least one row in front and behind, but if they don't do this, there are 7 of us flying together and we could probably shelter the kids in the middle without too much difficulty.

Thoughts on pre-dosing? Thanks.

_________________
DD 2004 Allergy to peanuts, egg, sesame, and new: lentils and chick peas
DS 2006 Allergy to peanuts, tree nuts, milk, egg, kiwi fruit, eczema


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PostPosted: Wed Jan 20, 2010 9:01 pm 
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Joined: Sun Apr 17, 2005 8:25 pm
Posts: 27
Location: GTA, Ontario
I would be afraid that pre dosing could possibly mask a more serious reaction.

I have traveled A/C with DS who is PN/TN 4 times. We pre boarded, wiped the seats/arm rests, covered his seat and brought our own food.

Have a good trip.

Ali


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PostPosted: Wed Jan 20, 2010 9:11 pm 
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Joined: Tue Jun 26, 2007 2:45 pm
Posts: 790
Location: Vancouver, BC
Thanks. Yes, that would be on my only concern, although I've read in some places that a full blown reaction won't be masked by benadryl and 'you would know'.

_________________
DD 2004 Allergy to peanuts, egg, sesame, and new: lentils and chick peas
DS 2006 Allergy to peanuts, tree nuts, milk, egg, kiwi fruit, eczema


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PostPosted: Wed Feb 03, 2010 6:54 pm 
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Joined: Sun Dec 17, 2006 2:38 pm
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Pre-dosing is absolutely the sanest and safest thing you can do for your child. This is the best advice I've seen on this site. A+ to your bright doctor. I'm an anaphylactic to a common preservative in medicines, and I'm 100% certain that my neurotic discipline to premedicate before potentially allergic events is the reason that I have lived to retirement age. This comment about not pre-dosing because it might mask something severe....OMG!!!! The reason you premedicate is that it's the safest way to keep the reaction from turning into full anaphylaxis. Waiting until a full anaphylactic reaction to do something is asking for death to come sooner.


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PostPosted: Wed Feb 03, 2010 8:45 pm 
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Joined: Tue Jun 26, 2007 2:45 pm
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Location: Vancouver, BC
Thanks Bon - I do love our doctor. I think the concern some people have is that if someone pre-doses with benadryl, it may mask certain symptoms which would lead the person to think they don't need to use the Epipen right away. I believe I have read that taking benadryl wouldn't keep the reaction from turning into full blown anaphylaxis, and in anything beyond a mild non systemic reaction, that the correct route of action is epinephrine first, (then 911) and benadryl second, with the benadryl only given to stop discomfort from itching, etc.

For what it's worth, we took all the usual precautions during our last flight - wiped seats and surfaces, brought all our own food and decided in the end not to pre-dose. We were lucky that in the end, not even benadryl was needed at all on our trip.

_________________
DD 2004 Allergy to peanuts, egg, sesame, and new: lentils and chick peas
DS 2006 Allergy to peanuts, tree nuts, milk, egg, kiwi fruit, eczema


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PostPosted: Wed Feb 03, 2010 9:47 pm 
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Posts: 16
For whatever it's worth....I've never carried an epipen because I'm anaphylactic to the sodium metabisulfite preservative used in the epipen. I only use diphenhydramine. I know in a few seconds of sulfite exposure- my lips and mouth swell, throat and lungs start swelling, and I go into severe respiratory distress. I can get to the liquid benadryl caps in my pocket and purse within seconds, bite down, coat my mouth and swallow. It's just enough to keep me breathing in distress and slow the chain reaction enough that I can recover without ER assistance.


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PostPosted: Thu Feb 04, 2010 1:40 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
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Location: Ottawa
Bon, your particular allergies make it necessary that you follow a different treatment but for most of us, this is the standard according to the Canadian Society of Allergy and Clinical Immunology (CSACI).

Now, can we agree to play nicely? :damnedcomputer

Quote:
1. Epinephrine is the first line medication that should be used in the emergency management of a person having a potentially life-threatening allergic reaction.

2. Antihistamines and asthma medications must not be used as first line treatment for an anaphylactic reaction.

3. All individuals receiving emergency epinephrine must be transported to hospital immediately for evaluation and observation.

4. Additional epinephrine must be available during transport. A second dose may be administered within 10 to 15 minutes, or sooner, after the first dose is given IF symptoms have not improved.

5. Individuals with anaphylaxis who are feeling faint or dizzy because of impending shock should lie down, unless they are vomiting or experiencing severe respiratory distress.

6. No person should be expected to be fully responsible for self-administration of an epinephrine auto-injector.

http://www.allergysafecommunities.ca/pa ... atsubid=21

Also, the definition of anaphylaxis is:
Quote:
While there is no universally accepted definition, anaphylaxis (pronounced anna-fill-axis) can be defined as:

a severe allergic reaction to any stimulus, having sudden onset, involving one or more body systems with multiple symptoms

http://www.allergysafecommunities.ca/pa ... p?catid=13

_________________
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


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PostPosted: Thu Feb 04, 2010 2:37 pm 
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Joined: Fri Oct 10, 2008 9:40 pm
Posts: 2034
Location: ottawa
I know that each and every one of us do what we think is in the best interest of keeping our children safe.

_________________
DD 12 yrs -no allergies
4 yr old DS - asthma/eczema Anaphylactic to Peanuts, all tree nuts, sesame , all pea/lentil legumes, gelatin.
Allergic to trees, grass,ragweed, feathers, dander, mold and dust.
Outgrew eggs, fish, shellfish


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PostPosted: Fri Feb 05, 2010 1:05 am 
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Joined: Sun Dec 17, 2006 2:38 pm
Posts: 16
Susan, with due respect, pre-dosing is not first line treatment, it is a prophylactic treatment that is widely used and sanctioned by the US medical community to reduce the risk and severity of severe allergic reactions in medical procedures. Perhaps it's time to write to the CSACI and ask them to update their recommendations to include this. - B


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PostPosted: Fri Feb 05, 2010 7:53 am 
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Joined: Tue Mar 22, 2005 11:17 pm
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Location: Ottawa
Bon- Is this what you mean?
Quote:
Previous allergic reactions to contrast material, asthma, and allergies are factors associated with an increased risk of developing an adverse reaction. Pretreatment of patients who have such risk factors with a corticosteroid and diphenhydramine decreases the chance of allergic reactions, including anaphylaxis, renal failure, or a possible life-threatening emergency. Awareness of the different types of risk factors and prescreening for their presence allows for early recognition and prompt treatment. Prophylactic treatment before administration of contrast material can prevent potential adverse reactions. If such reactions do occur, prompt recognition allows them to be treated immediately. Using the smallest amount of contrast material possible and low-molecular, nonionic agents also decreases the relative risk of reactions.

http://www.aafp.org/afp/2002/1001/p1229.html

Here they are talking about pre-treating prior to a procedure at a medical facility as a way of reducing potential adverse reactions to the drugs/dye introduced to the body. Presumably, the benefits of the procedure would outweigh the risks. what we are talking about in this thread, is predosing a child prior to taking off in a tin can 35000 feet above the ground. That is far different than in a medical facility. I have never heard of predosing prior to potenital exposure to peanuts or any other food allergen. I have looked through the AAAAI (American Academy of Allergy, Asthma & Immunology). If you have seen evidence, please suply it.

_________________
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


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PostPosted: Fri Feb 05, 2010 11:38 am 
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Joined: Sun Dec 17, 2006 2:38 pm
Posts: 16
http://www.aaaai.org/professionals/reso ... s_2005.pdf
This also seems to deal with it mostly in the context of medical products
http://pediatrics.aappublications.org/c ... /6/S2/1601
this is a great article with a practical approach
My allergen, sulfites, is present in thousands of foods, in carpet cleaner, in personal products and fragrances, in corn syrup, air fresheners and sprays. It is far more widespread and pervasive than peanuts. I cite my own personal experience that premedicating works as well on food reactions as it does for medicine reactions and environmental reactions, because I experience all of these. Doing this has vastly improved my quality of life so I can lead a semi-normal existence with the rest of society. Each person needs to pick their own treatment plan that works best for them. The primary objection to the use of diphenhydramine is that it has a relatively long time to take effect. This objection is eliminated by premedicating with a liquid diphenhydramine (I use dye-free liquid benadryl caps, but it's also formulated in liquid bottles (too easy to overdose, IMHO).
Susan, I will write some letters to the societies, get the policies updated to save some lives. This is an incredibly important subject. If it is not stated in the manual, it needs to be there.


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PostPosted: Fri Feb 05, 2010 1:07 pm 
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Joined: Tue Mar 22, 2005 11:17 pm
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Location: Ottawa
Glad to know what works for you.

I still stand by the most up to date information from the Canadian Society of Allergy and Clinical Immunology (CSACI) who have recently changed the protocol from responding with an auto injector when 2 body systems are affected, to now responding when 1 body system is affected.
Quote:
Because of the unpredictability of reactions, early symptoms should never be ignored, especially if the person has suffered an anaphylactic reaction in the past...

If an allergic person expresses any concern that a reaction might be starting, the person should always be taken seriously. When a reaction begins, it is important to respond immediately, following instructions in the person’s Anaphylaxis Emergency Plan.


I take this to mean that rather than mask the early symptoms, we should take them seriously and follow the Anaphylaxis Emergency Plan. Regarding the need to use medical products which the person may be allergic to, well, that is a matter in and of itself as you would usually be in a medical environment.

The original poster here was talking in the context of peanuts and tree nut reactions which are always taken as serious anaphylaxis reactions and should be treated as such.


You wouldn't expect a person with beesting allergies to pre-dose with Benedryl each time they went outside, would you?

_________________
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


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PostPosted: Fri Feb 05, 2010 1:23 pm 
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Joined: Fri Oct 10, 2008 9:40 pm
Posts: 2034
Location: ottawa
Quote:
Pre-dosing is absolutely the sanest and safest thing you can do for your child


Bon you say pre-dosing is the sanest thing we can do for our children. If I was to pre-dose our son every time he may come in contact with one of his anaphylactic allergens he would be drugged into a supor 99% of his life. He is 2 and trace is a huge issue for us as he still touches so many things and puts his hands into his mouth. As I would never know what he may touch which may have an allergen trace I'd have to drug him every time I left the house. I appreciate that everyone's circumstances are different, and that what may not work for us in fact is a great solution for someone else. You also are an adult and are able to identify how exaclty your body is reacting for yourself. I also would never say never due specific environments/situations my child may encounter. But to daily pre-dose on the chance encounter of a reaction I would see as more harmful to him than good. Also, I'm curious. Do you find less of an effect from the benedrly due to constant use?

I also think that to pre-dose as a common practice in MY opinion would instill a type of fear for our son. It would be like telling him that he can't go anywhere, step out of the house without having a reaction, therefore we are going to medicate always. In MY opinion he needs to know that he CAN in fact go out and be safe. I also think that he needs to know the symptoms his body will feel at the onset of a reaction. One day I won't always be there and he needs to be comfortable enough on his own to say, 'my body is reacting in a certain way that I know (and I am prepared for this) that I need to use my epipen'.
Again, we all do what we feel is right. I'm not here to criticize anyone else on what they find works for them,everyone has a comfort level and everyone also has different circumstances they are dealing with.

_________________
DD 12 yrs -no allergies
4 yr old DS - asthma/eczema Anaphylactic to Peanuts, all tree nuts, sesame , all pea/lentil legumes, gelatin.
Allergic to trees, grass,ragweed, feathers, dander, mold and dust.
Outgrew eggs, fish, shellfish


Last edited by BC2007 on Fri Feb 05, 2010 1:41 pm, edited 1 time in total.

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PostPosted: Fri Feb 05, 2010 1:38 pm 
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Joined: Sun Dec 17, 2006 2:38 pm
Posts: 16
I know a bee anaphylactic, he pre-doses with Benadryl before he goes outside. YES. And he's an old guy that's been anaphylactic all his life. He also carries an epi-pen, it isn't intended to replace the epi-pen but simply reduce the severity of the reaction and reduce the risk of death. Sometimes we can learn from old guys that somehow stayed alive.

BC, at age 2 I don't recommend it for regular use, and I totally agree with you. However, it's appropriate for high-risk events like trips to the airports, big parties, new restaurants, and those places where it's almost impossible to control the situation. I've had to use Benadryl for decades, so I will say that I have never found it addicting, it works consistently well even when used daily for weeks at a time, but it loses its sedative properties after a few days. Benadryl has a very sedative side effect in many people and other side-effects, so each person trying this has to watch for these and make sure they can tolerate the side effects.

I apologise to anyone I've offended on this thread (and evidently there's a few) but I'm passionate on this topic because it has saved my life a hundred times over. I premedicate and I stay alive. Every one has to pick a plan that's right for them. This one is worthy of consideration.


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PostPosted: Fri Feb 05, 2010 1:51 pm 
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Joined: Fri Oct 10, 2008 9:40 pm
Posts: 2034
Location: ottawa
Bon, I am glad to hear that the benadryl still has a positive reaction even after long term use. I often wondered how even speradic use may diminish it's effect on minor reactions. I may not pre-dose but I also never leave home without it. :D

_________________
DD 12 yrs -no allergies
4 yr old DS - asthma/eczema Anaphylactic to Peanuts, all tree nuts, sesame , all pea/lentil legumes, gelatin.
Allergic to trees, grass,ragweed, feathers, dander, mold and dust.
Outgrew eggs, fish, shellfish


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