Quote from: SilverLining on November 06, 2013, 06:42:12 AM

Quote from: candyguru on November 06, 2013, 12:43:48 AM

Quote from: SilverLining on November 05, 2013, 09:03:01 PM
Candyguru, was she in hospital or ambulance when she got the second?  Or did you have to administer?

(Just thinking, in twenty minutes the ambulance should be there.  If not, we have a problem here.)

The ambulance arrived within about 6 minutes (we had already given her an epi-pen before they arrived). We arrived at North York General, and they gave her another shot (they did not use our epi pen Jr) when we arrived as she needed it (weakness, lower blood pressure, stomach ache, breathing issues). 

So the second injection was given in the ER, but had we been outside the city, and more than 20 mins from an ambulance, I would have given the second epi pen even if we could not have reached a doctor to ask, as I have always been informed that an epi pen may wear off in 15 to 20 mins and symptoms could intensify.

I'm not at all questioning whether it would have been appropriate for you to give a second dose yourself.

I was just wanting to be sure the ambulance arrived that quick...because I know they should have.

yes, we have called an ambulance about 4 times now...  and each time it has arrived in about 5-8 minutes.  The fire department usually arrives first in less than 5 minutes (an advantage of living in the city (near Yonge Street) as you are not far from the fire station or paramedics.. plus the hospital is just down the street)

Quote from: CMdeux on November 06, 2013, 09:49:17 AM

Quote
I can literally walk to the ER in less than 20 minutes which I probably should have done instead)

You do know that isn't really a good idea, right?  Exercise + allergic reaction = horrible cascade of escalating events. 

I second your experience of having EMT's and other first-responders (including ER nurses) not recognize non-cutaneous anaphylaxis symptoms-- we've seen that several times.

If you haven't looked up asthma as anaphylaxis yet, jschwab, I really encourage you to read through some of that information.  We have a great collection of articles and several threads on the subject.  It's really important to be well-educated on that subject if you're prone to those kinds of reactions from food, because you may be the ONLY person who understands that you're not just experiencing an asthma attack that you can't control with asthma meds.

Yes, I realize that would be dumb to walk . I was just making a point about just how close it is but why I still think it's important to carry two pens for myself, despite that. It's about 5 minutes in a vehicle. I did not think about first responders not being able to distinguish between asthma and anaphylaxis but that is a good thing to be aware of - thanks for pointing that out. I don't have asthma in my family so I don't actually know what a full blown asthma attack looks like (a girl just died from one in the schools here, though - so sad). I carry an Epi and no asthma medicine so I would hope that would be a signal about what was really going on. I finally ordered a bracelet to put a point on it which I would hope would help, too. The next reaction I had from almonds included the full-on hives and nausea so things might be changing somewhat for me, too...

Quote
I can literally walk to the ER in less than 20 minutes which I probably should have done instead)

You do know that isn't really a good idea, right?  Exercise + allergic reaction = horrible cascade of escalating events. 

I second your experience of having EMT's and other first-responders (including ER nurses) not recognize non-cutaneous anaphylaxis symptoms-- we've seen that several times.

If you haven't looked up asthma as anaphylaxis yet, jschwab, I really encourage you to read through some of that information.  We have a great collection of articles and several threads on the subject.  It's really important to be well-educated on that subject if you're prone to those kinds of reactions from food, because you may be the ONLY person who understands that you're not just experiencing an asthma attack that you can't control with asthma meds.

Mine have always come in two packs. I started carrying two after this most recent (and worst) episode. The EMT's told me that it was not an allergic reaction but an anxiety attack and were very disdainful and angry about transporting me - they did not really examine me, in fact, even though I told them I had had the injection (I thought they were supposed to check vitals and all, at least?). That severely reduced my faith in paramedics' ability to treat appropriately if I'd relapsed. I would always want to have a second dose to self-administer even though services here are very close (I can literally walk to the ER in less than 20 minutes which I probably should have done instead).  I don't even know if they carry them in ambulances here? My symptoms have not traditionally been anything but respiratory so whatever other classic signs they were looking for, they were not going to find. The ER was great when my symptoms returned and were on it right away, but I don't trust rescue personnel to figure it out. They just had no understanding of how the epinephrine works and that you can look fine for a little bit and then suddenly not be fine. If I'm just out bike riding and don't plan to ingest anything, I will take one, but generally I always carry two now.

Last year when I had a reaction to sesame the ambulance came within 5 minutes. I was at the hospital my 15 I think. They gave me a second Epi dose as a matter of course. And as they were preparing it, I started to go downhill. Then they gave it and I was fine.

I told DS' teachers on his recent trip that if he has a reaction on the airplane and  he has to administer the Epi to give a second Epi 15 minutes later (assuming they'd be making an emergency landing). And if he starts to react again before he is in the care of EMS, to use a third.

Quote from: candyguru on November 06, 2013, 12:43:48 AM

Quote from: SilverLining on November 05, 2013, 09:03:01 PM
Candyguru, was she in hospital or ambulance when she got the second?  Or did you have to administer?

(Just thinking, in twenty minutes the ambulance should be there.  If not, we have a problem here.)

The ambulance arrived within about 6 minutes (we had already given her an epi-pen before they arrived). We arrived at North York General, and they gave her another shot (they did not use our epi pen Jr) when we arrived as she needed it (weakness, lower blood pressure, stomach ache, breathing issues). 

So the second injection was given in the ER, but had we been outside the city, and more than 20 mins from an ambulance, I would have given the second epi pen even if we could not have reached a doctor to ask, as I have always been informed that an epi pen may wear off in 15 to 20 mins and symptoms could intensify.

I'm not at all questioning whether it would have been appropriate for you to give a second dose yourself.

I was just wanting to be sure the ambulance arrived that quick...because I know they should have.

Quote from: Jessica on November 05, 2013, 11:40:26 PM

Quote from: SilverLining on November 05, 2013, 10:17:38 PM
CG does not. 

My question was not I reference to whether he should have administered to, but rather whether he was required to do it.

ETA:  many doctors recommend a person carry two.  While there is a risk of a misfire, the main reason to have two is in case you need two, isn't it.

Not to mention that I'm not even sure you can buy singles anymore. Aren't they always sold in twin packs these days?

They've never been sold in twin packs here.

Quote from: SilverLining on November 05, 2013, 09:03:01 PM
Candyguru, was she in hospital or ambulance when she got the second?  Or did you have to administer?

(Just thinking, in twenty minutes the ambulance should be there.  If not, we have a problem here.)

The ambulance arrived within about 6 minutes (we had already given her an epi-pen before they arrived). We arrived at North York General, and they gave her another shot (they did not use our epi pen Jr) when we arrived as she needed it (weakness, lower blood pressure, stomach ache, breathing issues). 

So the second injection was given in the ER, but had we been outside the city, and more than 20 mins from an ambulance, I would have given the second epi pen even if we could not have reached a doctor to ask, as I have always been informed that an epi pen may wear off in 15 to 20 mins and symptoms could intensify.

Quote from: SilverLining on November 05, 2013, 10:17:38 PM
CG does not. 

My question was not I reference to whether he should have administered to, but rather whether he was required to do it.

ETA:  many doctors recommend a person carry two.  While there is a risk of a misfire, the main reason to have two is in case you need two, isn't it.

Not to mention that I'm not even sure you can buy singles anymore. Aren't they always sold in twin packs these days?

Quote from: twinturbo on November 05, 2013, 10:37:12 AM
@jschwab. I'm not sure I'm answering your question, I'm not sure there's a centralized question in there. This may or may not be satisfactory.

You ask what we here at FAS (is that correct?) think what someone else should do. That's not a perspective I share. What I find in my experience here at FAS is support from a group that is extremely well versed in both the history of well documented conventional knowledge of IgE-mediated allergies and what is on the bleeding edge of where treatment is going. Many of those here operate by considerable experience, advisement and/or guidance from some of the leaders of immunology research and treatment; rely mainly on published articles (as opposed to op-eds) in well respected journals (not magazines); Code of Federal Regulations, legal decisions, settlements, and agreements; and last but not least hard bought experience. Some of us find our past industry experience is applicable to anaphylaxis management directly or indirectly in the most surprising ways.

I've found that management for an infant, for a special needs toddler, for a young developing boy or girl, for a tween, for a teen, all is different than me as an adult. I've also read enough hard data from enough credible sources to recognize that, as allergen agnostic as I am with so many confirmed allergens that are of clinical significance to my kids, that not all allergens are created equal. That some proteins are more durable, come in a form factor that are more easily spread to contaminate, are much less likely to ever be outgrown, have a significantly higher mortality rate, and have some of the lowest dosages to elicit reactions.

I also know that insurance companies aren't always sympathetic to years of paying $2k plus for every reaction--and that's minimal ambulance plus 4-6 hour stay. And I know even then I'm lucky to be insured in the first place. I know that parents are barely able to work in some cases dealing with school nonsense.

It's a personal decision to eat your allergen in the privacy of your own home. It's a personal decision to eat a food highly contaminated with an extremely potent allergen with a high mortality rate. It's also an extreme disservice for a content farm website for the sake of increasing traffic to publish such horribly dangerous misinformation that is likely to put an individual at higher risk under the guise of "medical advice", especially when it intersects with social pressure from a loved one at developmental ages more prone to that social pressure.

We respect each other's comfort zones, the dynamic factors we must each put in our risk-reward calculus. Unfortunately there is not much traction in this branch of medicine and because its acceptance in the public eye is more closely related to a lifestyle model than disease, our Achilles heel has been co-opted successfully to the point of obscuring IgE-mediation. What does allergy mean? Why is it important? Why must we adhere to standards? Because total avoidance is our only prescriptive choice. There is no high tech answer, nothing to mediate per instance.

I think you'll find why that torch is carried so vigilantly from person to person within a well-read support group who see Sicherer, Wood, Burks, and are more likely to read their research rather than only read what blurbs a magazine author brings into print. With all due respect to the docs I'm more than bleepin' ready to go back to a carefree lifestyle. Give me something else besides total strict avoidance.

In all this I also think we all realize to a certain degree we occupy the bad spot on the bell curve, the area that isn't often studied due to severity. Besides sucking mightily we will be the first ones to tell anyone that was done disservice by a naturopath or IgG or sloppy testing that before they try to live in strict avoidance make sure you actually are allergic. No history, bad testing, eats allergen all the time. Congrats!

As to what individuals should be doing on their own I highly doubt anyone is in great need to judge. What nonsense rears up vying for credibility then dishes out horrible 'medical' advice under a banner that supposedly represents us as a group? Yeah, gonna call bullcrap in response.

My question was more rhetorical than anything else. I think I was just trying to puzzle out on paper whether the advice was actually as irresponsible as it seems, given common medical understanding of the issue and what the real world looks like for most people who may not have all the resources (discipline, intellectual, family support, access to information and care) that those who are most careful in their management can be. There are so many areas in public health where compliance is a huge factor in staying well, but where most people and most experts recognize that 100% compliance is not always going to happen. I was not really being critical of anyone taking issue with the article. I was more trying to figure out if the article more accurately reflects common understanding of how allergies should be handled when strict compliance is tough for people.  I myself have given similar advice to people who I knew were going to take chances anyway, KWIM? I literally have no idea what most people are told about managing their allergies in the real world so I was kind of curious if this was being criticized from the perspective of a stricter standard for compliance or was actually in direct contravention to standard medical advice. I think you answered that very well. Thanks.

CG does not. 

My question was not I reference to whether he should have administered to, but rather whether he was required to do it.

ETA:  many doctors recommend a person carry two.  While there is a risk of a misfire, the main reason to have two is in case you need two, isn't it.

We live more than 20 minutes drive from a hospital. Even at high speed.

Candyguru, was she in hospital or ambulance when she got the second?  Or did you have to administer?

(Just thinking, in twenty minutes the ambulance should be there.  If not, we have a problem here.)

tt.   That post is sublime.

My daughter needed two epi pen jr injections (20 mins apart) when she had her severe reaction to lentils.  That is the only time 2 doses were needed in our experience. Plus when arriving at the ER she was hooked up to an IV.  A severe allergic reaction is more scary to me than a second epi pen jr injection.  Life is difficult and stressful with young kids when things happen... not surprised I am getting grey hairs this past year.