All drugs must be premeasured?

[MomTo3]

For premeasured dose I use Luer Lock syringe and label the outside.

Do I need to get those from the Dr. or can I get them  anywhere?  Found them on Amazon.  Do you put them in something so they aren't accidentally pushed?  A hard pencil case perhaps?  Maybe I am over thinking again!

You are all fantastic! I am learning so much (and I though I was pretty knowledgeable already )  I did also call my local fire dept. yesterday to find out if they have epi and the authority to use it.  I was happy that all squads in the city as well as the fire trucks all carry epi and are authorized to give it to pediatric patients!

[Mfamom]

http://www.medscape.org/viewarticle/733658

http://www.dailyrx.com/news-article/pediatric-food-allergies-are-increasing-16777.html

Both abstracts he talks about concerns in the delay of administering Epi pen.
When you see him again, please ask.  I may go to his Q/A this month, if I do, I'll ask him again to clarify.

[regular member]

Overdosing on Benadryl can cause respiratory depression and death, so I would not give a double dose of Benadryl.

Double dose is on my child's Allergy Action Plan.
And I do think Benadryl can HELP even in Anaphylaxis - it just may not be enough.  But Epi+ Benadryl likely to be more effective than Epi alone.  Hospital ER's use Benadryl for this reason!

[twinturbo]

That's a good question for school storage. There's with cap or without cap, obviously you want with cap. In our family we need syringes by the case. If you only need a couple a local medical supply store would probably have individuals for sale. The pencil box sounds good to me since it's a hard case that you can label.

What we did was buy a bag recommended by some kind soul here, a waterproof bag from Magellan's travel supply. On the outside we put a pic of child on label with name, medicines inside with dosage amount, parent contact info and allergens. Taped it all over with tough clear tape to repel liquids. On the inside we have epis, bottle of antihistamine, syringes, insurance card, EAP. The bag has a waist strap so the teachers can carry it around easily. In our case one medicine bag stays in the classroom, the other a teacher wears when they go outside the classroom.

In any case I'd load the pencil box with about 3 pre-loads of Benadryl in luer lock w/cap, scotch tape the cap in place. I'd label each tube with name and dose and medication contained within stating in bold "ONE DOSE" or similar, expiration date might be good idea, too. Then I'd label the outside well with whatever info you deem necessary, adding to the box whatever else goes in for child (epis, action plan, etc.).

Periodically I go in to the medicine bags at school to check on them, make sure everything looks good, fully stocked, expirations are still good. Our teachers are terrific on always carrying the bag but not the best at temp control.

[twinturbo]

http://www.medscape.org/viewarticle/733658

http://www.dailyrx.com/news-article/pediatric-food-allergies-are-increasing-16777.html

Both abstracts he talks about concerns in the delay of administering Epi pen.
When you see him again, please ask.  I may go to his Q/A this month, if I do, I'll ask him again to clarify.

Oh, he never mentioned delaying the epi in the face of clear anaphylaxis but the EAP was clear on Benadryl as a first line every time a reaction happened when it wasn't anaphylaxis yet according to the grading system.

I think that standard treatment a few years back was hives/itchiness give benadryl, if symptoms persist (vomiting, difficulty breathing, any other system reacting) give the epi pen. 

^This is what our EAP from Sinai says. I questioned the directive to give Benadryl first on a known ingestion of allergen with previous anaphylaxis and it was yes.

So are we talking about the same thing? I'm confused.

Gotta run but wanted to say thank you for the links... and any insight you have on what/if the EAP protocol has changed. Because my understanding based on the docs I've read is there's good reason to epi first on known ingestions of allergens that have history of causing anaphylaxis. That's most likely what I'd do anyhow regardless of what the EAP said.

Hope that made some sense. I'm at the point where I feel like I have to start carrying the papers endorsing use of epinephrine first in appropriate instances where it's warranted (i.e., not delaying) because of all the difficulty in the ambulance and ER. I was caught off guard by our EAP from Sinai. Actually, I think we were somewhat taken to task by Sicherer's assistant for our statement the ER should have given epi the first reaction, like we had to prove he had anaphylaxed from peanut 5 years ago. Gee, his eyes were swollen shut, he was grabbing at his throat, mucous and tears were streaming from his nose, mouth and eyes, then he started to pant for air. For our other child his first epi was given by the allergist in office, all he had to do was read the report.

It was somewhat frustrating but I think I should bring in the links and use that as the medium to talk about it rather than parent of patient to doctor or doctor's assistant. At least give it one more try for clarification.

[CMdeux]

Glad you understood what I was saying there.

You might try finding out whether or not the school will accept medications which are not in their original packaging before you invest in luer-lock syringes and try going that route.


(If they are concerned about drug safety and protocols to prevent accidental administrations, etc... they may be thinking about liability and NOT be willing to take any medication which is not in original packaging.  As inconvenient as it is, I can understand that with OTC medications.  Any chance that your physician will give you a SCRIPT for diphenhydramine that you can fill at a compounding pharmacy?  Then they might have to take it and deal with dosing themselves.)

As for diphenhydramine versus epinephrine, honestly, there is pharmacology to support the use of diphenhydramine for anaphylaxis.  BUT-- there are significant caveats.

a) LARGE dose (like 200%)

b) FAST administraion (within a few seconds, usually, of the onset of initial symptoms)

c) meticulous observation for progressing symptoms and rapid epinephrine for ANY vascular, airway, or neurological symptoms.

This is how our allergist has handled DD's systemic reactions in-office, and it's also how we've been instructed to manage things.  The reason that more allergists recommend "epi first" has to do with the relative complexity of that series of things.

The reason it works is that knocking out a high percentage of histamine receptors at the very onset of the cascade can prevent additional second-messenger relase (cytokines, etc.) and may actually help prevent progression, which in catastrophic anaphylaxis can be thought of as being like a snoball rolling down a hill.  IF you do it soon enough and with a high enough dose, you can stop that snowball while it is little.  BUT-- if you wait just a little too long, you can't and nothing but epinephrine will help, and benadryl is just a waste of precious time...

The reason that many top allergists have told people to stop using benadryl to treat reactions is that far too many people think that it has life-saving properties, and it doesn't. It does tend to delay the administration of epinephrine in laypersons, particularly in school personnel.

The above is definitely not something that I want other people caring for my child to do because of the relative risk... but it's also true that in a child with contact sensitivity, benadryl is going to be a way of life.  We've never had diphenhydramine expire in our house.  Not in 13 years.

Another good read is down in Reactions here-- there are a pair of threads stickied down there regarding antihistamines and epinephrine and their relative role during anaphylaxis.

[twinturbo]

Compounding pharmacy sounds like *the* way to go where feasible. I would love to see what ours could come up with.

[MandCmama]

 FWIW, Our school requires that all meds be in their original packaging.

[MomTo3]

I called the nurse and they want the original packaging BUT I must have it measured out into syringes.


Such a wise group!   

[Carefulmom]

Overdosing on Benadryl can cause respiratory depression and death, so I would not give a double dose of Benadryl.

Double dose is on my child's Allergy Action Plan.
And I do think Benadryl can HELP even in Anaphylaxis - it just may not be enough.  But Epi+ Benadryl likely to be more effective than Epi alone.  Hospital ER's use Benadryl for this reason!

How much is the dose and how much does your child weigh?

[lakeswimr]

Overdosing on Benadryl can cause respiratory depression and death, so I would not give a double dose of Benadryl.

Double dose is on my child's Allergy Action Plan.
And I do think Benadryl can HELP even in Anaphylaxis - it just may not be enough.  But Epi+ Benadryl likely to be more effective than Epi alone.  Hospital ER's use Benadryl for this reason!

Unfortunately hospital ERs are infamous for treating anaphylaxis improperly far too often.  There have been several studies on this and many ERs do not epi when they should nearly often enough (and do everything BUT epi for some weird reason) and fail to keep the people in the ER for observation for the recommended 4-6+ hours and fail to give a prescription for epi to even first timers.  Looking to hospital ERs for proper treatment of ana is a mistake unfortunately.  The National Institute of Health came out with guidelines for the treatment of anaphylaxis that makes it clear only epi has life saving capabilities and that antihistamines do not have any  life saving capabilities.

A person may feel better on both epi and antihistamine but I haven't ever read anywhere from a medical source that a person is likely to have a better outcome with both.  Would I give both?  Yes.  Would benadryl be a priority of any sort?  not really.  Getting that epi in and calling 911 would be priorities and if recommended, getting a dose of steroid in those who have docs who recommend it. 

[lakeswimr]

I called the nurse and they want the original packaging BUT I must have it measured out into syringes.


Such a wise group!   

That's best case scenario, actually! Our school used to let us do this and now they say only in the original packaging.  I do NOT want them fumbling around trying to measure Benadryl when DS needs 911 to be called.  I want them to epi, call 911 and then worry about Benadryl. You are actually lucky with this outcome!~

[Carefulmom]

Overdosing on Benadryl can cause respiratory depression and death, so I would not give a double dose of Benadryl.

Double dose is on my child's Allergy Action Plan.
And I do think Benadryl can HELP even in Anaphylaxis - it just may not be enough.  But Epi+ Benadryl likely to be more effective than Epi alone.  Hospital ER's use Benadryl for this reason!

I just noticed the last line in this quote.  I was focused on the "double dose", which I really don`t know what dose you consider to be a "double dose" and how much your child weighs.  But I have worked in hospital ERs, and the reason of epi + benadryl being more likely to be effective than epi alone is not true.  That is not why we give epi + benadryl.  We give Benadryl after epi because the epi can wear off quickly and that way the antihistamine is kicking in when the epi is wearing off.  I don`t think anyone in an ER actually thinks epi + benadryl is more effective than epi alone. 

[Mfamom]

so, you are supposed to fill the syringe with the benadryl and supply the packaging it came from?  do they want you to label the syringe?  it seems like if there is chance for error this way too because you can't verify what is in the syringe.  any chance a syringe full of benadryl could get mixed up with someone else's syringe filled with a different med?

[MomTo3]

I will put a few labeled, pre filled  syringes into a hard pencil case with the original box. I will put labels on all they syringes as well as on the case with his picture on it.