Reaction? What to do differently next time?

[OopsieDaisie]

Hello all,

Would love some insight into our experience last night... Before I start, our kiddo is fine this morning, so all's well that ends well, but I need some thoughts on how to handle it differently, if needed.  I *think* we were lucky.  I think we made a lot of mistakes.  (Please be gentle with me, in your responses!)

DS(7) is allergic to peanuts, tree nuts, sesame and banana.  We have had mystery reactions as well.  He has environmental allergies and asthma to boot.

Last night, right after eating State Fair Corn Dogs (yuck, I know, but we found out they were safe for peanut/tree nut/sesame & he gets very little junk food - it's an occasional treat), and drinking apple juice - he had a sore throat, he said it felt hot.  He got himself a drink and told us about it.  He seemed concerned and scared, but we had just given him benadryl (for the environmental allergies) and we decided to wait and watch.  He said it felt like his throat was opening and closing (I have never heard anything like this before from him - he demonstrated with his hands) and said it was hard to get a deep breath.  We checked his peak flow and it had dropped 25 points from the number he had blown several hours prior, and I gave him his inhaler to be safe.  He then complained of a stomach ache.  There were no hives, but other than that - these are basically his usual symptoms after exposure, and we had the epipens handy.  He thought it was time to dpi, but DH and I were not sure and we told him that we were going to wait and make sure. 

But then... he said his arm hurt, near the shoulder, and he was acting very melodramatic, pretending to fall down and acting silly.  It seemed like he was clowning around, and DS is our little actor.  It was hard to tell what was going on.  So we waited and watched.  In the meantime, we cuddled up together and watched a movie.  He said he was nauseous, but did not vomit.  Again, it was hard to tell if it was his inner actor, or real. 

This morning - he's fine.  But there is eczema around his mouth.  With that, I *do* think it was an allergic reaction.  [Sigh]  I think?

Would you walk me through this?  What would you have done differently?

Thanks.

Oh!  I am editing to add that DH had heartburn after eating the same food (!) last night, so we were also thinking that this might be heartburn, while this was happening.  Just to put all the info out there. 

[rebekahc]

Wow, that's really a tough call!  It's so hard to know - especially with dramatic kids.  My feeling is that if DS thought he needed the epi, then I guess you should have used it?  But, if a kid has enough energy to appear melodramatic/falling down/acting silly, then it would seem he was fine.  I know with both my kids during a serious reaction they would NOT have been able to act that way.  It's life and death.  They feel it.  They're just focusing (intently) on staying alive.  It's serious business, kwim?

From the description of his throat symptoms it could have been either throat closing or just reflux/heartburn.  When I've had a reaction, my throat feels tight but doesn't go back and forth.  Reflux might feel that way to him, though.  And with the tummy ache/nausea, it could go either way - reaction or indigestion.  For us, reactions that have involved GI have been pretty violent vomiting and/or diarrhea it never just stays at nausea.  Since he's fine this morning with just slight eczema, maybe it wasn't a reaction and the eczema is from environmentals?  Usually, after an anaphylactic reaction we have lingering symptoms for several days and need benadryl and steroids every 4-6 hours.

I guess I'm not much help.  Sorry!

Really glad your little guy is fine now!!

[OopsieDaisie]

Thanks so much.  It's really very helpful to hear that you think it could be heartburn as well.  It was a tough call, and DH and I were looking at each other with question marks in our eyes a lot last night. 

His prior reactions - which were clearly reactions that required epi and the ER - were easier to call.  This was tough!

[YouKnowWho]

I am wondering about heartburn as well.  DS1 has heartburn issues that almost mimic a reaction (he vascillates between cough/body hives and stomach reactions).  Honestly?  I would try a Tums next time to see if it helps.  I hate to say it but it took more than a few doses of Benadryl and keys in hand to head to the hospital before we realized that beans do him in everytime.

As far as the drop in peak flow - not sure about where you are but our allergy levels have been high for grasses and ragweed and the weather has been gorgeous, so both boys play outside and come in coughing.  I have changed things around in the house to allow them to go outside, come in and shower and then do their homework.  It's about to get worse when the leaves start changing for both of them.  And while showering before dinner is a pain, it has definitely helped both of them.

I know how you feel about junk food, we are the same way here.  You could send it to FAARP to be tested or just toss the box.  We have tossed more than a few boxes of things not being sure if it was a reaction or not when things weren't entirely clear.

If he does have mystery reactions (and we know those all too well in our house as DS2 has them frequently enough to make me lose my mind), it may be worth calling State Fair to see what their true list of ingredients, including spices are.  If they quibble with you, ask your allergist to send a letter requesting that info.  DS2 seems to react to certain spices (and just for good measure, they seem to be an issue and then not which drives me batty hence the mystery reactions including one ana rxn and we still don't know the cause).  It may just be pieces of a puzzle that you cannot put together yet.

[Macabre]

Well, with those symptoms and especially if he said he needed the epi, we would have given it.  There have been several times where we just relied on our plan and followed it like a formula--especially  helpful during weird reactions. IMHO kids don't tend to ask for a shot--it would take something for a kid to do that. 

And giving it helps them understand that it's not so bad and it makes things better. 

Also, as he grows, you want him to learn to trust their instincts where rxns are concerned.  And not to second guess himself. Certainly you want him to learn when it's a rxn and when it's not really one.  But I think it's a powerful lesson to learn--and they can either learn to wait (and waiting is what leads to most fatalities) or recognize anaphylaxis and to treat it. 


to you.  It's a hard situation to be in. I know.   It''s really hard to know what to do when it's not clear.  I would go over the anaphylactic grading chart and consider last night.  It may be that reading it you might not have used the epi, but it could be instructive. 

(((hugs)))

[momma2boys]

Sounds like a tough call.  How old is he?

[OopsieDaisie]

Thanks so much for all the input and thoughts on this.  He's 7, by the way.

We've talked a lot about this today, and I think if we were to find ourselves in the same situation again - we would epi.  It's hard to say, and obviously everything worked out, but after reviewing the grading chart again... and thinking of McCobbre's points... I think we will err on the overly cautious side.  Teaching him to trust his instincts, and not to wait... That's what tipped me to the epi side.  That, and seeing the grading chart again.

It's worse when we *know* we need to epi - because it's so frightening.  But the not knowing and second guessing is a bad place to be also.  Just thankful that this time around it was all fine.  He had had benadryl (for a runny nose) about 20 minutes before eating, so maybe that was helpful.

We are looking for a new allergist - and I think we are going to ask the new one for an action plan that lays out what to do/when very clearly.  Our current allergist has always simply said to epi for any throat symptoms.  I've learned more about food allergies here, at this board, than we did from DS's allergist in our small town. If you have any tips on what to ask a new allergist, I'd love to hear them.

Thanks again.  Knowing that you are all here is very comforting!