Would you have used the epi?

[allerav]

Interested in feedback. A year ago, my son with MFA had his first anaphylactic reaction -- severe stomach pain, listlessness, minor edema (facial swelling) and then severe vomiting.  We used the EPI immediately once he started vomiting and thankfully it resolved with additional steps taken at the ER (steroids, nebulizer).  Over the weekend, my son ate some pizza (from a place we have eaten at dozens of times) and started getting moderately severe stomach pains and feeling like he wanted to lay down.  He also had some minor facial swelling.  No chest pain, trouble breathing or other symptoms, he did not vomit.  I really debated whether to use the EPI.  His symptoms did not progress beyond what I described, we gave him some Benadryl and he fell asleep (it was late by that point).  Just curious what you other allergy parents would have done.  It's so scary reading how fast symptoms can progress that it was a really tough call even though he did not progress in his symptoms.

[CMdeux]

YES.


Why?

Because
stomach pain = GI symptom
Sleepiness/altered awareness = neurological/cardiac symptom (depending on the manifestation, this MIGHT be due to low blood pressure)
swelling-- cutaneous symptom.


That's three.  With only two of those symptoms, that = Epinephrine.  Frankly, with only the middle of the three, depending on how profound it was, and how it manifested (this is one of those things that once you have SEEN it, oh crap that symptom is distinctive and scary)...

well.  The next steps are:  Loss of consciousness, cardiac arrest.  Not necessarily in any particular order.  But once either of those takes place, epinephrine just got a LOT less effective in the field.

Am I scaring you?  Probably.  But here's the thing-- I've done what you did, and it turned out the same way.  One unfortunate physician in CA did it, too-- and his 13yo DD is dead.

[twinturbo]

Yes.

[Linden]

Yes, because in my case, I have a written Epi Pen plan given to me by my allergist that has a long list of symptoms. "Abdominal pain" and "lethargy" are included among them.

[Macabre]

About that wanting to lay down thing--that's one of my symptoms frequently. 

Unrelated, yet stay with me: the day I learned I was pregnant (about 5-6 weeks in), I was at work and felt soooooo tired.  I had never felt tired like this in my life, and I had plenty of all-nighters in college.  I went to my boss' office, and I told her, "I am inexplicably tired.  It's like I have to lie down right now.  I hate to leave early, but I absolutely must sleep."  (It was my last few hours before leaving for vacay--not a good time to up and leave, but this was WOW sleepy.)

Did you get sleepy like that?  It was an irrational, MUST.SLEEP.NOW.AT.ALL.COSTS. sleepy. 

That's how I feel when I am like this while having a reaction.  It's such an irrational kind of sleepy.  I'll be in the middle of a meeting at work and having eaten something they provided (stupid, I know), I've had thoughts like:

"This meeting will go on for another hour. I bet they won't notice if I just lie on the floor behind my chair and sleep."
"It will be okay if I just go lie down on the bench in the foyer and sleep."

It's crazy.  But it's an absolute need to sleep at all costs. 

I don't know if your kiddo was feeling that way, but that's how I feel.  Wow--it leads to horrible judgment on my part, too.

I will tell you that when this has been my only symptom I have not epid.  I've given myself benadryl, yes (oh, wow, and like that helps, lol.  Seriously, it has helped relieve the symptom--ironically.) 


We have followed the Anaphylaxis Grading Chart during tiimes like this--when the symptoms aren't classic. 

This happened the first time we epid--after an allergy shot, btw. 

The second time we epid--DS was at school.  He had asthma that developed and was persistent/worsened in spite of albuterol (DS' asthma isn't bad, and it's rare he has a flare up).  And he had the spaciness and tiredness.  In talking with him and the school nurse we couldn't identify what he had eaten--that he had eaten anything.  But we followed the chart and had the nurse epi him. He had a biphasic reaction 8 hours later that involved stomach cramping and other symptoms.

So twice we've simply followed the Anaphylaxis Grading Chart and it was the right thing to do.

Here's the chart in plain English, btw:
http://the-clarkes.org/stuff/ana.html


It's really hard to know what to do, btw.  It is.  As my child gets older, we simply do not see cutaneous symptoms.  It's gotten trickier (not easier, darnit) to identify reactions. 

Glad your kiddo was okay.  Do not beat yourself up over what you should or should not have done.  Just move forward. 

[lakeswimr]

Do you have a written emergency plan from your allergist?  If not let us know and we can give you a link to some.  Some here will post the Ana grading sheet.  I personally do not like it because it makes it sound like you don't epi until  a person is pretty bad off.

In general, most people have plans that call for giving the epi for any systemic reaction (involving more than one system), any reaction involving any swelling or tightness around the mouth,throat, lips and any reaction with any involving any breathing issues.  Our plan would call for the epi in the situation you described.  We are supposed to give it for anything more than localized hives if we have known or suspected ingestion.

It is hard to epi but it relieves pain, as well.  #1 most important thing is that it is potentially life saving and it is the ONLY thing that is.  Benadryl won't stop a reaction that is going to progress to life threatening from progressing.  It is for comfort only.  Most reactions will self resolve so your child had one that did.  Not unusual.  But you can't count on this.  So, that's why the epi is so important.  We don't know which reactions will progress and which will not once a reaction starts. 

But #2 important thing about epis is that they prevent suffering through the pain of a reaction.  Reactions can be very painful--stomach pain, etc.  The epi, when given asap, can relieve that pain in seconds or minutes.  So, to avoid hours of potential suffering through a reaction it can be stopped quickly.

Also, if your child was still having a reaction at the er it sounds like they should have given a 2nd epi.  A huge % of people need more than one epi.  ERs often give everything but the epi for some strange reason.  I'd review your plan with your allergist and ask about that and about when to epi.  You shouldn't have to wonder.  It should be printed in black and white for you to refer to if you aren't sure. 

But you know the saying, 'when it doubt, epi'. 

[Mom2G]

I would.  My concern is that the feeling of being very tired was due to his b/p dropping.  My ds has only had 2 reactions, both anaphylactic.  He's had the Knowpeanut test which indicated he is at high risk for anaphylaxis.  So if we think hes having a reaction epi and off to the ER.  I've spoken to the school nurse about this too.  Luckily the only time he has reacted is due to consumption of actual peanuts.

[mommabridget]

I'm a little late to the discussion. When I saw the question, before I read the situation, I thought YES.  If you are asking the question, you probably should have.  It is amazing how it it HELPS and how we are sll scared to use it.