New to all of this--DS SFA reaction last night?

[DysonsMom]

So should the epi be given if he has a swollen bottom lip and a few red bumps on his face like the other night? The pediatrician did not give an allergy plan, and I won't be able to get him to an allergist until Feb.
If he had any trouble with breathing, coughing, or his throat, I would give it immediately.

[LinksEtc]

So should the epi be given if he has a swollen bottom lip and a few red bumps on his face like the other night? The pediatrician did not give an allergy plan, and I won't be able to get him to an allergist until Feb.
If he had any trouble with breathing, coughing, or his throat, I would give it immediately.

I'm not a doctor so I don't feel comfortable telling you when to give the epi, but what I would say is that the above plan is a good guide.  Can you print it off and bring it to the ped so that they can sign?  It would only take a few seconds and you shouldn't need to make another appointment in order to do so.

Here is another link that you might find helpful:
"Allergic Reaction or Anaphylaxis: Signs, Symptoms and Treatment"
http://www.kidswithfoodallergies.org/resourcespre.php?id=149&title=anaphylaxis_symptoms_and_treatment

[LinksEtc]

I don't want to overwhelm you with links, but this is one more great resource:

"Guidelines for the Diagnosis and Management of Food Allergy in the United States"
http://www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAguidelinesPatient.pdf

What else you should know: Epinephrine should be given immediately to treat anaphylaxis. Delays in giving epinephrine to patients can result in rapid decline and death within 30 to 60 minutes. Epinephrine acts immediately, but it may be necessary to give repeat doses.

If you or someone you know is having an anaphylactic episode, health experts advise that you do the following as quickly as you can:

• Remove the allergenic food from the mouth or skin.
• If an auto-injector is available, inject epinephrine into the thigh muscle.
• Call 9-1-1 if you are not in a hospital, or summon a resuscitation team in the hospital.

When medical help arrives, the patient should be placed lying down, if possible, with the legs raised and given oxygen and IV fluid.

What else you should know: Antihistamines should only be used as a secondary treatment. Giving antihistamines instead of epinephrine may place you at significantly increased risk for a life-threatening allergic reaction.

[twinturbo]

Most people will think you're overreacting. Include many medical professionals on that list. We can show you how to manage those social situations including medical professionals later but right now yes, your priority list looks right to me.

You have to keep in mind that allergic disease in this current generation of kids is unprecedented with regard to food allergy. I was in the group of disbelievers before it happened to my kids. I started believing.

Plan is in place. I'm assuming you're bringing your partner up to speed so you're both on the same page.

[LinksEtc]

I have a couple of relatives who think I may be over reacting. (The benedryl worked just fine. Don't panic. Don't over react. He doesn't eat much seafood, anyway. He probably would have been fine eating the Ramen noodles--he has had them before. What is the likelyhood he would react to cross contamination?)

I don't know if he would react to CC. I don't know how severe the allergy might be. I just know I am taking anything that could possibly kill my baby VERY seriously.

Relatives often feel that way, but I'd try to tune them out for now 

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As far as cross-contamination & regular label reading, these are the last links I'm going to give you today (sometimes I have to hold myself back from providing too many links  ):


"FREQUENTLY ASKED QUESTIONS ABOUT THE FOOD ALLERGEN LABELING AND CONSUMER PROTECTION ACT OF 2004 (FALCPA)"
http://www.kidswithfoodallergies.org/resourcespre.php?id=50&title=food_allergen_labeling_law


"Cross Contamination of Foods with Allergenic Ingredients"
http://www.kidswithfoodallergies.org/resourcespre.php?id=7


http://home.allergicchild.com/cross-contamination/


"Can consumers trust allergen advisory labels on food products?"
http://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/Can-consumers-trust-allergen-advisory-labels-on-fo.aspx

highlight the need for allergic customers to avoid products with advisory labels and to have some concern for products that have no advisory labels, particularly from small companies within categories of higher risk products.

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Take everything step by step ... Don't overwhelm yourself ... Getting epinephrine, an allergy plan, an allergist, & becoming familiar with label reading is where I would start.  It's normal for there to be some stress & anxiety when 1st diagnosed  .

[CMdeux]

First thing this morning, I gave some instructions to the daycare, including to call 911 if he starts having a reaction that includes 2 symptoms and call me for any hives or lip swelling.

Sometimes 1 symptom is enough to epi for ... for example, "LUNG" symptoms after ingesting the allergen is something many of us here have been told to epi for.

Yes-- it's important to know which symptoms are "life-threatening" or indicative of imminent/hard-to-see life-threatening responses.

SKIN symptoms, ironically, are the easiest to see, but the least dangerous type of allergic response.  Just like in first aid class-- remember your A B C's.

Airway-- anything that obstructs the airway is BAD, BAD, BAD, and can kill-- this includes swelling anywhere along or near that airway, particularly in young children, who have SMALL airways to start with.   So lip or mouth swelling is a LOT more serious than eye swelling, basically.

Breathing-- this is a tricky symptom in young children, but wheezing, coughing, or other signs of respiratory distress of ANY kind should be treated with epinephrine because they are IMMEDIATELY life-threatening.

Circulation-- this is, at least in my mind, the ULTIMATE bad news set of symptoms (could be because I've seen these relatively often in my DD).  The reason is that they are SO darned hard to pin down in kids when you're on the outside looking in.  Symptoms of shock are so hard to spot early.  Glassy eyes, dazed behavior, or unusual lethargy with pallor... all call for epinephrine if you have ANY reason to suspect an allergic reaction is in progress.

Basically, that's it.

Get to know this:

Anaphylaxis Grading Chart

Which is the plain-English version of the one originally published in a medical journal (the link is in the chart)-- I'd take that with you to your allergist and discuss previous history (the symptoms you saw) as well as what to do about each of the ones listed in the future. 

Understand that the "neurological" symptoms usually indicate cardiovascular involvement-- pay VERY close attention to those last three columns, as those symptoms can kill in just a few minutes, and there also seems to be a "tipping point" beyond which medical intervention (even epinephrine) is no kind of guarantee of anything.  I don't say that to scare you-- but to cement for you that your family MIGHT think that you're overreacting, so you need to KNOW that you are not. 

[DysonsMom]

Don't worry about overloading me with links and information. I am going through and reading them all now.
I really appreciate the support. I am going to call an allergist recommended by a coworker today and get him set up with an appointment. And I am going to go through this thread with my coworker and teenage son, so we are all on the same page.
Until an allergist tells me differently, I will use the Epi if his airway is involved, even if it is just lip swelling. I would rather have him safe and have a huge ER bill than jeopardize his life. I never thought Russian roulette was very wise.

[twinturbo]

Man, I hate to say this but it has to be said my instincts are telling me to. Keep your cards close to your chest on this one with friends and family. There are some family members that believe it's made up, not so bad and that they are going to 'prove' it to you--by putting the child at risk. They are not evil just misguided. Beware the family member too eager to watch or feed your child.

This should ease up once you get everything in place for emergencies and find a groove. If it's only shrimp (and I don't say that lightly) then it may not have as much life altering social impact as peanut or milk would. You may not have to make as many life alterations with a more narrow category of food like crustaceans.

Bottom line is watch out for adults wanting to 'test' the child. Need to know basis. Nod your head and empathize, cite doctors orders, etc. Don't get into involved conversations with anyone. That will at least save you time and frustration.

[twinturbo]

One last base to cover just to be sure. Does child have any history of asthma? I'm not saying expect it but a history of asthma is a bit of a gamechanger.

[DysonsMom]

I appreciate the caution regarding my friends and family, but most of them have medical backgrounds (nurses and emt's), so they aren't going to intentionally "test" by exposing. They know it can be life-threatening. We have a mutual friend allergic to shellfish who is alive because she happened to have her first reaction actually at the ambulance service.

They just don't think he will actually be exposed to shellfish if I don't feed him shrimp or crab. However, I have a gluten intolerance, so I am aware of how often cross-contamination can happen, even when being careful. That being said, I am certain milk or nut allergies would have a far more life-changing implications.

As for asthma, he has never been diagnosed with it. However, (I don't know if this is related or not), but we have not yet had a cold and flu season when he did not end up on steroids and breathing treatments for coughing. As a side note, my oldest son and myself have eczema and my identical twin had asthma, but has not had a flare in years.

How would asthma be a game-changer? I am supposing it would increase the likelihood that his lungs would become involved?

[LinksEtc]

As for asthma, he has never been diagnosed with it. However, (I don't know if this is related or not), but we have not yet had a cold and flu season when he did not end up on steroids and breathing treatments for coughing. As a side note, my oldest son and myself have eczema and my identical twin had asthma, but has not had a flare in years.

Based on my experiences, I would suggest taking him to a pulmonologist for a formal evaluation to see if he has asthma.  Needing to be on oral steroids so many times is generally not a good thing. 

It is possible, although I can't say for sure, that severe symptoms might be reduced by adding a daily controller med like Pulmicort or Flovent.  If it is asthma, you really want to get that airway inflammation under control.

When my dd was very young, her ped didn't think that she needed to see a pulmo ... that is, until she ended up hospitalized.

How would asthma be a game-changer? I am supposing it would increase the likelihood that his lungs would become involved?

People with asthma are at higher risk of having severe food allergy reactions.  Plus it adds a layer of complexity in that lung symptoms require judgment calls as to whether symptoms are from asthma and/or food allergy.  I wouldn't worry too much about this unless your ds is diagnosed with asthma.

[DysonsMom]

I gave him some pizza a about 15 minutes ago--same stuff he has had a zillion times. Now he has a welt beside his mouth. I have an appointment to get the epipen with county health on Monday. I figured I would just give him stuff I know he can eat. But this throws a kink into things.
I gave him benedryl and he is still on prenisone, so I gave him the dose he was due for. I am going to watch him carefully and pray there is no more swelling.

[twinturbo]

After a reaction for a while after it's possible to react to stuff you normally eat. Having said that keep a log of what he eats and if there's any noticeable reaction. Think back to the shrimp if there was anything it was cooked with or in. You're watching contamination so you'd know if it was a shared dish sponge, cooking equipment.

[DysonsMom]

Nothing shared. The pizza came from Little Cesar's. The shrimp was cocktale shrimp straight from the package to a paper plate. I immediately got rid of anything that had touched the shrimp, washed his clothes, the counters, and took out the trash.

The welt on his face seems to be going down. It is no where near as bad as the other night. Maybe it was just a hyper reaction to something from his system still being hyped up?

[YouKnowWho]

Tomato sauce could be the culprit - already sensitive skin reacting to acid.

Having said that, over the years Little Caesars has been known for mystery reactions and no one can seem to figure why.  As much as I love the pizza for being cheap and handy (given that I pay almost $10 for a pizza the size of Totinos that is safe for son allergic to wheat, rye, barley and egg), it is no longer worth it to me.