The bad news? My “baby,” now a tween, had an allergic reaction to something he ate at school which necessitated the immediate deployment of his allergy action plan involving epinephrine, a call to 911 and an ambulance ride to the emergency room.
The good news? He was treated quickly and effectively and discharged from the emergency room.
When I received the call from the school nurse, I was at work and had just sat down to eat lunch. The professional calm in her voice did nothing to dispel the butterflies racing frantically in my stomach. This is always how I feel when my son’s school nurse calls me, whatever the reason.
This time she told me that my son had eaten his usual lunch but afterwards had come to her office complaining that his mouth and throat felt dry and scratchy and that he felt like he was going to throw up. At this point, he had no hives, wheezing, difficulty breathing or swelling. She gave him Benadryl and observed him closely.
The next 20 minutes were a blur as his symptoms progressed.
The What If’s
During this time, the “what if’s” consumed my mind.
- What if his body is reacting on the inside releasing chemicals that may cause his throat to swell, leaving him unable to breathe?
- What if he just has a stomachache?
- What if I’m wrong?
- What if his scratchy throat is just the tip of the iceberg?
- What if this is just a cold virus?
- What if I’m wrong?
- What if I’m overreacting?
- What if I’m wrong?
- What if the epinephrine and ambulance aren’t necessary?
- What if I make the wrong decision that costs him his life?
How could I live with that? How can I live without him?
In addition to the “what if’s,” I had flashbacks of my son’s previous reactions as well as the many food allergy tragedies from around the globe. My son had previously suffered his worst reaction at the age of 5 when he ate an entire bag of Cracker Jacks not knowing it contained peanuts and said he felt as if “there was a string around my throat.”
I thought about food-allergic children and adults who were taken away from us too early like Nathan Walters, Trent A. Hankins, Emily Vonder Meulen, Cameron Groezinger Fitzpatrick, Ammaria Johnson, Sabrina Shannon , Natalie Giorgi and numerous others.
I thought about the many times I had it drilled into my head that epinephrine, NOT an antihistamine, is the drug of choice for anaphylaxis.
I thought about how, as a medical intern, I had seen both successful and unsuccessful resuscitations in the hospital.
Although we decided to give Benadryl at first due to my son’s mild symptoms and no known exposure, I made the decision for him to get his epinephrine once additional symptoms appeared. The consequences were too high.
Was that the correct decision? Would he have been okay with Benadryl only? Perhaps. Perhaps not.
What I do know is that the epinephrine resolved all of his symptoms and he was out of danger. He was observed in the emergency room for several hours and discharged.
What is the right thing to do each time?
I wish I could tell you. Allergic reactions are often not black or white. You should have an allergy action plan that you discuss with your child’s treating physician and know ahead of time.
Even so, it can be difficult to know what to do since there are so many compounding factors such as your child’s current state of health (is he/she sick with a cold), coexisting conditions (e.g. asthma), amount of allergen ingested (trace vs. a large dose), route of exposure (skin contact vs. ingestion), severity of your child’s allergies and proximity to medical care (limited access to health care).
What I will say is:
- Plan: Consult with your child’s physician about an emergency action plan now rather than later. Have a clear plan to follow with treatment options given different clinical scenarios (known ingestion, possible ingestion, hives, itching, wheezing etc.). Know the plan. Discuss the plan. Keep the plan readily accessible.
- Learn: Learn about food allergies and teach your child about his/her food allergies in an age-appropriate manner with books, online resources, DVDs, etc. Learn how to prevent, recognize and treat a reaction.
- Avoid: Avoid allergens at all times. Read ingredient labels vigilantly and don’t let your child eat food without labels unless you have inquired about the ingredients. Minimize exposure to food allergens on others’ hands by asking family members, friends and classmates to wash hands with soap and water. This is key. Don’t share food. Don’t share drinks.
- Inform: Inform your child’s Food Allergy Circle (family, friends, caregivers, teachers etc.) about his/her food allergies and make sure that they know the signs and symptoms of an allergic reaction as well as how and when to treat.
- Practice: Practice your emergency action plan. Know where medication is kept and how to administer. Practice administering epinephrine with trainers or use expired epinephrine auto-injectors on fruit such as apples.
Last but not at all least, if you believe in a higher power, pray or tap into that power. Mine is God. On the way to the hospital, I prayed to Him to watch over my child. While there I prayed for continued healing and care for my son, and on the way home I thanked Him for sparing my child and allowing him to be with us another day.
The next morning was never so glorious as I sat stroking my sleeping child’s sweet cheek.
Supporting the Food Allergy Circle
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Donna DeCosta, MD ( @foodallermomdoc ) is founder of FoodAllergyMomDoc an online community dedicated to supporting the Food Allergy Circle with tips, ideas and resources and author of A Little Bit CAN Hurt: The Shocking Truth about Food Allergies — Why We Should Care, What We Can Do.