What should I do In Case of an Allergic Reaction?
A food allergic reaction can be a frightening experience. Below I hope to help guide and empower you to be able to know the most effective way to treat an allergic reaction should your child have one.
How common are food allergic reactions?
Studies have shown that the rate of food allergic reactions is greater than 15% per year per child. One study even showed that there is a 1 in 2 or 50% chance that your child will have an accidental ingestion leading to a food allergic reaction per year.
This happens because it not always easy to know if a packaged food or restaurant meal contains a food allergen. As a result, it is very important to know how to treat an unexpected allergic reaction.
What should I do in case my child has an allergic reaction?
It is important that your doctor complete a food allergy action plan for your child that goes over exactly what to do in case of an allergic reaction. Your doctor can tailor the food allergy action plan specifically to your child based off your child’s history of reactions and special circumstances. These food allergy action plans can be found at foodallergy.com. You should review the food allergy action plan with your child’s school, as well as with family members and baby sitters so that they know exactly what to do in case of an allergic reaction.
The general recommendation for food allergic reactions is to give injectable epinephrine and call 911 unless your child is only having mild itchiness or hives. Epinephrine is the only life-saving medication in a food allergic reaction. When in doubt, give epinephrine. The benefits of giving it to prevent life-threatening complications in nearly all circumstances outweigh the risks of side effects (including fast heart rate, dizziness, shakiness, and/or nausea). Moreover, these side effects go away as epinephrine is a hormone naturally produced and broken down by the body.
Should I carry one or two dose of Epinephrine with me?
In 10-20% of allergic reactions, a second dose of epinephrine is needed to treat the allergic reaction. Therefore it is very important to carry two doses with you at all times.
What if I am scared to use the Epinephrine?
If you are too scared to give the epinephrine make sure that family and friends know how to use it. You can give it to them to administer to your child if she or he is having an allergic reaction.
We recommend practicing how to use epinephrine with a training device with your doctor or nurse in their office as well as by watching the training videos that accompany the device at home. There are many different brands of epinephrine including Auvi Q (which verbally gives you directions on how to use the medication), Epipen Twin Paks, etc. You should use the brand that you feel most comfortable with and is the most convenient for you to carry. The more you practice with the device and train others on how to use it the more comfortable you will feel. I also recommend using the real device on an orange or melon as the feel of the training device is slightly different than that of the actual injector.
Giving injectable epinephrine can be less painful than receiving a vaccine and will within seconds to minutes help stop or slow down the allergic reaction. Some children have told me how surprised they were at how little it hurt and were grateful that they could breathe again or no longer have tummy pain. Every child though has a different pain threshold and some may cry when it is administered, which is normal. Please talk to your doctor if you have concerns about using epinephrine.
How do I take care of my the epinephrine?
It should be carried with your child at all times. Avoid extremes of temperature (e.g. glove compartment of a car on a hot day) as this can degrade the epinephrine. Avoid direct sunlight exposure. If the clear white boxed opening on the EpiPen turns colors or becomes cloudy, the epinephrine is no longer effective. EpiPen Twin Packs should be refilled every year. Please make an appointment with your doctor when your EpiPens need to be refilled. With old or expired EpiPens we recommend that you practice with them on melons or oranges and train family members and friends to do so as well.
What if I only have an expired epinephrine on me when my child has an allergic reaction?
Use it. It is better than not receiving any epinephrine at all. One study has shown that expired epinephrine still may contain an effective amount of epinephrine.
What is the role of antihistamines such as Zyrtec or Benadryl in treatment food allergic reactions?
Antihistamines such as liquid or chewable Zyrtec (generic name = cetirizine) or Benadryl (generic name = diphenhydramine) only help relieve itching or hives and may take up to 20-30 minutes to start working. Antihistamines do not help breathing problems, airway swelling, stomach problems, or reverse low blood pressure. As a result they are considered second-line treatment for food allergic reactions. Epinephrine should always be used first unless the reaction is only mild itching or hives.