By Sally Noone–
Watching your child experience an allergic reaction can be frightening for a parent. Instinctively, you want to make your child feel better and use every trick you have to make them better.
It starts with recognizing when something is happening. Allergic reactions to foods can have different types of symptoms. Some involve the skin, with hives or an itchy rash or eczema flare. Others may begin with difficulty breathing. Whatever the symptoms, we must be ready to start treatment quickly.
You might work with your child’s doctor to personalize an emergency treatment plan for every contingency. A cool bath can soothe your child’s skin when there is a rash or itchy hives, but it provides no real treatment for the cause. You must understand the underlying physical process, and treat that. For example, hives are caused by a release of histamine during an allergic reaction, but only focusing on the hives may distract you from other symptoms such as swelling or breathing problems that are potentially very serious. Treating with an antihistamine medication that you doctor has recommended, such as Benadryl or Zyrtec, can help to block this histamine release as you carefully continue to observe for signs of a progressing allergic reaction. Often, the hives and their itchiness begin to resolve within 20 to 30 minutes but it is important to continue to watch for other symptoms.
A food allergy reaction accompanied by difficulty breathing needs to be treated promptly. It is a medical emergency. A steamy shower is an excellent treatment for croup, but breathing problems associated with a food allergic reaction require different treatment. Epinephrine, given by injection, is the medication universally prescribed to treat this type of reaction. This medication is available in auto injectors such as EpiPen, EpiPen Jr. or Twinject, which are available by prescription. Anyone who may be in a position of having to use these devices—you, your child, the babysitter, teachers, grandma and grandpa—should be trained in their use so when the time comes, they don’t panic or hesitate. Other treatments are administered by inhaler or nebulizer. These can make the child feel more comfortable and less panicky. It is best to give epinephrine first, then the inhaler or nebulizer treatment if you suspect a food allergy reaction. Stopping the life-threatening event comes first; comfort comes second. Anytime epinephrine is given, your child needs to be taken to an Emergency Department for further care and observation. Sometimes the symptoms of a reaction can appear to have resolved, and then come back later. If this does occur, it is best to be in the Emergency Department where they know what to do. Don’t be tempted to skip the Emergency Department!
In most cases, it is best to allow 911 to provide transportation to the hospital because you don’t want to drive in an anxious state. When you call, tell the 911 operator that your child has had an allergic reaction and has received epinephrine. This alerts them to send the proper level of responder to meet your child’s needs as they provide transportation to the hospital.
An emergency treatment plan can be very helpful in providing information about allergic reactions and their treatment to anyone who may be in a position of having to look after your child in an emergency. Typically, the plan includes the signs and symptoms of an allergic reaction, along with the correct dosages of medications to be used. Reviewing the plan with your child’s caregivers provides a good opportunity for you to practice with the auto injector trainers.
Is it still scary? Of course it is. This is your child we’re talking about. But knowledge and training will allow you to react like a pro when the time comes.
Sally Noone, R.N., M.S.N., C.C.R.C., conducts clinical research at the Jaffe Food Allergy Institute of the Mt. Sinai School of Medicine in New York City. She was drawn into the field by the case of a girl who was hospitalized after a milk-allergy attack at the age of 4. Read more about Sally and her work with food allergic children in chapter 13 of Asthma Allergies Children: a parent’s guide.