L.M. asks from San Luis Obispo, CA on May 26, 2008
My 27 month old son was diagnosed with an allergy to all nuts last week. I would love any advice, suggestions, and resources from anyone who has experienced this (parents, relatives, teachers, etc.). He has an epipen and a stash of Benadryl. The allergist suggested giving him the Benadryl before the epipen if he has a reaction. Anyone hear of this protocol? We have already ordered his medi-alert bracelet and a "nut allergy" t-shirt. He is in preschool 2 mornings a week and will be in preschool full time starting in the fall when I return back to work.
So What Happened?™
Thank you all for the wonderful advice and support. Because of all the advice, I have learned that I need to continually make friends and family aware of my son's allergy. It takes constant reminders. I am also more comfortable to talk to other new moms about our situation and have already made a few connections in my community. Another nice network of support. I am taking the summer to plot a course of action for when the school year starts in the fall. Thanks again for all the great support.
J.C. answers from Reno on May 27, 2008
As an adult with allergies, I know you have to be cautious, but when it's your child, it's even more scary. I am allergic to weird things like mushrooms, bees, and cephalosporin medications, my hubby is allergic to walnuts and pennicillin so we've been super cautious with our son.
Benadryl now makes quick dissolve strips. I go into anaphylactic shock so like one other mom responded, it can be hard to take pill-form Benadryl if your throat is swelling shut. I have the liquid, chewable tablets, and the quick-dissolve strips on hand for my son just in case he ends up allergic to something new. (Thankfully so far, he doesn't go into shock like me.)
Good luck and don't be shy about asking what's in your food everywhere you go. Be prepared to get annoyed looks from the waitresses, but it can be a matter of life and death if you just assume the food is OK.
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J.W. answers from Los Angeles on June 01, 2008
I was erasing emails and just saw your request. My daughter (age 5) has nut allergies. Peanuts will kill her- she has the EpiPen and all that stuff, too. She just had her allergy tests done a few months ago, and although I knew she was allergic to peanuts, I had no idea just how badly.
Just as a result of the oil on the end of the needle during the allergy testing, her shoulders, neck, part of her face, and some areas down the side of her back turned into raised, burning, red welty blotches. Poor baby was just in agony as she couldn't move and couldn't touch anywhere so to not disturb the other oils and make them run into each other. The nurse was very surprised to see this reaction because she hadn't ever before.
In the past, I would simply give Benadryl and monitor her condition. When the doctor told me that I was lucky she didn't have a very serious reaction any of those times because she could have died, my insides just wanted to fall out my rear end. He told me that if she is that allergic to nuts- particularly the peanuts, then the Benadryl wouldn't do anything; in the future, she needs the EpiPen right away. He further told me that every time there is a reaction it can be different than the last time she had one. She can have one not so severe, and then next time not have a reaction at all leaving me to think she's outgrown her allergy, or that Benedryl is fine, and then the next time, she can go immediately into Anaphyllactic (spelling?) shock and could possibly die. For you, those EpiPens NEED to be at school- at least 2. You should have 2 of them with you in your purse and 2 to pass over when he goes to a friend's house or out with another family member. In addition, have at least 2 in your home and know how to use them. I say at least 2 because if after 15 minutes your child is not showing signs of improvement, then another dose is needed. As soon as the first shot is administered, you MUST get him to the hospital or call an ambulance within the first 15 minutes of the initial dose. However, having that 2nd pen if things take longer, God forbid any of this ever happens, you have the capability to save his life and keep his airways from swelling shut.
When he goes back to school, give the teacher and the office a big picture of his face with all known allergies listed to hang on the wall. That's good to have so it's right there in front of them all day so they won't forget and so other parents who may come in to help won't give your child something by mistake. Also, be sure to CHECK THE ALLERGY CONTENT on the labels of the foods he eats!!! My daughter didn't even get plain M&M's from The Easter Bunny this year because they may contain peanuts. Many foods you wouldn't expect are processed on machinery that also processes peanuts and other tree nuts. I won't even take chances with those things now either- like for example, Nestle Toll House Chocolate Chip Cookie Dough. My daughter LOVES that, but if there's the slightest possibility she might eat a nut- FORGET IT!!! It's not worth her life. So just be sure to check everything!!! Let everyone know his allergies and always leave your cell phone number or whatever number so you are reachable at any moment. My daughter was sitting next to a boy who was eating a PB&J sandwich in her class and it bumped into her completely irritating her skin. It's scary. I hope your son isn't as badly off as my daughter. Neverhteless, you can't be too careful. I do hope he grows out of it though!!
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A.P. answers from Los Angeles on May 27, 2008
I have a very severe nut allergy. A couple of things: I am allergic to all tree nuts -- if you don't know, peanuts are not actually nuts, they are legumes. Your son should probably be specifically tested for peanut allergies (I am not allergic).
It is standard to give Benadryl before an epi-pen. The epi-pen is not fun, and causes extremely fast heartrate, plus may cause anxiety, etc. Benadryl causes drowsiness, but is not as traumatic as the epi. I use liquid Benadryl b/c it acts faster than the tablets. If you do need to use the epi, take him to urgent care/emergency so that he can be monitored.
It is really not that hard to avoid nuts, thanks to the new labeling laws and general public awareness. I do a lot of label reading. Be careful with cereal, granola bars and protien/power bars. Chinese food also uses lots of nuts. Of course, when in doubt, skip it!
Some surprises: Mangos are actually related to cashews & pistachios. I have horrible reactions (took me a while to figure it out). I am also allergic to sunflower seeds and corriander (cumin). I gather there is a relationship to nuts there as well.
My first sign of a reaction is a stomach ache. When I first found out I had allergies, I took Benadryl at the first sign of stomach problems. Now I can tell the difference in stomach aches. My next sign is hives/itching. At this point, I usually also start to get nervous/scared, so don't be surprised if your son does as well (I was told it's the increase in some hormones). If I haven't taken any Benadryl, I usually chug a double dose. If it gets any worse, or I start to have trouble breathing, it's epi-time!
Honestly, once you figure it out (give yourself some time), it's really not that bad. Hopefully he'll outgrow it! Feel free to let me know if you have any other questions!
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J.S. answers from Los Angeles on May 27, 2008
I'm a mom to a 9 year old who is severely allergic to peanuts. We did not find out about it until she was 7. She went to a "peanut-free" school and she didn't like peanuts - ever. She accidentally got a peanut in her mouth and had a reaction that caused her to go into respritory distress, break out in hives - from head-to-toe - threw up, and swelled up to the point of non-recognition. She carries an Epi-pen ON her at all times because the MD explained that she WILL have an anaphylactic response if exposed to peanuts again. In other words, it won't start off like hives and puffy eyes. Therefore, he explained, our first line of defense would not be benedryl, but the Epi-pen. If she can't breathe, then she can't swallow! I wonder if your son has ever had a severe reaction (breathing difficulties). If not, then benedryl is the first line of defense. If the opposite, then I would always weigh on the side of err - and give the Epi-pen.
I have found that fellow parents are quite sympathetic. At the beginning of the year, I always explain the situation and ask that they call me before bringing in birthday treats. It's never been an issue for me. Remember that your son is much younger than my daughter; she remembers the event and she is the one who will not take chances if she even THINKS there could be some sort of nut in a food item.
There are some awesome web sites available to you. The best out there -the most involved- is FAAN (THE food allergy and anaphylaxis network) Their web-site is www.foodallergy.org. They were the first place my allergist told me to join/look at after she was diagnosed. I will warn you that peanut butter does not come off of utensils in the dish washer. As much as I miss it, we simply made the decision to rid the house of all peanut products. We also have to be careful if we choose to eat peanut-things away from her; I had some peanut M&M's while at work. When she got into the car, I kissed her. Her cheek broke out in hives where I had touched it with my lips. Islands Restaurant is a peanut free eating establishment. We feel very safe dining there. Chinese and Thai food are permanently out, as is California Pizza Kitchen after I found a peanut in my ceaser salad.
Feel free to contact me, if you have any other questions. J.
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R.L. answers from Los Angeles on May 27, 2008
My 15-yo dd has a severe peanut allergy. If she has an accidental exposure, she takes benadryl first and waits to see if the symptoms progress. If they don't abate but don't improve w/in 10 - 15 min, she takes a second dose of benadryl. If there's still no improvement after another 10 minutes, or her symptoms get worse, she uses the epipen. Fortunately, she's only had to use the pen once.
Her allergist actually isn't happy with this protocol. In his opinion, she should take both the benadryl and the epipen at the same time, because the danger for her of progressing to anaphylaxis is pretty high. His concern is that she won't realize that she really needs to use the pen until too late, when she might no longer be able to administer the shot or it won't be as effective. He would prefer that she take the benadryl and the epipen shot at the same time. The jitteriness of the epinephrine is somewhat counteracted by the benadryl, but the dose isn't high enough to cause other problems if it wasn't actually "needed."
With a toddler, I would be concerned about his being able to communicate symptoms to know if things are getting better or not. Can you or his caregivers adequately monitor is respiration? What about his blood pressure (which will crash if he progresses to anaphylaxis)? Are you and his caregivers trained well enough to recognize other signs of distress?
The most important "treatment" for allergies is strict avoidance. This is really difficult to maintain in a preschool or elementary school environment because it's hard to get small children to practice good hand hygiene and safe eating habits. Is he allergic to nut dust generated by another child eating nuts near by? Does he react, either locally or systemically, if he touches nut products? If so, he can have a reaction if other children have not washed their hands after eating nuts and they share a toy, sleeping mat, touch the same door knob, etc. You should definitely talk to the preschool about making it a nut-free zone (and his elementary school, later on), to make sure he's as protected as possible. You may need to speak to the other parents at the preschool about this directly, so that they understand that the risks to your child are far greater than their child's desire to eat nuts at preschool.
Eventually, you'll have to teach your son how to be safe in a world that he can't control, but for now, you just need to keep him safe.
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