I learned how to use an EpiPen recently; the hard way. No, I had never practiced before. Yes, I always meant to. Thankfully, everything turned out okay.
For the uninitiated, an EpiPen is one brand name for a prescription medical device that delivers a jolt of epinephrine, a drug that can calm severe allergic reactions to many things, including food. It is something my family has known about since 2004, when we began dealing with food allergies ranging from eggs to peanuts to tree nuts, and with my younger son, beef.
We learned about the egg allergy after a rash appeared all over his face at six months. He had not eaten an egg, but was being held by my sister-in-law who was eating Eggs Benedict and kissing him. When he developed a rash after being licked by our dog, I took him to the allergist where we discovered allergies to eggs, dogs and cats. He was too young to eat nuts, so we didn’t test for that. But before he was even three we knew about that too: After he touched some cashews I was eating, he immediately sneezed six times in a row and his eyes and face swelled.
But I made a choice not to live in a food allergy bubble. We did a lot of hand washing and kept a nut-free home. I adapted my cooking, fed my kids balanced meals, thought creatively while eating on the road, and made adjustments that contributed to a feeling of normalcy. I brought my own cupcakes to birthday parties and always carried “back-up” food.
When we did eat out, we avoided foods like pancakes and waffles, and I asked to see the labels for chicken fingers in restaurants. (They can be prepared with either a vegetable oil base or an egg base, in some places they were actually safe to eat.) If a restaurant wasn’t sure, or a server couldn’t tell me, we would order a “safe food” like a burger or baked potato. Those safe foods became comfort foods but my husband and I became concerned that we were limiting our children’s exposure to other cuisines. So, we came up with a plan to take the kids out to try other foods. First up: Indian.
We headed to a Montclair restaurant several people had recommended. This was unfamiliar territory for all of us, but we had agreed to try something new. And until that night, we had never had a problem with food allergies in a restaurant. Navigating the menu, I saw chicken Tikka Masala, made with what the menu said was “a tomato cream sauce flavored with dried fenugreek leaves”. It seemed safe.
My son’s reluctance to try new foods probably saved his life. He ate one bite smaller than a dime and the reaction was almost instantaneous. His bottom lip swelled, his throat itched, his stomach hurt. His eyes were huge and scared.
With any allergic reaction, I always use Benadryl first. I had it out immediately as we paid and quickly left. Practically flying home, I held the EpiPen in my hand hoping I wouldn’t have to use it. For the entire seven minute drive, I thought about my quip that the best place for my kids to have a severe allergic reaction would be in school because at least the nurses know how to use an EpiPen.
Among moms of children with food allergies there is often the EpiPen conversation: “Have you used one? Do you know how to use one? How does it work? Most importantly, how do you know when to use one?” If you have an EpiPen and are unsure of any answers to these questions, ask your doctor. You don’t want to find out the hard way you should have used it and didn’t.
Once back home, his symptoms were improving but not gone. We decided to use the EpiPen. My son was scared. My husband comforted him by holding him with his whole body and covering his eyes. I jabbed the EpiPen into his leg and the needle went through his jeans. His scream broke my heart, but the swelling in his lip dissipated almost immediately.
We called the pediatrician and Mount Sinai Medical Center, where our food allergist is part of the Jaffe Food Allergy Institute. They directed us to St. Joseph’s Children’s Hospital, where our Verona pediatrician has admitting privileges. The good news is that we did everything right, and by the time my son got to St. Joe’s, all he needed was some more Benadryl, steroids and monitoring. He was home by 11 p.m.
I learned a few things from this experience:
- Just because the menu doesn’t say a dish has nuts, always ask. This dish had cashew paste in it, which is not traditionally part of the recipe for this dish and was not stated on the menu.
- Practice with the tester that comes with an EpiPen.
- Once you use the EpiPen, go to the hospital and bring your second EpiPen. The epinephrine is only good for 20 to 30 minutes, the symptoms can return and you may need it.
And finally, if you suspect your child has food allergies, see an allergist. The worst that can happen is that you’ve paid for an office visit and found no allergies.
This story is an introduction to “Parenting Unplugged”, a new series that lets Verona parents share parenting experiences. E-mail us your stories.
EpiPen photo by gregfriese via Flickr.
I could have written this article…
Back when I was in school, there was not as much knowledge about food allergies. There was no way that just the smell of egg cooking could set off a reaction in me, or so the experts said. I could tell you differently.
There is no truly safe place to dine out. Even if the ingredients do not call for egg, what if someone uses the same spatula for flipping and egg as they do for a burger? Or what if the burger has been grilled on the same grill? That is enough to send me to the hospital (after injecting the epipen).
If you find a restaurant in the area that is TRULY allergy friendly (Hobcaw comes as close to anything I know), please share because I’m older than I care to admit and dining out is still a scary experience for someone with egg, poultry, shellfish, hard beans, lentils, peas and lentil allegies).
My son also had a reaction to cashews in chicken Tikka Masala. We have ordered it from restaurants a bunch of times with no issues. I always ask about nuts and it has always been fine. Once when my husband was traveling I went to Trader Joes with the kids on a busy Sunday afternoon and decided to pick up some frozen convenience food. The kids saw the chicken tikka masala and asked for it, so I picked up the box to check the ingredients as usual. However, there were approximately 1 billion ingredients and the store was packed and the kids were whiny, so I just skimmed, looking for bold allergen labels. We got home that night and I served the meal to the kids. My son instantly complained that it was “hot”, but I was not surprised since it was a little spicy. We were watching a movie so he was distracted and it was not until the movie was over that he complained his belly hurt and I noticed his lips were swollen. I gave him Benadryl and we did not need the epi, but that was a long night! Later I dug the box out of the recycling bin and yep, there it was, cashews right in the middle of the giant list of ingredients. I felt terrible but was happy that his reaction was it too bad.
Epinephrine should be administered immediately for any reaction involving more than one body system, and 911 called. One simply cannot know if a reaction will suddenly take a drastic turn for the worse, and I’ve always been told that the epinephrine can wear off within 10 minutes, not 20 to 30. My understanding is that the only time it’s okay to give Benadryl and watch and wait is for hives only (unless of course the hives are massive/covering most of the body, for which case I would Epi.) I’ve had to use an Epipen on my daughter once. It was very scary but very reassuring when she was able to breathe again within seconds. Also, even a lot of medical personnel don’t know this, but always insist on a full 6 hours of monitoring in the ER in case of a biphasic reaction.
Beth and Susan,
It sounds like we all have some valuable experiences with food allergies. I think that one of the most challenging aspects of dealing with them is that the allergies and reactions to foods can be as individual as the person. Varying food preparation (recipes) and cross contamination make eating anything not prepared at home risky but there are nights when dinner just needs to be picked up or ordered in, which typically has worked out OK for us. And Susan, I’ve done that rush out-of-the-store-because-kids-are-whiny thing enough times to know that mistakes can easily be made, especially with new brands of foods. However, we’ll be staying away from Indian food in the future. As a mother with no food allergies, except some fruits that make my mouth itch, all of this was new to me and the learning curve was huge. I’m still learning.