Allergy Shmallergy

Simplifying life for families with food allergies.

The Fire Drill – 5 Key Lessons from an Intensely Scary Night February 22, 2017

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I had been home from the restaurant only ten minutes with my preschooler almost tucked into bed when I got the call.

 

“Miles isn’t feeling well. He’s nauseous and is having terrible asthma. We’re heading home early,“ my husband informed me calmly. My husband and two sons left our regular sushi dinner to attend a tennis lesson, still chewing as they walked out the door.

 

My oldest son has suffered from asthma since he was 10 months old, but this just didn’t sound like the typical onset of asthma for him. Something about Eric’s voice suggested something “other.” “Do you think it could be a food allergy reaction?” I asked.

 

“I don’t know; but we’re getting home as quickly as possible.”

 

Completely abandoning my daughter in her bed, I walked to our emergency medication and unsheathed the freshest EpiPen. I was reviewing our emergency action plan as headlights tore into the driveway.

 

Calm but focused, I greeted my son at the door. He was red and hot and choking out words as I tried to check in with him about his symptoms. He could barely speak. He felt nauseous and clutched his stomach as he made his way into the bathroom, afraid he would throw up. His description of his symptoms came out in – sometimes inaudible – spurts. He was fighting for breath. He felt and looked worse than I had ever seen him.

 

While my hand calmly rubbed his back and my eyes scanned his face assessing the situation, a million thoughts raced through me in a nanosecond. Was it something he ate? Was he possibly reacting to a new allergen? Was this anaphylaxis or pure asthma…or both? The flu and other upper respiratory viruses were spreading so rampantly that nearly a third of my son’s class was out that week. And, he had mentioned having a headache and feeling a little nauseous after school – something that had seemingly subsided by dinner.

 

No matter how I weighed my options, a few small words reverberated in my brain: two systems. Most emergency action plans state that if two or more essential systems (gut/stomach, lungs, skin, heart) are affected in an allergic reaction, epinephrine should be administered immediately. I held up the auto-injectors behind my son’s back, signaling to my husband that we might need to use them. Neither of us have had to use an auto-injector on my son before (knock on everything wooden). We knew it was probably the right call now. We were both looking for the other to validate that decision.

 

As with all things, I wanted the use of the auto-injector to be the absolute right decision. I called my father-in-law, a doctor of more than 40 years, for one last vote on how to proceed. It was a brief conversation. “Get him breathing! Give him albuterol, I’m coming right over.”

 

Having caught sight of me waving the EpiPen in the air to my husband, my son had now begun to sweat with panic – making everything much worse. I sat him on the couch and tried to cool him off for just a moment – considering the facts again. Asthma. Nausea. No throat, mouth, or tongue swelling. No hives. No clear relationship between this reaction and food – but always a real possibility.

 

I looked at my sweet boy once again, suffering for breath, and noticed his pallor wasn’t quite as red any longer; it was now tingeing blue. I grabbed the epinephrine and pulled off the safety cap. At that very moment, my brother-in-law (another doctor) and father-in-law walked through the door. With stethoscope in hand and exuding a calm and caring in doses that make me tear up in appreciation even now, they examined my son and set him up on a nebulizer – a machine that delivers asthma and other respiratory medications as a penetrating, breathable mist.

 

We monitored Miles’ pulse (which was steady) and his breathing (which was labored and difficult). It took a lot of medication and effort, but Miles began processing air more efficiently. I didn’t realize until the second hour of treatment that I had been clutching his auto-injector the entire time.

 

As Miles’ color returned and the dust began to settle, he began to recall details about his day – clues that might have been helpful earlier. Like, the fact that he experienced asthma during recess at school. As he continued to improve, we noted that he was simultaneously experiencing a migraine, which can bring about nausea. Together, we determined that this was likely an acute asthma attack and not a result of his food allergies.

 

All four adults watched Miles for another several hours (well into the night) before anyone was willing to even entertain sleep. And, by then, sleep didn’t come so easily. I awoke in a gasping sweat several times that night and slipped into my son’s room to check on him. At around 5:45 am, I placed my hand on his back and he broke the quiet of the pre-dawn, humorously stating, “Mommy. Your hand is like a furnace!” Smiling and with great relief, I knew the sun would come up that morning and all would be well.

When I relayed these events to my own father, he captured it perfectly. “You had a fire drill last night.” We certainly did. And, as with any good training exercise (intentional or not), we learned some valuable lessons that night.

 

  1. Trust your instincts. I knew we needed to use epinephrine. Had there not been two doctors in the family within arms’ distance from me, I would have absolutely used it. And, so would my husband. Even though it was not anaphylaxis and everything turned out well, I STILL regret not having used the auto-injector sooner. I had my doubts about a food allergy reaction for a number of reasons. The afternoon nausea as well as the absence of hives and swelling gave me pause – which is why I called my father-in-law. But, did being right about his diagnosis make me feel better about my hesitation? No. Severe food allergic reactions can present themselves with a number of symptoms and they can escalate very quickly.

 

  1. Always, ALWAYS carry your epinephrine auto-injector with you. EVERY TIME. And, make sure that your friends, family and/or whoever is caring for your child knows how to use it (procedures are slightly different for Auvi-Q, the Adrenaclick and the EpiPen, so I recommend reviewing often). In our case, we accidentally forgot to transfer the auto-injectors from my purse to my husband’s bag, taking for granted that he’d no longer be around food; out only for an hour to play tennis. Thankfully, we live two minutes from the tennis courts. But had they been further, my husband would ABSOLUTELY have needed those auto-injectors.

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  1. As if you needed an extra reason to carry your auto-injectors: Those who have asthma are more likely to suffer from severe food allergic reactions– particularly if that asthma is not well-controlled. Asthma can complicate food allergies. Asthma occurs when there is narrowing of the airways, making it difficult for an individual to take in the proper amount of air. In my son’s case, his lungs were taking in so little air that initially my father-in-law couldn’t hear any movement with his stethoscope. No wonder he was turning blue. In an emergency situation, epinephrine can be used to treat a severe asthma attack. We were milliseconds from using it.

 

  1. If you use an epinephrine auto-injector you must go the nearest emergency room immediately. This is not because you gave the injection. Rather, those having severe food allergic reactions need additional medication and treatment. Furthermore, patients can suffer something call a bi-phasic reaction – that is, a second, delayed bout of anaphylaxis. It is estimated that up to 20% of patients suffer such a reaction.

 

  1. Once Miles went to sleep, we recapped the night with my father-in-law, who’s served in some fast-paced emergency rooms. I’ve been repeating something he said that night to everyone who will listen:

“We used to tell surgical residents,” he began, “‘If you’re considering performing a tracheotomy, then you need to do a tracheotomy.’”  The same holds true for anaphylaxis. If you think you might need to use an auto-injector, then you DO need to use one. If you’re considering it, then the time is now.

 

I’m beyond grateful that our story ends happily.  I pray you all never have to experience the intensity of a severe reaction (whether that be from food allergies or acute asthma).  But I hope that by sharing our experience and the lessons we learned, your story will end happily, too.

 


 

Essential Resource:

I can’t recommend enough this informative piece on when to give what medication during a severe allergic reaction. The information contained in this article echoed in my head during the above incident.

 

From the Food Allergy Treatment Talk blog:

Putting the Fire by Dr. Brian Schroer

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EoE – A Learning Process May 26, 2015

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My husband, my father-in-law (a doctor) and I have been trying to manage next steps in what appears to a forthcoming EoE diagnosis.  Ironic, considering last week was EoE Awareness Week, eh?!

 

So, what is EoE?

 

According to GIKids.org, Eosinophilic Esophagitis (EoE) is an inflammation of the esophagus.  The wall of the esophagus becomes swollen with white blood cells called eosinophils.  A person with EoE might experience trouble swallowing, pain, heartburn, nausea, regurgitation or vomiting. They may note mild symptoms like heartburn or more severe ones like the feeling that they are choking.  It’s a relatively new diagnosis that doctors are still struggling to learn more about.

 

This emerging health issue for my food allergic son has been brewing for at least the past year, growing steadily worse and more frequent each month.  Originally appearing to be a classic case of acid reflux, my husband and I tried everything suggested to reduce his discomfort.  We raised his head at night, tried to feed him earlier in the evening so that he had time to digest, stayed away from acidic foods as much as possible, and gave him acid reducing medication as directed by his pediatrician.  However, his symptoms seemed resistant to medicine and relatively unphased by our other efforts.  And, other symptoms were muddied with his food allergies and asthma.  My son would complain of burning in the lower part of his throat.  He began wheezing within only a few minutes of laying down at night.  He began complaining of pain (actual pain) in his stomach.  His throat felt “weird” after having dairy (to which he’s no longer allergic, but that symptom is always scary to food allergy parents!).  And, started articulating a sensation that finally rang my alarm bells on EoE:  he felt like he had something stuck in his throat.

 

We immediately went back to the pediatrician who ruled out a number of conditions like celiac disease and quickly thereafter booked an appointment with a pediatric gastroenterologist.  One Upper GI (where they watch barium travel down your esophagus and into the stomach via x-ray) and one Upper Endoscopy later and we’re only a *little* closer to figuring this thing out.  EoE is more common in patients with food allergies and other allergic diseases (like asthma) and far more common in males than females – although the connections aren’t clear.

 

While his doctors rule out causes, his symptoms persist and we have more endoscopies, food challenges and allergy tests (I almost can’t believe it) on the horizon.  I’m certain many of you have already gone through this cycle of testing and I would love to hear your experiences and any advice you have to offer.

 

 

 

 

Put This on Your To Do List Today: Food Allergy Action Plan October 15, 2014

Severe Allergy Action Plan

One of the most helpful food allergy documents I ever received first came, not from our wonderful allergist, but from our  pediatrician.  An Allergy Action Plan is a vital document for you and your family.  It clearly outlines what to do and who to call in a variety of allergic situations.  It spells out how much medication to give and reminds the reader if the patient is asthmatic.

We keep copies of our Allergy Action Plan everywhere.  I have one in our emergency medication basket in the kitchen, one in the car glove compartment, one in our Emergency On-The-Go Kit, one at school, one at religious school, and others at camp.  Now that I’m writing this, I think I should give a copy to my parents and in-laws so that they can familiarize themselves with the right course of action and know where to access this crucial information in case my son is staying with them (even if his On-The-Go Kit also contains one).

To complete your Food Allergy Action Plan today:

1.  First download Allergy Shmallergy’s:  AS – Severe Allergy Action Plan;

2.  Bring to your allergist or pediatrician to fill out.  This is not for a parent/patient to complete;

3.  Make more copies than you think is necessary to display/distribute to anywhere you/your child keeps epinephrine;

4.  Date the document and remember to update it every 12 months.

 

React? Act! April 25, 2012

Like a lot of people these days, my kids are sneezing up a storm from spring airborne allergies.  And, for my older son:  this often means an increase in his asthma.  As if the sniffling wasn’t bad enough!

 

After his first spring asthmatic reaction in school (a doozy – the kind that he hasn’t had in a long time!), we had a chat.  Knowing my son and his proclivity for following classroom rules,  I assumed correctly that my son was trying to wait until his lesson was over to let his teacher know he was wheezing.  That won’t do!  Not only is wheezing the first symptom of asthma, but can also be a symptom for a food allergy reaction.  We had to re-emphasize the importance of reporting to adults even if it means interrupting them or demanding their attention.

 

My husband and I told him that one of the FEW exceptions to following the school and classroom rules is when you don’t feel well. “If you are wheezing, you need to tell the teacher right away – even if she’s talking or teaching the class.  If you are at recess, find an adult in charge and tell THEM right away.”  We very calmly expanded the lesson to include food allergy symptoms, “If your belly feels sick, if you have hives or an itchy throat, you must also tell an adult right away.  Even if those feelings aren’t really bothering you yet. It’s important to let the nurse see what’s going on so you can get back to playing!”

 

Thankfully, my son digested this lesson very well.  Since this chat, he’s been speaking up and heading to the nurse to get a puff of his inhaler as needed.  Not only does it empower him, but it helps keep his wheezing from escalating to a full-blown asthma attack.

 

Our hope is that calmly and gently teaching kids to recognize signs of asthma and allergic reactions will make them feel in control and ultimately help protect them.

 

Spring Break Bound! Hotels Accomodating Food Allergies March 11, 2011

As we (thankfully) approach Spring Break, I’ve read a lot about hotels that are tuning in to guests with food and airborne allergies.

 

Last year, the Marriott resort we stayed at in the Caribbean sold soy milk in a market in their lobby.  And, the concierge knew exactly were to find it elsewhere on the tiny island.

 

The Hilton at Walt Disney World in Orlando, Florida has added 52 PURE guests rooms.  These rooms are equipped with a state-of-the-art air purification system and are treated to remove allergens and irritants from all surfaces and fabrics (think hypoallergenic pillowcases, mattress covers, and microfiber sheets).  http://www.childmode.com/2011/02/07/hilton-adds-52-pure-guest-rooms-for-families-and-travelers-with-allergies-or-asthma/s And the Hilton isn’t the only hotel providing this service (see Allergy Friendly Hotels, below).

 

The Fairmont Hotel Group recently began offering a dedicated menu for guests and diners with dietary restrictions.  Their Lifestyle Cuisine Plus concept lists gluten-free, raw, peanut-free, and macrobiotic food options.

 

At Miraval Resort near Tuscon, Arizona, guests are asked about their food allergies and dietary requirements upon booking.  That information is relayed to the resort’s executive chef and Miraval employs a nutritional director.   They would like their guests not only accommodated, but happy.

 

The chefs at the Mandarin Oriental Hong Kong partnered with British designer and lifelong vegetarian Stella McCartney, to offer an organic and vegetarian afternoon tea throughout the month of March.

 

In addition to the above hotels featured, you can investigate allergy-friendly hotels as well as bed and breakfasts through Allergy Friendly Hotels website.  This site has listings in the U.S. and U.K., Ireland, Germany, Spain and Canada.

 

With so many excellent, allergy-sensitive places to stay this spring break, the only question I have is:  when are we going?!