For some kids, a single bee sting, or one bite of a peanut-butter sandwich or crab cake can lead to a severe, life-threatening allergic reaction. Anaphylaxis can occur within minutes or seconds after exposure to an allergen and requires immediate treatment to save a child’s life.
“The threshold for causing a problem can be different for everybody,” said Dr. Erik White, an allergist and immunologist at Akron Children’s Hospital Center for Allergy and Immunology. “One child who is allergic to peanuts may be able to tolerate half a peanut, while another child may experience anaphylactic symptoms right away from ingesting that half a peanut.”
The good news is anaphylaxis is not common, but kids with certain allergies to nuts, shellfish, insect bites and some medications, among others, are at a greater risk.
During an anaphylactic reaction, the immune system goes into overdrive to attack the “foreign substance” and floods the body with chemicals. This can cause a child’s blood pressure to suddenly drop and his airways to narrow, possibly blocking normal breathing.
In most cases, critical signs of anaphylaxis can include significant hives, coughing, wheezing, tightness of the throat, difficulty swallowing, vomiting and diarrhea.
With increased awareness, most parents understand the dangers of anaphylaxis and know to administer epinephrine for these severe symptoms to stop the reaction.
However, when mild symptoms occur, such as headache, itching or nasal congestion, there may be confusion as to whether the reaction requires epinephrine, especially if the child is playing and acting normally.
“People think, oh, he just has a few hives and stomach discomfort, it must not be that bad of a reaction,” said Dr. White. “However, symptoms can come on fast and the severity can change quickly. The negative outcomes come from delaying giving the epinephrine.”
It’s impossible to predict if and when a reaction will become life threatening. That’s why it’s critical to know how to identify a reaction and when to administer epinephrine.
If there’s any doubt, Dr. White says it’s better to give epinephrine and take your child to the emergency room than wait to see what happens.
“A lot of people are hesitant to give their child epinephrine because they’re afraid if he didn’t need it, it’ll hurt him,” said Dr. White. “The child will be fine if given a dose prematurely, but if you give him Benadryl first and wait to see what happens, the outcome isn’t always so positive.”
To help clear the air and save lives, the Food Allergy Research & Education organization created the Anaphylaxis Emergency Care Plan. Dr. White and his team follow the below protocol in their practice and he recommends families do the same to determine if and when to administer epinephrine.
Once a child receives epinephrine, it’s critical he is rushed to the emergency room for observation.
“The reaction can seem like it has dissipated, but then come on again 4 hours later,” warned Dr. White. “Or, the epinephrine can wear off while the reaction is still ongoing and the child may need a second dose.”