A as in Anaphylaxis, All About Allergies

Sooner rather than later…


Maybe the most raised question in the allergy community: when is the right time to apply the epipen? No doubt it is the only drug able to break the vicious cycle, and its benefits outweight the risks. But actually when is the right time for it?

Even experts discuss the issue widely and have not come up with a formal consent. Based on experience, literature and recent incidents, this is one of the most sufficient answers I have encountered yet. So please take five minutes of your precious time and read this excellent advice by M.D. Phil Lieberman.


4 thoughts on “Sooner rather than later…

  1. Thanks ever so for posting this – so helpful and very comprehensive. I still have question marks over the use of antihistamine, which we administer (thankfully rarely) if our little one has a hive reaction during a taste challenge, for example. I worry whether this will always be enough – but it’s as we have been directed by our allergist. Epi is to be used in the event of swelling, coughing, wheezing, floppiness etc… Although if I suspected ingestion of one if his known severe allergens I would use the Epi immediately in that instance. What do you think..? Antihistamine is an approved course of action in the event of hives – should it not be?

    • Yes in my personal opinion, antihistamines are ok for mild allergic reactions without oral contact or indigestion and in cases when only one symptom occurs (couple of hives, or redness, or sneezing, etc.). In case of oral contact, if immediately afterwords a symptom occurs, I would at least think about the epipen. It so much depends on the individual situation.
      When I got a call from ab’s nursery last week to inform me “that ab is fine but (hearing this I got very suspicious, and how right I was) that he, by mistake, was offered a piece of regular wheat and egg containing bread, which he ate”, I immediately advised to administer 5ml of Cetirizine. Of course. And then I moved my bottom to nursery. 20 min after the incident, he did not have any hives (hives used to be one of the very reliable features of ab’s anaphylactic reactions, but since the latest food challenge, which he failed, he seems to react more towards the cardiovascular side of things).
      He was very pale and a little less active and alert as usual. No vomiting, no belly ache, no wheezing, no coughing. So, what to do? Should I just watch him and risk that the “critical first 20min” are passing by? Would he get better or worse? One of the many situations that do not give you a clear picture. I ended up not giving him the epipen and he was fine. I think in restrospect, I should have administered it, just to be on the save side. But who lightheartedly sticks a needle into his child’s thigh?
      Not even a trained surgeon.

      This comment is not intended to give any medical advise.

      • Oh lord that must have been so worrying for you. Bloody nursery – what were they thinking?? So hard to know what to do… As you say, depends on each situation & as parents we’d hope to read our children’s symptoms. I guess if they’re away from home Epi in first instance makes sense? Would Ab’s nursery administer it?

      • They are usually very very good with food allergies. it was a sole incident with a member of staff that usually does not work with ab and who was not instructed into every detail. i knew it would happen someday… .i agree, parents know their child best so they recognize the symptoms much better than anyone else. I immediately saw that he was not feeling well. yes nursery is fully instructed and trained and was sent on courses about first aid and anaphylaxis. and I left a trainer pen so on regular basis they can give it a try. not sure if away from home (and me!) epipen should be first course of action. But yes, if in doubt, give it! I personally prefer a more sophisticated approach, but, we have to keep in mind, nursery staff are not professional medical staff, they are not supposed to diagnose and treat. So there is a huge responsibility on their shoulders. And I am glad for every day they do the best they can to keep ab safe.

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