For a parent who is not familiar with food allergies, having a food allergic child over to play may seem intimidating. This blog is intended for parents whose children do not have food allergies who would like to know more about food allergies in order to safely host a food-allergic playmate.

Meals and Snacks

Obviously meals and snacks are the most critical times to be vigilant when you are caring for a child with food allergies. Follow these steps to keep your guest safe.

• Prior to the play date, arrange for the child’s parents to pack enough safe foods for the time they will spend at your house. Let them know if you plan to have a certain food so that they can provide an allergy-free alternative for their child and nobody feels left out. The most important thing is to only give the child the food that their parents provided. Food allergens are often hidden ingredients and it takes a lot of time and practice to master the art of reading food labels and detecting potential allergens. Never assume a food is safe.
• Make sure to clean the surface of the kitchen or table to remove any food protein residue from earlier meals. Soaps and commercial cleansing agents work well on counter tops, but dishwashing liquid is not enough.
• Be sure to wash your hands before and between handling foods. It’s important to remind the kids to wash their hands before eating as well. Use soap and water; hand-sanitizers will not get rid of food protein residues.
• When preparing food for the kiddos, be careful to avoid cross contact, where the proteins from one food mix in with another food. Even a tiny amount is enough to cause an allergic reaction in some people. To avoid it, use separate utensils when preparing food for the kids (or yourself).
• For the younger children, be sure to monitor the kiddos during meal or snack time and explain that it’s not safe for them to share or trade foods.

Airborne Allergens

Most children’s allergic reactions occur from actually eating the food that they are allergic to so as long as you keep the kid’s foods separate, you don’t need to worry about what your family eats around them. However, some kids have airborne allergens where they can have an allergic reaction by just being near the allergen. For example, you’ve probably heard of the “peanut-free” schools or lunch tables which are intended to protect children with peanut allergies who can react by just being around other kids eating foods with peanuts. You’ll need to use extra caution with these kiddos and be sure to not have any foods containing that allergen while the child is around.

Arts and Crafts

It’s important to note that food allergens can be triggered by non-food items too. For example, Play-Doh and most stickers are not safe for a child with a wheat allergy. For more information on allergens hidden in non-food items, refer to Christine’s blog post, from earlier this year.

Emergency Plan

No matter how careful you are, it’s still important to know the signs and symptoms of an allergic reaction just in case exposure occurs. Symptoms typically appear within minutes to two hours after a child is exposed. If you suspect an allergic reaction has occurred, call the child’s parents immediately. If the child is having a serious allergic reaction and having trouble breathing, call 911 first, then call the parents.

Some allergic children experience anaphylaxis, a severe allergic reaction that progresses rapidly and can lead to death. These kids are usually prescribed an automatic epinephrine injector (aka an “Epi-Pen”), which must be kept with them at all times. It’s up to the child’s parents to notify you if their child carries one and explain to you how to use it just in case of an emergency. FAAN provides some online videos that demonstrate how to properly use an epinephrine auto-injector, which may help you feel more comfortable using one yourself.

As many of you may know, food allergy symptoms can appear in a variety of ways. One of the most concerning symptoms of a food allergy is when a person goes into anaphylactic shock. In fact, food allergies are believed to be the leading cause of anaphylaxis outside the hospital setting. The CDC reported that food allergies result in over 300,000 ambulatory-care visits a year among children.¹ Because this is the most life threatening response to food allergens, we wanted to review what the signs of anaphylaxis look like.

Anaphylaxis – What to Watch For

The signs of anaphylaxis may occur within seconds of exposure, or be delayed 15 to 30 minutes or even an hour or more after exposure (which is most typical of reactions to aspirin and similar drugs). Early symptoms are often related to the skin and include:

• Difficulty breathing; wheezing
• Changes in consciousness (including confusion, light-headedness, or stupor)
• Rapid swelling throughout the body
• Hives
• Blue skin
• Severe abdominal pain, nausea, or diarrhea
• Flushing (warmth and redness of the skin)
• Itching (often in the groin or armpits)

Throat and tongue swelling, difficulty swallowing, and difficulty breathing frequently follow the above symptoms. Vomiting, diarrhea, and stomach cramps may also develop.

If you know a child or adult with food allergies and suspect they are having an anaphylactic reaction, the most important consideration is time. Calling 911 or driving the person to the emergency room are the first things that should be done. Also, it is important to have an Epi Pen on hand for those times.

How You Can Protect Yourself or Others

• Follow-up with your doctor or allergist if you or your little one had a severe reaction.
• If you’ve been prescribed self-injectable epinephrine (i.e., EpiPen® or Twinject®), carry it at all times. (Here’s a great recent post on EpiPen usage)
• Educate others about your allergy. Teach them what you need to avoid, the symptoms of an allergic reaction, and how they can help during an allergic emergency. (Check out this post I did on being a PAL to a person with food allergies.)
• Teach yourself and others how to use an epinephrine auto-injector. Practice until it becomes second nature.
• Wear medical identification jewelry noting your allergy.

Have you or your little ones ever had an anaphylactic reaction? If so, what have you done to help minimize the risk of such a reaction?

- Christine

We’ve talked about EpiPens before on Food Allergy Living, including how to travel with them and what to do in case of an accidental injection of epinephrine. With the new school year upon us, many parents of children with food allergies are faced with the dilemma of where to store their child’s EpiPen at school. Should they carry it with them at all times? Should it be stored in the nurse’s office? What happens on the playground or on a field trip?

Carrying an EpiPen at School

If your child is old enough, some schools will allow them to carry the EpiPen with them at school or on a field trip and self-administer in the case of a reaction. While many states have passed legislation to allow this, New York, Pennsylvania, Rhode Island and Wisconsin have not. To find out specific details about what the legislation mandates in your state, you can visit the Allergy & Asthma Network website which provides links to each state’s current law regarding anaphylaxis medications.

EpiPens in the Classroom as well as the Nurse’s Office

If your child is not old enough to carry their own EpiPen, or their school will not allow it, you will want to determine whether or not one can be stored in their classroom (in addition to the nurse’s office). If they are in multiple classrooms each day, you may want to store one EpiPen in each room to be safe. You will also want to make sure that all of your children’s teachers are properly trained in how to administer the EpiPen.

Planning for EpiPen Use When Outside the Classroom

One thing that can help you address where your child’s EpiPen or other medications are stored at school is a 504 plan. A 504 plan refers to Section 504 of the Americans with Disabilities Act, which ensures that children with special needs get a level playing field from government services like public school. Depending on the details of your child’s food allergy, he or she may qualify for a 504 plan for the school to follow. The plan will outline not only where their EpiPen is stored, but also where they will eat, what allergens are permitted on school grounds, and how teachers and other personnel are trained to react in the event of an anaphylactic reaction.

Planning ahead is key to ensuring that your child will be safe at school in the event of an allergic reaction. What plans do you have in place for your children?

- Sarah

EpiPens, for any child with allergies, can be a huge life saver. However, sending your little one to school with their EpiPen can be rather stressful for a parent. There are a thousand questions that might go through your mind, “Will they be safe even with the EpiPen?” or “Will someone know how to use the EpiPen?”.

EpiPen and Anaphylactic Shock Basics

For those of you who don’t know, anaphylaxis or anaphylactic shock can be a life-threatening allergic reaction to specific triggers, such as food proteins and medication. This results in hives or swelling of the throat or tongue, which can lead to constricted airways and/or a dramatic drop in blood pressure.

An injection from an EpiPen is imperative when anaphylactic shock occurs and can save a person’s life. An EpiPen is a premeasured dose of epinephrine, which is injected into someone’s body during a severe allergic reaction to avoid or treat the onset and symptoms of anaphylactic shock, which provides a window of time to seek further medical attention. ¹

EpiPens at Schools

If you are a parent of a child who is at risk for anaphylactic shock, you probably carry his or her EpiPen with you at all times, in case they are exposed to an allergen to which they are allergic. This is excellent for when you are with your child; however, your child could be exposed to many more allergens at school when you and your EpiPen aren’t there!

In fact, one study of children and adolescents found that 10 out of 13 fatal or near fatal anaphylactic reactions occurred outside the home. All the fatalities did not have an EpiPen and those who survived received an EpiPen shot before or within 5 minutes of developing severe symptoms.²

So, what does this mean? EpiPens can save lives! You need to ensure that the other adults who spend time with your child are trained and able to assist in any situation if you’re not around.

Don’t worry, this isn’t as difficult as it sounds! I suggest sitting down with your child’s teacher in the beginning of the school year to set up a 504 plan. This will ensure he or she receives proper care and attention when you aren’t there and that all adults that are around your child have the proper training to use an EpiPen if an emergency situation arises.

Also, there is good news for all you Massachusetts residents! Thanks to your persistent neighbors, starting March 2010, all newly hired school bus drivers in the state of Massachusetts will be required to have EpiPen training. Unfortunately, the law doesn’t mandate the existing school bus drivers to be trained; however, it’s a step in the right direction. Hopefully the other 49 states will follow suit. Good work Massachusetts!

How have you been able to ensure that your child is safe and can receive the proper care if they go into anaphylactic shock? Did it involve a 504 plan or EpiPen training?

- Nita

References:

1. www.epipen.com/
2. Sampson H, Mendelson L, Rosen J. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327:380-384.

While we usually write about common food allergy symptoms, such as diarrhea or eczema, more severe reactions like anaphylaxis are possible for many children and adults with allergies. Allergens that cause anaphylaxis include food, insect stings, drugs, latex, and even exercise.  When anaphylaxis happens as a result of contact with an allergen, a rapid immune reaction occurs that can quickly make breathing very difficult.  For those patients an immediate injection of epinephrine can prevent very serious complications.  Sometimes even the few minutes it takes emergency medical care to arrive is too long, and a personal device with automated injectable epinephrine, an auto-injector, such as the EpiPen® Auto-Injector, is essential.

The EpiPen, made by Dey Pharma, works by delivering a quick shot of epinephrine to the thigh.  There are also similar devices available, such as the Adrenaclick® and TwinJect®, both made by Shionogi Inc. Twinject is unique in that it has a built-in backup dose of epinephrine, which can take the place of two auto-injectors in an emergency.

Epinephrine helps the body to keep the airway open so that breathing does not become as difficult, allowing time for emergency medical care to arrive. But many parents worry that one auto-injector might not be enough or that something might go wrong that could require additional auto-injectors. For instance, someone nearby might experience a severe allergic reaction and need to use your child’s auto-injector. Or what if your child’s only auto-injector was unknowingly broken? What if the auto-injector were accidentally put in the fridge or left in the sun? What if the contents were cloudy? Or if it had expired? So many scary possibilities!

So, what is the right number of auto-injectors? The answer to that question depends on a number of factors. Bear in mind that the Twinject has two doses of epinephrine, but according to the company the second dose should only be used as a backup to the first dose and should not be saved for future allergy emergencies.

How Many to Carry?

On their websites, Dey Pharma and Shionogi recommend that patients at risk for allergic emergencies carry two doses of epinephrine. This is because up to 20% of patients who have an allergic emergency requiring epinephrine will require a second dose. At all times the injector should be kept close to room temperature, out of sunlight, and replaced by the expiration date. You can even sign up for an expiration date reminder on either of the websites. It’s a good idea to occasionally check the solution in the auto-injector to make sure it hasn’t discolored, which can be a sign of a possible loss of effectiveness.

If a long trip is planned, especially one overseas where similar products may not be readily available in pharmacies; two auto-injectors (or one that contains two doses) may not be enough.

Should you or your child carry more than two auto-injectors? Not necessarily. Additional backups would likely be for peace of mind. A second dose of epinephrine may be needed in an emergency, but more than two doses during an emergency should only be given with medical supervision. Some caregivers choose to carry two auto-injectors from different lots for added precaution.

Multiple Locations

Some patients who use auto-injectors prefer to carry the standard two with them and also keep backup injectors in one or more strategic locations. These might include an extra one or two at work, school, daycare, and/or a relative’s house. These are great because they can serve as backup in case someone forgets their daily go-everywhere auto-injectors. Just make sure you follow the recommended storage instructions everywhere you keep an auto-injector and check your backups for discoloration and expiration dates. Knowing that you have extra auto-injectors in places like this, in addition to the daily carry-with auto-injectors you have, may bring you more comfort.

How about you? How many auto-injectors does your family keep on hand, and where? Please share your thoughts in the comment section of this blog post.

- Rob

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