It’s back to school season, parents of young children who have severe allergic reactions to certain substances (such as peanuts) will have to prepare for their children in case an allergic reaction happens at school.
Let's start by reviewing what is an Anaphylactic reaction.
An Anaphylactic reaction is a severe, acute, and can be life threatening allergic reaction that often happens within minutes to hours after the person comes in contact with the allergens. The allergens can be ingested as food or medications, or through insect bites. The obvious symptoms are: difficulties breathing, wheezing, nausea/vomiting, dizziness, .. etc. Other symptoms include skin rash, hives, and itchiness.
If the allergic reaction develops slowly through days with skin reaction only, or if the rash and itchiness is mild with no other symptoms, then it’s most likely a non life threatening allergic reaction and is not anaphylactic. (non life threatening allergic reaction still need to be dealt with, but not as urgent as anaphylactic reaction, we will only focus on treatment of anaphylactic reaction here)
Handling of Anaphylactic reaction:
The mainstay of treatment is to inject Epipen immediately into the upper front of the thigh upon suspicion of developing anaphylactic reaction. If needed, Epipen can be injected through clothes. Epipen can counteract the detrimental symptoms of allergic reactions by improving breathing, maintaining blood pressure, reducing throat swelling, … etc. Epipen is very safe, so whenever in doubt whether it’s actually an anaphylactic reaction or not, always give it first. There are two doses of Epipen, body weight 30 kg and above uses Epipen 0.3mg; body weight 15 kg to below 30 kg uses Epipen Jr 0.15mg.
Keep in mind, the effect of an Epipen can last as short as only a few minutes. Hence, a follow up 911 call or visit to the closest emergency department is needed.
Antihistamines like diphenhydramine, cetirizine which take a long time to start working can be used only to supplement the effect of Epipen if needed, NOT to replace Epipen.
Prevention is always a better option:
Educate children not to share food with others
Educate children and school staff how to identify when an anaphylactic reaction is coming
At the beginning of the school year, parents need to check the expiry date of the Epipen before packing it into the schoolbag, and label the Epipen with their children’s name accordingly
Ensure the child gets training on how to inject an Epipen, or if the child is too young to be able to self inject, ensure somebody at school can do the injection on their behalf.