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Scary experience last night/do we need an epi pen?


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We had a scary experience last night with food allergy and ended up in the ER. I would like experienced thoughts about how concerned I should be and how I reacted?

 

My son who is five has had hives from oranges before and outgrew a dairy allergy. No other food allergy issues.

 

Last night he had zucchini bread and cobbler someone made us. Within 15 minutes he was complaining of itching and had a spreading rash/bumps and hives. They started on his cheeks and neck and spread downward. No breathing issues and he only reported his throat itchy on the outside. I gave him his regular dose of zyrtec. The hives and bumps continued to spread despite the zyrtec.

 

Two hours later he began vomitting and vomitted a total of three times over the next hour. Then he had diarrhea. At that point I noticed his face was swollen--eyelids, cheeks, nose but not his mouth/lips. No breathing problems. I took him to the ER anyway?

 

My dad has anaphylactic reactions to foods so there is family history for serious food reactions. My son has mild asthma. Yet his lungs were clear and I knew he was breathing ok. They prescribed oral steroids and suggested we see an allergist.

 

It seemed to me that since his lungs were clear they wondered why I brought him? Did I do the right thing last night? Do we need an epi pen?

Edited by sbgrace
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You absolutely did the right thing!!!! Food allergies are SCARY and can go downhill VERY quickly. They can progress from hives, itching, etc to breathing issues FAST and you don't want to be home when that happens. Thank God his lungs/throat were clear. I'm sorry the ER didn't react like they should have. Food allergies are life threatening and should be treated as such.

 

If I were you, I'd be getting him in to an allergist ASAP so that you can pinpoint his allergies. Food reactions get worse with each exposure. So, the next time, you may start at breathing difficulties. And, yes, you need an epipen. In fact, I'd call my regular doctor and get him/her to prescribe one right away as it can be a while before you can get into an allergist.

 

:grouphug: I'm sorry you have to deal with it!

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Oh, my! Yes, I would say that any allergic reaction that involves swelling of the face and progressing despite antihistamines on board needs immediate attention, and if that means a trip to the ER, then do it.

 

I'm not much on seeing the doctor or interventions for things we can deal with naturally. That said, one of our boys has a peanut allergy that manifests itself as OAS (oral allergy syndrome - I have the same, related to raw carrots, stone fruits, almonds, etc) with itching lips and contact dermatitis. OAS is not necessarily a harbinger of more serious reactions at all, and our pediatrician is aware of the situation and is not terribly concerned... We have an epi pen. Because, you know what? We'd rather keep one and replace it when it expires and never, ever use it than have one of the kids have a life-threatening reaction and watch that ticking clock while the ambulance is en route (in this case a whopping block from our house, but they could be out and the next one? not so close).

 

Also, I don't know anyone in an ER (and I've spent some time in them, when I was a paramedic, way back in the olden days) that would assume you know his lungs are clear. You can hear subtle wheezes with a stethoscope long before you can hear them sitting next to a person. It would be entirely reasonable that somebody with a family history of food related anaphylaxis and a child exhibiting a violent reaction to food show up at the ER.

Edited by MyCrazyHouse
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Definitely see an allergist.

 

Just so you know, an allergic reaction can continue for 4-6 weeks. Dose your child with Benadryl at the onset of symptoms and monitor carefully.

 

My dd had an allergic reaction that did go a full six weeks. The first week or two she was breaking out daily. It then eased up so that she was breaking out less frequently. She had hives just once that sixth week.

 

You cannot get allergy testing until your child's system is free of anti-histamine. Set up an appointment for 4-6 weeks from now. In the meantime carry Benadryl everywhere and see your pediatrician about getting an epi scrip to hold you over.

 

FWIW I find that an allergist is waaaaaaay more helpful than my family doctor for this. Please follow through with an allergist.

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Absolutely get an Epi. Get it prescribed now, don't wait for an appointment. Keep Benadryl with you also.

 

Write a list of everything he had (including candy, drinks etc) for the day prior and day of the event. Ds's food allergies weren't noticeable individually, but when he had several triggers on the same day, we would end up in a serious situation.

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I would absolutely get a dual pack of epi-pens, melt away benadryl, and an inhaler of albuterol (as prescribed by your doctor of course) to carry with at all times on your person where ever your son is.

 

Of course, I would see an allergist to have skin testing and RAST blood work done. I would try to see if they knew ingredients of food your ds ate that night.

 

I am an RN and have a ds with severe food allergies and you most definately did the right thing in bringing ds to the ER. I am not a doctor, obviously, but what you described sounds like an anaphylactic reaction which presents in many different ways. Frankly, I am surprised someone made that comment to you.:grouphug:

 

I highly recommend FAAN:

 

http://www.foodallergy.org/

 

It is a very informative website. I also recommend that you always bring a safe snack for your ds. Our rule is we do not eat it unless it is a store brought item with a food label that we can check. Also, we rarely eat out anymore which does have a huge plus in saving money.;)

 

Blessings.

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Thank you so much everyone for the information and support!

 

I don't know..it was 12:30 am and I was exhausted and worried. But it seemed like the doctor was saying "his lungs are clear" in a way that implied I shouldn't be there. I asked him directly if I did the right thing bringing him in and he sort of averted eye contact and said something about breathing being the main issue. Maybe I misunderstood him. His face was so swollen--his eyes were slits and his cheeks and nose huge and I think that is what worried me most. But I did get the impression the ER doctor wasn't worried. He did tell me the next reaction could be worse and we needed an allergist. He did not give an epi pen.

 

At any rate, I read here and called the pediatrician who prescribed an epi pen. They are making an allergist appointment for us. I'll get benadryl. Can I give that even though he's on zyrtec regularly? .

 

With oranges his hives went on for 1.5 months but I hope the round the clock zyrtec will help us avoid that this time. I'm going to be scared to eat out and at pitch in dinners now.

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I would give benadryl immediately. We use liquid b/c it's easier to get into a swollen throat/mouth.

 

Definately go to the ER if you ever think you've got a reaction on hand. My children progress from food in mouth to anaphlaxis in about 30 seconds. They literally stop breathing in less than a minute. You do not have time to goof around, treat the second you suspect.

 

I'm all about treating things naturally but this is the one instance where we treat with OTC stuff. I have two epipens on my person anytime we leave the house (have 6 in the house) and liquid benadryl. You do not want to mess around with this sort of thing.

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Thank you so much everyone for the information and support!

 

I don't know..it was 12:30 am and I was exhausted and worried. But it seemed like the doctor was saying "his lungs are clear" in a way that implied I shouldn't be there. I asked him directly if I did the right thing bringing him in and he sort of averted eye contact and said something about breathing being the main issue. Maybe I misunderstood him. His face was so swollen--his eyes were slits and his cheeks and nose huge and I think that is what worried me most. But I did get the impression the ER doctor wasn't worried. He did tell me the next reaction could be worse and we needed an allergist. He did not give an epi pen.

 

At any rate, I read here and called the pediatrician who prescribed an epi pen. They are making an allergist appointment for us. I'll get benadryl. Can I give that even though he's on zyrtec regularly? .

 

With oranges his hives went on for 1.5 months but I hope the round the clock zyrtec will help us avoid that this time. I'm going to be scared to eat out and at pitch in dinners now.

 

Yes, you can give benadryl with zyrtec. Zyrtec is more long term, benadryl is for the immediate response.

 

Lungs being clear doesn't mean a thing if the throat is swollen shut.

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I think you did the right thing taking him to the ER. Good for you, and who cares what the doctor thinks? Remember that ER docs see a lot of people who really do come in for no reason, so he may be a bit biased and cynical about it.

 

It is a great help to have Benadryl and an EpiPen with you at all times. I have sometimes used the Benadryl. For us, the epi is insurance--we have never used it, but it's there just in case we need it. I would rather pay for one and not need it than not have one on the day that my daughter needs it to save her life.

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It seemed to me that since his lungs were clear they wondered why I brought him? Did I do the right thing last night? Do we need an epi pen?

 

Yes, you did do the right thing!!!!!!!!!!!!:grouphug::grouphug::grouphug:

 

Both of my kids are anaphylactic and asthmatic, and if they had the multitude of symptoms (and probably less) your son had, we'd be at the ER in a flash, if not in an ambulance. I'm not a person to rush off to the hospital/dr., but I don't mess with anaphylaxis - I've heard too many stories of breathing changing very quickly.

 

I'd definitely look into keeping an epi-pen on hand at all times. Or a Twin-ject (two doses - one is a backup, same price, same drug).

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It seemed to me that since his lungs were clear they wondered why I brought him? Did I do the right thing last night? Do we need an epi pen?

Yes you did! My son had a reaction to vaccines (every one we tried!!) where he would produce copious amounts of mucus and throw up. I didn't catch it as an anaphylictic reaction until he was 9 months old and I was describing it to the nurses when I took him in for more vaccines!! They knew waht it was, but I sure didn't. It is better to be safe!

 

That said, it appears all the ERs do is load them up on benedryl and the like... can't we do that ourselves?

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That said, it appears all the ERs do is load them up on benadryl and the like... can't we do that ourselves?

 

The ER will give the severe cases shots of epinephrine and steroids (among others). These will have a much higher level of effectiveness than Benadryl because they work faster and on different systems in the body.

 

The hospital can also monitor oxygen absorption, heart rate and breathing. They are also there to step in with higher doses of meds, different meds, and physical intervention if needed.

 

The ER doesn't need to be visited with every allergic reaction, but when swelling or airway compromising is occurring it is a good idea, if not a necessary one.

 

There are some people who don't do well in emergencies also. They loose all sense of what is happening, and those people need to make sure they get the child to the ER, so that a medical professional is overseeing the care.

 

So, while, yes, you can do a lot at home, it is not appropriate to stay home and self treat with Benadryl and Epi pens in every case.

 

Most doctors will tell you that as soon as you administer an EPI pen, an ambulance should be called because they are not always strong enough and the patient needs to be assessed. If an ambulance is out of the question, then at least go to the doctors office. If money is tight, then at least go sit in an ER waiting room or Urgent care without checking in. That way if you need help, they don't have to travel to you.

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It is better to be safe!

 

That said, it appears all the ERs do is load them up on benedryl and the like... can't we do that ourselves?

 

Yes, we can, but I'd much rather be in the ER anyway, even with me having given Benedryl and epinephrine, just in case breathing trouble comes suddenly.

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My son had a one time anaphylactic episode, has occasional unexplained hives and has had allergy testing (which wasnt terribly illuminating).

 

We carry benedryl and have the albuterol inhaler.

 

The allergist said no epi-pen necessary, but we do have one bc the ped wrote the scrip before we saw the allergist.

 

 

When we went to the ER we got a chest Xray, steroids and a breathing treatment via nebulizer. I cant do any of that at home.

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So, while, yes, you can do a lot at home, it is not appropriate to stay home and self treat with Benadryl and Epi pens in every case.

 

Most doctors will tell you that as soon as you administer an EPI pen, an ambulance should be called because they are not always strong enough and the patient needs to be assessed.

 

 

 

 

We always go to the ER if an epipen has been used. Epinephrine can make the heart race uncontrollably (it doesn't usually but still) so we stay in the ER for at least 6 hours being monitored so the docs can be there to take care of any heart emergencies that may arise (note: we've never had any heart emergencies and they are very rare, but I don't want my kids to be the one case of it with no doc around).

 

We have also had cases with my daughter where the epipen I had with me was not enough and she had to be dosed higher by the EMS so basically she had 2 high powered epinephrine shots within 8 minutes so they kept us overnight to monitor her. Sometimes you just want the docs on hand b/c they have all the meds at hand and can think alot more clearly than the parent.

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The ER will give the severe cases shots of epinephrine and steroids (among others). These will have a much higher level of effectiveness than Benadryl because they work faster and on different systems in the body.

 

The hospital can also monitor oxygen absorption, heart rate and breathing. They are also there to step in with higher doses of meds, different meds, and physical intervention if needed.

 

The ER doesn't need to be visited with every allergic reaction, but when swelling or airway compromising is occurring it is a good idea, if not a necessary one.

 

There are some people who don't do well in emergencies also. They loose all sense of what is happening, and those people need to make sure they get the child to the ER, so that a medical professional is overseeing the care.

 

So, while, yes, you can do a lot at home, it is not appropriate to stay home and self treat with Benadryl and Epi pens in every case.

 

Most doctors will tell you that as soon as you administer an EPI pen, an ambulance should be called because they are not always strong enough and the patient needs to be assessed. If an ambulance is out of the question, then at least go to the doctors office. If money is tight, then at least go sit in an ER waiting room or Urgent care without checking in. That way if you need help, they don't have to travel to you.

Thank you so much for the information and ideas.
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one of the problems with anaphylaxis is that it can result in a sudden drop in blood pressure which can lead to cardiac issues

 

We give benedryl at the first sign of a reaction and would administer the epi if the reaction involves more than one body system (for example, just hives he only gets benedryl....but hives and breathing problems, facial swelling and vomitting etc get an epi.) Each child may have their own specific guidelines for epi use

 

Also be sure to watch for a biphasic reaction

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You definitely did the right thing, and you should definitely take him to an allergist. I'd also get a double-pack of Epi-pens.

 

Also, you should find out the exact ingredients of the zucchini bread that he ate as well as anything with which it could have become cross-contaminated. He could have reacted to something that isn't on the standard list of foods for which allergists test.

 

As for testing, I know that almost everyone believes that skin-prick testing is essential, but I personally will not allow my son to ever have SPT again. It triggered atopic dermatitis in him. I now only allow blood testing.

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YES!!!!!

 

Typically every time a person is exposed to an allergen the body reacts faster and harsher each time. Our daughter has severe life threatening allergies. We carry pens EVERYWHERE. She has food, and insect (some are not even what are normally suspected) :glare:

 

I would call the dr and explain, and see if they can get you a pen now, and then see an allergist for testing.

 

;):001_smile:

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I feel so much better knowing so many of you with experience think taking him in was the right thing to do. I feel fortunate that he's ok. I think we were actually in dangerous territory long before I took him in.

 

In fact early in the itching he complained of a "rock" stuck in his throat. I didn't make the connection until last night. I just never expected this because of his age and not experiencing anything like it before with him. Foolish of me.

 

I don't know how I'm going to get more than one epi pen but I'll try.

 

 

As for testing, I know that almost everyone believes that skin-prick testing is essential, but I personally will not allow my son to ever have SPT again. It triggered atopic dermatitis in him. I now only allow blood testing.

 

How do you find someone willing to do blood testing? We've seen two allergists in the past and both insisted on skin prick. He's not a reliable skin prick in my mind. The first time he reacted to almost everything they tested (his control spot was fine). The second time he reacted to nothing...which we knew also had to be incorrect. But I asked three different pediatricians over the years to run blood labs and they all deferred to allergists.

 

He also had blackberry cobbler. I'm pretty sure the allergist won't have blackberries for skin prick but I think it is a possible culprit. He has an orange allergy and I suspected raspberries when he was three. I may buy some blackberries and freeze them so we could do an oral challenge at some point. I'm not counting on the allergist figuring this out with skin prick.

Edited by sbgrace
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I feel so much better knowing so many of you with experience think taking him in was the right thing to do. I feel fortunate that he's ok. I think we were actually in dangerous territory long before I took him in.

 

In fact early in the itching he complained of a "rock" stuck in his throat. I didn't make the connection until last night. I just never expected this because of his age and not experiencing anything like it before with him. Foolish of me.

 

 

NO not foolish of you - you've never experienced it before! Put it behind you, and carry on with figuring out what to do now.

 

I found out ds was very allergic to peanuts, when he was only 11 months old. I had never heard of food allergies before, so I had no clue what was going on. I gave him a tiny smear of PB on a small square of toast, and next thing I knew, he was all swelled up and his eyes were closing. I was concerned, but didn't rush out to the hospital. Finally I called a community health nurse and described everything, and she calmly urged me to take him to the ER NOW. I felt ridiculous later on when I learned about food allergies and how bad off he probably was. And he was only a baby so of course he couldn't tell me how he was feeling. I am just so glad that he was fine after a few hours at the hospital, and that we have a great allergist to guide us through everything. He even told me to stop feeling guilty about eating PB while I was pregnant and nursing.

 

:grouphug:

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Get him to an allergy specialist ASAP! and YES, get and Epi pen!!!

 

 

In the meantime, carry Benedryl everywhere he goes. I give my ds zyrtec daily, and Benedryl in those cases where he comes into contanct with something, but it's not serious enough to warrant the epi-pen.

 

....and figure out what he's allergic to, adn teach him to avoid those things. (we've had some nightmares in grocery stores....from product samples given to my ds to nut displays where he can reach... even smell...:glare:)

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check with your doc about combining zyrtec and benadryl...that's important.

 

You didn't overreact at all. I probably would have been in the ER sooner; in fact a few months ago my 9yo son walked in the door in hives, coughing, a weird consciousnes to him...we were out the door quickly giving him Benadryl on the way. Never could narrow it down to any particular cause and he cleared up w/in an hour. Just didn't want to take any chances! so don't let that doctor give you head trips.

 

Glad to hear you are prepared should there be a next time!

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We started investigating allergies when she said that eating an apple made her face itch. Turns out, she is allergic to all fruit, nuts, peanuts, and latex. The worst reaction she has ever had is red, blotchy skin that we were able to treat with Benadryl. However, we do carry an epi-pen. Food allergies can turn suddenly worse and are not to be messed with.

 

Get to an allergist for testing. I am sure they will give you a prescription for an epi-pen.

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In fact early in the itching he complained of a "rock" stuck in his throat. I didn't make the connection until last night. Children and adults have many different descriptions for serious reactions such as "bumble bees in my throat or tongue" or "my tongue feels thick."

 

I don't know how I'm going to get more than one epi pen but I'll try.

I definately would always carry at least 2 epi-pens. If syptoms do not improve, a second injection can be given after 10 minutes. Check with your doctor for instructions. Also once an epi-pen has been given, 911 should be called and be sure to ask for Advanced Life Support. Also, paramedics may need the other epi-pen since they may not have it on board.

 

 

How do you find someone willing to do blood testing? We've seen two allergists in the past and both insisted on skin prick. FAAN website has great info regarding these tests. Both tests have limitations. I think the skin testing is preferrable, but the RAST is useful as well.

 

He also had blackberry cobbler. I'm pretty sure the allergist won't have blackberries for skin prick but I think it is a possible culprit. He has an orange allergy and I suspected raspberries when he was three. I may buy some blackberries and freeze them so we could do an oral challenge at some point. I'm not counting on the allergist figuring this out with skin prick.

 

The allergist can use the blackberry that you bring into office for skin testing. I do not think I would try an oral challenge since it may have been the culprit. Were tree nuts used in any of the foods he ate? make sure to get a list of ingredients.

 

 

I highly recommend FAAN. It is must see website for anyone dealing with food allergies.

 

http://www.foodallergy.org/

 

 

I also found Allergy Kids to be a useful site:

 

http://www.allergykids.com/

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I hesitated to bump my thread up again but I want everyone who responded to know how much I appreciate all the information, the shared experiences, and the validation of my decision to take him in. Thank you!!

 

Pris, It's good to know that I can have the blackberries used for skin prick! I've got some in the freezer now and I'll bring them. I'll also ask for ingredients of the foods given to us that day. I feel so bad about that/hope she understands that he's reacting to something new and we and she had no way of knowing.

 

Yes, the zucchini bread did have tree nuts--walnuts I think. I do know that's a prime culprit.

It was his first nut ingestion though I suppose he may well have had trace exposure/cross exposure prior. I'm hoping for blackberries as I know we can avoid it so much easier!

Edited by sbgrace
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I don't know how I'm going to get more than one epi pen but I'll try.

Your insurance may only cover one. However, I'd still insist on two and would be willing to pay out-of-pocket for the second one if at all possible.

 

 

How do you find someone willing to do blood testing? We've seen two allergists in the past and both insisted on skin prick. He's not a reliable skin prick in my mind.

I just had to insist on RAST (blood test). One allergist in particular wasn't thrilled with my insistence against SPT.

 

 

He also had blackberry cobbler. I'm pretty sure the allergist won't have blackberries for skin prick but I think it is a possible culprit. He has an orange allergy and I suspected raspberries when he was three. I may buy some blackberries and freeze them so we could do an oral challenge at some point. I'm not counting on the allergist figuring this out with skin prick.

As Priscilla said, I would NOT try an oral challenge at home. You may be able to get blackberry testing done through RAST.

 

 

Yes, the zucchini bread did have tree nuts--walnuts I think. I do know that's a prime culprit.

It was his first nut ingestion though I suppose he may well have had trace exposure/cross exposure prior.

Yes, he could have had trace exposure before. Also, if you breastfed him, he could have been sensitized through that as well. That's what happened with my son. When ds had testing, the allergist said that he had never seen a child react so highly to Brazil nuts and hazelnuts. (He's allergic to a slew of other foods and environmental allergens as well.) To my knowledge, he's never eaten those nuts himself. However, I did eat them when I was breastfeeding. I didn't know any better at the time; I thought I was eating healthily. :(

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In regards to 2 epi-pens, ask your doctor to order the dual pack epi-pen. It comes with 2 epi-pens. Also, several insurances of mine allowed us to get one dual pack every month. If you insurance gives you a hard time I would call them on it. If that does not work, then maybe your doctor would be willing to call or write a letter on the necessity of having 2 epi-pens. In the worse case scenario, if those measures do not work, then I am pretty sure you can get an additional one the following month. I would fight it though since my allergist has always prescribed a dual pack and I have never had any problems. I also had Express scripts send me a 3 month supply of 3 dual packs recently. It is good to have extras especially if your ds frequents his grandparents or a school or the like. However, I always have on my person whenever my ds is with me.

 

In regards to the benadryl, you might want to consider the Benadryl melt-a-ways. I think that they are a good choice since it is a thin film of benadryl that melts on your tongue. The advantage to this is that it may be absorbed quicker. The other advantage is that it would be safer to administer in the event that a dear child develops severe respiratory symptoms or tongue/throat swelling. I would ask your doctor about this for their opinion. My allergist like the idea.

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P.S.

 

The benadryl melt-a-ways come in 12.5 mg and 25 mg dose. They are harder to find. Our local Walmart does not carry them, but CVS Pharmacy does. I would check with your doctor for dose and form of benadryl though. I know that my ds is huge, so I buy the 25 mg dose:).

 

 

One other thing about the epi-pens and please excuse if I am "the master of the obvious" as my dh says;).

 

I save the expired ones since they are handy to help train your loved ones. I use the trainer first as a demonstration. Then I have the person I am training use an expired epi-pen to inject an orange with great care of course;).

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Well let's just say that I am not surprised by poor response from the er doctor. I had one with my own er doctor just this last week. At least he decided to consult with a higher up doctor who overruled him. He was thinking that my cellulitis was an allergic response when I was not itching and it didn't respond to an antihistamine nor a hydrocortisone cream. Thankfully the next doctor was concerned and started antibiotics intravenously right away and admitted me.

 

In terms of epi-pens and allergists, when my youngest had her ananphalactic reaction to a wasp last summer, her pediatrician prescribed the epi-pen which came in a two pack of real medicine plus a practice epi-pen. We also made an appointment for the allergist then but since we lived in a county with low amounts of specialists for children, we had to wait two and a half months for that appointment.

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Allergy Testing

One of the most popular and effective uses of medicine testing is allergy testing. The results of EDST allergy testing have been compared to standard diagnostic modalities (RAST, serum IGE, intra-dermal allergy skin testing, food rechallenge testing, and allergy history analysis). EDST medicine testing of allergies was shown to be as accurate and effective as any of these. EDST results were similar to food rechallenge testing, which is widely considered the most effective of the standard methods.

from: http://www.healthy.net/scr/Article.asp?Id=1085&xcntr=4

 

I must tell you this has been very effective for my children. Eliminating the foods that showed up on the scan made their symptoms disappear. DD had reflux disease as a result of food allergies. DS had trouble breathing (producing copious mucus) along with vomiting.

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