Nut Allergy

Hi L.,

My 15-yo dd has a severe peanut allergy. If she has an accidental exposure, she takes benadryl first and waits to see if the symptoms progress. If they don't abate but don't improve w/in 10 - 15 min, she takes a second dose of benadryl. If there's still no improvement after another 10 minutes, or her symptoms get worse, she uses the epipen. Fortunately, she's only had to use the pen once.

Her allergist actually isn't happy with this protocol. In his opinion, she should take both the benadryl and the epipen at the same time, because the danger for her of progressing to anaphylaxis is pretty high. His concern is that she won't realize that she really needs to use the pen until too late, when she might no longer be able to administer the shot or it won't be as effective. He would prefer that she take the benadryl and the epipen shot at the same time. The jitteriness of the epinephrine is somewhat counteracted by the benadryl, but the dose isn't high enough to cause other problems if it wasn't actually "needed."

With a toddler, I would be concerned about his being able to communicate symptoms to know if things are getting better or not. Can you or his caregivers adequately monitor is respiration? What about his blood pressure (which will crash if he progresses to anaphylaxis)? Are you and his caregivers trained well enough to recognize other signs of distress?

The most important "treatment" for allergies is strict avoidance. This is really difficult to maintain in a preschool or elementary school environment because it's hard to get small children to practice good hand hygiene and safe eating habits. Is he allergic to nut dust generated by another child eating nuts near by? Does he react, either locally or systemically, if he touches nut products? If so, he can have a reaction if other children have not washed their hands after eating nuts and they share a toy, sleeping mat, touch the same door knob, etc. You should definitely talk to the preschool about making it a nut-free zone (and his elementary school, later on), to make sure he's as protected as possible. You may need to speak to the other parents at the preschool about this directly, so that they understand that the risks to your child are far greater than their child's desire to eat nuts at preschool.

Eventually, you'll have to teach your son how to be safe in a world that he can't control, but for now, you just need to keep him safe.

Good Luck!

As an adult with allergies, I know you have to be cautious, but when it's your child, it's even more scary. I am allergic to weird things like mushrooms, bees, and cephalosporin medications, my hubby is allergic to walnuts and pennicillin so we've been super cautious with our son.

Benadryl now makes quick dissolve strips. I go into anaphylactic shock so like one other mom responded, it can be hard to take pill-form Benadryl if your throat is swelling shut. I have the liquid, chewable tablets, and the quick-dissolve strips on hand for my son just in case he ends up allergic to something new. (Thankfully so far, he doesn't go into shock like me.)

My Dr's explanation for doing Benadryl before the epi pen is to stop the histamine allergic reaction, then use the epi pen to stop the body's over-response to the allergen.

Good luck and don't be shy about asking what's in your food everywhere you go. Be prepared to get annoyed looks from the waitresses, but it can be a matter of life and death if you just assume the food is OK.

Hi L.,

I was erasing emails and just saw your request. My daughter (age 5) has nut allergies. Peanuts will kill her- she has the EpiPen and all that stuff, too. She just had her allergy tests done a few months ago, and although I knew she was allergic to peanuts, I had no idea just how badly.

Just as a result of the oil on the end of the needle during the allergy testing, her shoulders, neck, part of her face, and some areas down the side of her back turned into raised, burning, red welty blotches. Poor baby was just in agony as she couldn't move and couldn't touch anywhere so to not disturb the other oils and make them run into each other. The nurse was very surprised to see this reaction because she hadn't ever before.

In the past, I would simply give Benadryl and monitor her condition. When the doctor told me that I was lucky she didn't have a very serious reaction any of those times because she could have died, my insides just wanted to fall out my rear end. He told me that if she is that allergic to nuts- particularly the peanuts, then the Benadryl wouldn't do anything; in the future, she needs the EpiPen right away. He further told me that every time there is a reaction it can be different than the last time she had one. She can have one not so severe, and then next time not have a reaction at all leaving me to think she's outgrown her allergy, or that Benedryl is fine, and then the next time, she can go immediately into Anaphyllactic (spelling?) shock and could possibly die. For you, those EpiPens NEED to be at school- at least 2. You should have 2 of them with you in your purse and 2 to pass over when he goes to a friend's house or out with another family member. In addition, have at least 2 in your home and know how to use them. I say at least 2 because if after 15 minutes your child is not showing signs of improvement, then another dose is needed. As soon as the first shot is administered, you MUST get him to the hospital or call an ambulance within the first 15 minutes of the initial dose. However, having that 2nd pen if things take longer, God forbid any of this ever happens, you have the capability to save his life and keep his airways from swelling shut.

When he goes back to school, give the teacher and the office a big picture of his face with all known allergies listed to hang on the wall. That's good to have so it's right there in front of them all day so they won't forget and so other parents who may come in to help won't give your child something by mistake. Also, be sure to CHECK THE ALLERGY CONTENT on the labels of the foods he eats!!! My daughter didn't even get plain M&M's from The Easter Bunny this year because they may contain peanuts. Many foods you wouldn't expect are processed on machinery that also processes peanuts and other tree nuts. I won't even take chances with those things now either- like for example, Nestle Toll House Chocolate Chip Cookie Dough. My daughter LOVES that, but if there's the slightest possibility she might eat a nut- FORGET IT!!! It's not worth her life. So just be sure to check everything!!! Let everyone know his allergies and always leave your cell phone number or whatever number so you are reachable at any moment. My daughter was sitting next to a boy who was eating a PB&J sandwich in her class and it bumped into her completely irritating her skin. It's scary. I hope your son isn't as badly off as my daughter. Neverhteless, you can't be too careful. I do hope he grows out of it though!!

In Light,
Jennifer

I have a very severe nut allergy. A couple of things: I am allergic to all tree nuts -- if you don't know, peanuts are not actually nuts, they are legumes. Your son should probably be specifically tested for peanut allergies (I am not allergic).

It is standard to give Benadryl before an epi-pen. The epi-pen is not fun, and causes extremely fast heartrate, plus may cause anxiety, etc. Benadryl causes drowsiness, but is not as traumatic as the epi. I use liquid Benadryl b/c it acts faster than the tablets. If you do need to use the epi, take him to urgent care/emergency so that he can be monitored.

It is really not that hard to avoid nuts, thanks to the new labeling laws and general public awareness. I do a lot of label reading. Be careful with cereal, granola bars and protien/power bars. Chinese food also uses lots of nuts. Of course, when in doubt, skip it!

Some surprises: Mangos are actually related to cashews & pistachios. I have horrible reactions (took me a while to figure it out). I am also allergic to sunflower seeds and corriander (cumin). I gather there is a relationship to nuts there as well.

My first sign of a reaction is a stomach ache. When I first found out I had allergies, I took Benadryl at the first sign of stomach problems. Now I can tell the difference in stomach aches. My next sign is hives/itching. At this point, I usually also start to get nervous/scared, so don't be surprised if your son does as well (I was told it's the increase in some hormones). If I haven't taken any Benadryl, I usually chug a double dose. If it gets any worse, or I start to have trouble breathing, it's epi-time!

Honestly, once you figure it out (give yourself some time), it's really not that bad. Hopefully he'll outgrow it! Feel free to let me know if you have any other questions!

L.,
I'm a mom to a 9 year old who is severely allergic to peanuts. We did not find out about it until she was 7. She went to a "peanut-free" school and she didn't like peanuts - ever. She accidentally got a peanut in her mouth and had a reaction that caused her to go into respritory distress, break out in hives - from head-to-toe - threw up, and swelled up to the point of non-recognition. She carries an Epi-pen ON her at all times because the MD explained that she WILL have an anaphylactic response if exposed to peanuts again. In other words, it won't start off like hives and puffy eyes. Therefore, he explained, our first line of defense would not be benedryl, but the Epi-pen. If she can't breathe, then she can't swallow! I wonder if your son has ever had a severe reaction (breathing difficulties). If not, then benedryl is the first line of defense. If the opposite, then I would always weigh on the side of err - and give the Epi-pen.
I have found that fellow parents are quite sympathetic. At the beginning of the year, I always explain the situation and ask that they call me before bringing in birthday treats. It's never been an issue for me. Remember that your son is much younger than my daughter; she remembers the event and she is the one who will not take chances if she even THINKS there could be some sort of nut in a food item.
There are some awesome web sites available to you. The best out there -the most involved- is FAAN (THE food allergy and anaphylaxis network) Their web-site is www.foodallergy.org. They were the first place my allergist told me to join/look at after she was diagnosed. I will warn you that peanut butter does not come off of utensils in the dish washer. As much as I miss it, we simply made the decision to rid the house of all peanut products. We also have to be careful if we choose to eat peanut-things away from her; I had some peanut M&M's while at work. When she got into the car, I kissed her. Her cheek broke out in hives where I had touched it with my lips. Islands Restaurant is a peanut free eating establishment. We feel very safe dining there. Chinese and Thai food are permanently out, as is California Pizza Kitchen after I found a peanut in my ceaser salad.
Feel free to contact me, if you have any other questions. J.

Hi L.,

I don't know if you have picked out your son's preschool yet, but I would suggest having a serious talk with them regarding peanut rules in their school. My son does not have an allergy, but the preschool he attends is an official "peanut free zone". There are large STOP signs everywhere (on the front door, at the front desk and every door of every classroom). Make sure your son's school is willing to take these types of measures to protect his safety. My son's school takes this very seriously. Again, my son has no allergy, but I can tell you, from my point of view, you will probably find that the other parents easily adjust and have the highest respect for this rule. The fact that my son cannot have a peanut butter & jelly sandwich at school is hardly an inconvenience when, just having it in the building would risk the health of another's child.

By the way- this was not a rule when my son started school. It was implemented this past year when a new student arrived with the allergy. As parents, we want ALL of the children to be safe. I would be surprised and terribly disappointed if you receive anything less than total support and vigilance from the school and parents. I am sorry I have nothing to offer you but support and best wishes, since I do not have any personal experience with allergy protocol.

Good luck to you.
R.

My daughter has allergies, too. We've been told the same thing about doing Benedryl first. We use the premeasured liquid because it is fast and easy. The great thing is that it works so fast that we've been able avoid using the epi-pen by being fast enough with the Benedryl. Whether or not you can just use the Benedryl will depend upon the severity and speed of your child's reactions. I have the same issues myself with egg allergy. If I can get a Benedryl down my throat while I am still in the lip swelling stage, the Benedryl almost always stops the reaction in it's tracks. I have only had to have epinephrine a few times in my life, and every time it was when I didn't have access to Benedryl and the reaction went into the throat swelling, chest constriction stage, which is terribly frightening and life threatening. But if the Benedryl will stop your child from getting to that point, use it first. Epinephrine is NOT FUN. It is like downing 30 cups of coffee at once and is really bad for your heart. I feel like a jitterbug for days after having it. It really wears out your body. My husband and I both carry a bendryl in our wallets at all times so that we can avoid the reaction escalating to that stage. So, follow your doctor's advice. If there is any chance that you can avoid the epi-pen, it is worth it.

Dear L.:

It sounds like you have already prepared well and all the advice you've been given sounds great. I just wanted to share one thing we've gone through with this same situation.

When you discuss this with people, look them in the eye and see if they take it seriously. Talk to the teachers and ALL the helpers personally. I, too, was a teacher but even among those in the profession, there was ignorance regarding food allergies. People actually rolled their eyes as if it was merely "picky eaters!" Some people just don't "get it"!

There was an instance where I was helping in a room where my son was (spying, really!) and food was offered. I observed that none of the ones "in charge" checked the food. I told my son, "Wait and don't touch it until I come back." I went to the kitchen and asked for the wrappers/containers and discovered the food had peanuts in it. I ran back to the classroom and there was my son with lips like an inner tube and his hands on his throat. The instructor started whining, "He just SAT there and delayed us so I told him to hurry up and eat!" Yes, we ended up at emergency. (No, we never went back!)

Be careful when screening those who have to care for your son. Not only do they have to carefully monitor his diet and those around him who might "share", they also need to know what to do regarding the Benadryl and the EpiPen without delay.

Best wishes,

M.

I am so sorry, I understand how difficult it is. My 12 month boy has peanut and legume allergies. I haven't had an episode of swelling ...yet but I do carry an epipen and I have benedryl in my kitchen. You might watch any reaction to legumes. Peas are what made me decide to get a blood test after many months of sever excima. Legumes are anything in a pod ie. peanuts, peas, soy beans, any beans, string beans ect... The food situation seems to be getting harder since her went from baby food to solids. I feed him lots of natural foods. fruits, veggies, and meat. It seems like all packaged food has nuts, soy protein, or are made in a factory that produces it. I have found 1 cereal that isn't a problem called Oatios by New Morning. I found it at Bonies. My mother-in-law suggested posting a sign with your child's picture that gives all the info in it about an epipen..ect and post it at their school. She is a teacher and said the picture really helped for those teachers that don't know the child. Good luck to us both!!!

Hi, L.. My youngest son has nut allergies and we found out with peanut butter. My main advice is to educate you son on what he can and can't have. You have to be a detective too with food products. I gave my son a store brand of cinnamon rolls and didn't read the label and it had nuts in it. My son had a bad asthma and allergy attack by eating this. I read the label AFTER and was very surprised. The pillsbury brand is nut free. Anyway, in school and church, everyone asks about allergies. Most, if not all, are very aware of children with allergies. Most parents are helpful and as long as you educate your son, he will be the best source of information to others that you can imagine. My son tells everyone what he is allergic to and then some. (like peas and green beans so he won't have to eat them) ;-) Always, have benadryl and the Epi pen with you. My son gets asthma so find out what his reaction would be and just be prepared but don't stress about it. You won't be able to administer any meds if you get stressed during an attack.

My son has a severe allergy to peanuts and walnuts. He's 13, and we've never had to use an epi pen. Benadryl works wonders, especially the liquid. We can actually watch the swelling go down as soon as he takes it. Just keep some on hand - purse, glove compartment, etc. We've never had to hospitalize him, either. It sounds very scary, but it'll be OK! My son learned VERY early what foods to turn down, even when we weren't around.

My twin boys have severe tree nut allergies. We also have epi pens. My DR said not to mess around and give him the epi pen and go to the ER immediately.

The last episode we did give benedryl immediately and I think it prevented us from having to use the epi pen but often allergic reactions get more severe with each episode.

Also-- FYI-- if they are allergic to tree nuts-- stay away from mangos. They are in the same family as pistacios.

My 3 year-old son is also allergic to peanuts, among other things. As many others have said here, "educate!" This includes your son, teachers, friends, family, neighbors, anyone who has contact with your son. He'll soon be able to tell others what his food allergies are. For his preschool, put your son's picture on a piece of colored paper. Print his full name on it and clearly print all of the things he is allergic to. This should be clearly posted in the place where the children eat. It's not just for the teachers, as they become aware of their students who have allergies very quickly, but it is more important for days when there may be a substitute, room parent, or other volunteer who may not be as familiar with your child's allergies. Good luck!

J.

My son has a peanut allergy. If he indicated any symptoms with breathing trouble I would use the Epipen immediately. If he brakes out in hives I give him Benedryl. I always carry Benedryl and the Epipens in a bright red first aid bag. His school has a set of Epipens, each enrichment activity teacher has a set of Epipens and when he goes on playdates I give the mom the Epipens. I train them how to use it. Also, by the time my son was 3, he knew to ask if something had peanuts in it before accepting ANY snack and to let every caregiver know he has a peanut allergy. Good luck!

Hi L.:
Yes I have. Years ago,when my oldest son had terrible allergies. My son would break out in big welts(Hives)and begin itching all over. His eyes would get puffy and red.I was told to give him a dose of any antihistamine,Like Benadryl,and it would reverse the alergic reaction.I couldn't believe my eyes!Within an hour,all the hives and itching were gone.I'm guessing, that your Dr. wants you to try the Benadryl first, because it works fast,to relieve syptoms.I had a reaction as an adult,to (Brazil Nuts) and my throat began swelling and closing up! I ran in and grabbed some cold medication I had on hand,and the symptoms subsided.This is great to know, for anyone with an alergic reaction.I have no knowledge of the Epipen.

Sorry I don't have any experience from a mom's perspective but I do as a teacher. I once had a student that was severally allergic to bees. I had to carry the epi pen whenever we were outside for PE or walks to the park. In Southern CA most schools are nut free. In my son's preschool the check all lunches that come in and only provide nut free snacks. Check with your school as to what their policy is. You can send a collection of nut free snacks to school for your child to be handed out when there is a birthday celebration. Remind teachers or caretakers that the only way to get the nut contaminant off is soap and water, germie gel won't do it. (If they ate a PB&J they need to wash their hands before coming back into the classroom.) I was at an indoor playground and my DD had brought PB crackers that I was not aware of. The gal who worked there said that she could not eat them in the play area but that she cold sit outside and eat them and use the germie gel when she was done. Ummm.. hello? Shouldn't you know this stuff if you work with kids and have a no nut policy?

For field trips and times when your child is not with you you can also use these temporary tatoos. You can put them on their forearm so that they are visable. I would put it on their dominant hand, the hand they would reach for food with.
http://safetytat.com/order/

I think another reason for the "benadryl before epi-pen" protocol (obviously, only if your child is able to swallow at the time of discovery of the reaction) is because the use of the epi-pen is pretty traumatic relative to swallowing benadryl. Granted, if your child is having a potentially deadly reaction, e.g., swelling up with trouble breathing, the pain will most likely not be noticed. Thus, if the benadryl alone is sufficient to cause the allergic reaction to subside, then would not need the epi-pen.

hi L., my daughter (almost 3 years old)is allergic to peanuts, eggs, dairy, shrimp...you name it! yes, you must try giving the benadryl before the epi-pen and you should have at least 2 epi-pens on hand. always check the expiration dates on your benadryl and epi-pens.

don't be embarassed about telling ALL your friends and family about his allergies. especially the preschool. i'm a school nurse and had to respond to a child who was exposed to peanut butter - i couldn't believe that they allowed the kids to eat peanut butter in the classroom...she probably touched one of the toys that the others played with and was exposed that way.

never be embarassed to ask what the ingredients are or what kind of oil food is cooked in - especially at restaurants! the more you ask, the better you'll feel about eating out. soon you'll know of all the safe places to eat. also, don't be afraid to ask them to cook his items in a clean pot/wok etc...most places are really nice about doing so.

teach him what he is allergic to and remind him to always ask you if he can get permission to eat something that might be given to him. don't underestimate him - soon you'll find him asking YOU if he can eat something...he'll soon be able to tell people what he's allergic to. please always tell your friends and family because you know how it goes at parties - everyone trying to feed each other's kids!

good luck! always keep your benadryl and epi-pens on hand. also, if possible, keep another stash of benadryl and epi-pens at her preschool. make sure you get one of those epi-pen trainers so you can have the staff practice using it. write down instructions - they may become frantic at the time of an emergency. take care!

Hi L., I can sure understand where you are at with this problem! My son has a SOY allergy and it is in just about everything and used in many plastics, car seats, Ford even uses it in their interior of the cars so we had to watch not only what he ate but also came in contact with. He is 30 years old now and I can relax a bit but I remember the confusion and fear I had as if it were yesterday! Benedryl is great and does work fast but you must be the judge of how severe the reaction is. If you feel that your son is having any difficulty breathing you must not wait for the benedryl to work and use the epipen. Any swelling of the airway needs immediate action such as the epipen!!! Look to see if his tongue has any swelling at all and if so, use the epipen!!!

What helped me was to educate myself as much as I could, I read as much as I could. You have great and virtually unlimited resources available to you now with the internet. I spent hours at the library back then, books were my best friend. The more you know the less frightening your situation can become. I think MAMASOURCE is a wonderful place for support! Peace, V.

I suggest benadryl prior to the epipen as the epipen is gnarley [I have shell fish allergies and avoid the epipen like the plague and leave it only for the near death experience]...for little kids I just follow the advice of doctors...0.5mg per pound of kid over 2 every 4hrs. My daughter had her first nut allergy problem tonight and benadryl worked like a charm!!! Great idea that you ordered the braclet and have the tee-shirt. I think I'll do the same.

Hi,

My son is allergic just to peanuts I am sorry to hear that your son is allergic to all nuts. As far as taking Benadryl before the Epipen you might talk to your pediatrician to get a second opinion. Mine told us to give him the epipen if we think he has injested something. Now our son test results were in the severe category though and I don't know what yours came back as. Personally I would rather try the Benadryl first as Epipen in the same as a huge surge of adrenaline and that is not good for the little heart, but I have my instructions from the pediatrician so I don't know. I can tell you we have been accident free for almost a whole year since we found out at 11 months of age. It can be done. How does his preschool handle the allergy?
Best of luck, you do get used to it after a while. All the little things you have to check and read and think about become second nature. My son has a lot of cousins so we ordered the "More than a Peanut" allergy flash cards and showed them to all the little kids he is around. The older ones are great at monitoring and don't let anyone give him food. Talking to each member of our family helped too, it can be difficult for them to understand how serious it is, until it was explained specifically to them that he could stop breathing even from trace exposure.

Again best of luck!
C.A.

Hi L.,

My son got diagnosed with a peanut allergy at 14 months old (had hives, eyes swelling, lips swelling). It's pretty scary, we called 911 (I'm a nurse and know that things could get really bad) they took us to the ER where they gave benadryl which helped him immediately. I've been to 3 allergist and finally found one that I agree with. The 1st one said to avoid everything (milk, dogs...pretty much everything). So, we just went to our year follow up (my son is 2 1/2) and they did a skin test to recheck his allergies vs the blood test. He ended up being allergic to peanuts, sesames, walnuts and almonds. So, our house is nut and sesame free now. Check out allergykids.com, I ordered these green bags that say "allergy kid" on them where I can fit his benadryl, singulair and 2 epi pens along with instructions. Our doc also recommended benadryl, 2 singulair's and if he has breathing difficulty the epipen. It's super scary, but our preschool is peanut free, but they make us bring his own food just to be safe. Please let me know if you have any questions. I really haven't found anyone to discuss this with that has gone through it, so let me know if you find out anything interesting.

Thanks and good luck!