May 3, 2011 3:41 PM
Carol Kelling of Peoria, Ariz., carries an epinephrine auto-injection pen such as Epi-Pen or Twinject auto-injector in her purse at all times. After an unexpected allergic reaction, she learned that her 10-year-old son, Jeffrey, was severely allergic to cashews and other tree nuts.
Jeffrey's first food allergy reaction happened when he was six. He was taken to the ER on Christmas Eve after eating a cashew. His lips and eyes had become swollen, and a rash quickly spread over his body.
Kelling tried to remain calm. She gave Jeffrey a Benadryl and called a nurse, who instructed her to take him to the hospital. After that frightening experience, Carol took Jeffrey to an allergist who diagnosed his cashew allergy. The allergist also told Kelling that Jeffrey's allergy could be life-threatening. "Our lives were forever changed after that," Kelling says. "We live differently, we travel differently, and we eat differently."
Now Kelling has shown their whole family how to use the epinephrine injection. She makes sure that Jeffrey has one on hand during all outings, including school field trips. Jeffrey also has an epinephrine injection pen at school and at his grandmother's house, where he spends a lot of time.
An epinephrine injection is commonly used to treat food allergies that could lead to anaphylaxis, or anaphylactic shock.
Anaphylaxis is characterized as a sudden allergic reaction that can be fatal, says Scott H. Sicherer, MD, professor of pediatrics at Mount Sinai School of Medicine and author of Understanding and Managing Your Child's Food Allergies. Typically, multiple areas of the body are affected. So someone in the middle of anaphylaxis might also break out in hives or begin vomiting.
"It's important to know how to use [epinephrine injectors]," Sicherer says. "We did a study years ago that found the majority of patients that carried around a prescribed injection pen didn't know how to use it. Have the physician review with you not only when to use it -- in other words, what symptoms to use it for -- but how to use it." If you think that someone is having an allergic reaction, but you aren't sure, Sicherer says "it's always better to err on the side of giving it if you're not sure what to do. It's a very safe medication."
Epinephrine injection pens do expire. So check the expiration dates before you buy or use them. (Most companies offer a reminder system if you register.) They should not be stored in extreme temperatures, such as in a refrigerator, in a car, or in direct sunlight. "Basically, keeping it on one's person will keep it in the right temperature range," Sicherer says.
A recent study in the April issue of Pediatrics suggests that children with a history of severe food allergies should carry at least two doses of self-injectable epinephrine, because two can offer greater protection in an emergency.
Kat Eden, who lives in San Carlos, Calif., took every precaution to make sure her son had an epinephrine injection with him wherever he went. Eden even brought a training injection pen to her son's school, in order to educate his teachers and the staff on how to use an epinephrine injection pen. Although it does not include a needle or any medication, the training pen simulates the pressure required to activate the epinephrine in a real injector. Talk to your child's pediatrician for more information about how to get a training pen.
"Let your child's teacher know that if they're thinking about using the injection, they should use it," Eden says. "If the injection is given but your child didn't really need it, there's no medical downside. But if they don't use the injection and your child needs it, there's the possibility of a terrible tragedy."
Eden advises parents to make sure their child knows exactly where in his/her classroom the pen is being stored. For her son, Eden included an easy-to-follow instruction card in the storage bag along with his injection. Eden also advises parents to include a reminder with the epinephrine injections that injections can be given through a child's clothing. She reminds them that, in an emergency, you don't want anyone wasting time trying to get your child's pants off to give them an injection.
Take extra steps to prepare for using an epinephrine injector when you are planning to travel. When flying, always bring extra epinephrine injectors and carry them with you at all times. A signed letter by your doctor or pediatrician will allow you to bring your child's epinephrine injectors onboard a plane.