It was the end of a very busy day. Dinner was late. My 9-month-old daughter was convinced she was on the verge of starvation. Unable to endure the heart wrenching wails any longer, I plopped her into the high chair and grabbed the quickest table food I could find—puréed roast from last night’s dinner. There was blessed silence as she eagerly chewed her first several bites. Suddenly, without warning, she arched her back and with a blood-curdling scream attempted to spit out the contents of her last bite. I studied her closely, wondering at the sudden outburst. In horror I watched as her lips became puffy and large hives appeared around her mouth and neck. Amy was having an anaphylactic reaction. She needed help, and needed it now!

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. The most common symptoms are severe itching and lip/tongue swelling followed by shortness of breath and wheezing. In severe cases, it can even close the airway. In addition, anaphylaxis can also present as nausea, vomiting, diarrhea, low blood pressure, or chest pain mimicking a heart attack.1

The first line treatment is epinephrine, which must be administered immediately. Epinephrine treats anaphylaxis by forcing small blood vessels to squeeze shut, thus preventing swelling in the airways. It also improves airflow in the lungs and decreases the release of inflammatory chemicals from cells.2 Common side effects include transient moderate anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.2

Despite these potential side affects, in a potential anaphylactic situation, it is better to give epinephrine unnecessarily than to wait for further symptoms to develop. Delay can be deadly. Recently, a 13y/o girl died after her injection was delayed by just 20 minutes due to lack of severe symptoms.3 Any time epinephrine is given emergency medical personal must be rapidly contacted for prompt transfer to an acute care facility.

In children, the most common cause of anaphylaxis is food (legumes, nuts, fish, shellfish, cow’s milk, and eggs) followed by hymenoptera (bee or wasp) stings and medications (penicillin is the most common).1 In my daughter’s case, the offending food turned out to be cashew nuts, which I’d used to garnish the roast.

By the time my daughter reached the ER, she was throwing up and the swelling had progressed to involve her tongue. There was no waiting. The triage nurse took one look and made a quick phone call. Suddenly a team of well-trained doctors and nurses swarmed us. After epinephrine was administered, her symptoms rapidly improved. Within 30 minutes, her lip swelling had nearly resolved and her hives were starting to fade (she did receive oral Benadryl and Prednisone as well). I left the ER with a prescription for two epinephrine injectors (commonly called epipens) and a follow up appointment with a community allergist.

According to the CDC, food allergies are on the rise with up to 6% of US children under the age of 18 diagnosed with a food allergy. Thankfully, not all these food allergies manifest with anaphylaxis. More subtle symptoms include eczema or rash, abdominal cramps/diarrhea, hives around the mouth and neck.4

Why are food allergies increasing? It’s a big question scientists would love to answer. Unfortunately, no one really knows. Until that question is answered, avoiding the offending agent is the key to management. This is difficult, but not impossible. Thanks to the FDA, most of the common food allergens (milk, egg, fish, Crustacean shellfish, tree nuts, wheat, peanuts, and soybeans) are clearly labeled in food products.5 Although not fool proof, it goes a long way to preventing possible exposure.

There are good resources for those who have recently been diagnosed with food allergies. Probably my favorite is kidswithfoodallergies.org. Free to anyone are its webinars, forums, and blogs. Members only (with a nominal membership fee) can access the online cookbook, which features recipes specifically designed to leave out common allergens. They also have a host of free electronic and printed resources.

Other excellent resources include:

http://www.foodallergy.org/

http://www.aaaai.org/conditions-and-treatments/just-for-kids.aspx

http://www.allergykids.com

While our lifestyle has been altered a bit, my daughter is fine, thanks to prompt medical intervention. I carry two epinephrine pens at all times. In addition, we don’t have ANY food with tree nuts or peanuts in our home, Amy is learning to politely decline food offered by well-meaning friends, and I’ve learned to read the ingredients on every single food item I buy. I hope someday we do come up with a cure for food allergies. Until then, Amy will carry her epinephrine pens and avoid her triggers.

 

Refrences:

  1. Goldman RD. Acute treatment of anaphylaxis in children. Can Fam Physician 2013;59(7):740-1.
  2. http://www.epipen.com. In.
  3. Girl with peanut allergy dies after taking bite of treat at California summer camp. In: Fox News: Associated Press; 2013.
  4. CDC. Food Allergies in Schools. Accessed August 20 2013.
  5. Food Allergen Labeling and Consumer Protection Act of 2004. In: Administration FaD, ed.; 2004.


About the Author

Rachel Nelson MD

graduated from Loma Linda University and completed a pediatric residency at UC Davis. She has a passion for helping children reach their full potential. She is married to a colorectal surgeon and together they have two children: Amy and Michael. Dr. Nelson enjoys playing outside with her kids, gardening, and music.

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