There is an estimated 5.9 million children in the United States that have a food allergy. Of these children, 38 percent have a history of severe reactions. Severe reaction is usually anaphylaxis, which is a total body reaction that occurs suddenly after contact with any number of substances that cause allergic (Immunoglobulin E mediated) and nonallergic reactions (non-IgE mediated).

Anaphylaxis should be highly suspected in any individual (child or adult) that suddenly has both skin and breathing problems. Usually, it’s the sudden onset of a generalized hive (urticarial) with itching and flushing, a swollen lips-tongue-uvula and at least one of the following: 1. Breathing problems such as dyspnea (trouble breathing), wheezing, stridor, turning blue; 2. Low blood pressure and collapse, fainting and incontinence; and 3. Nausea, vomiting and crampy abdominal pain.

Most preschool-aged children have respiratory problems which are similar to adults while the cardiovascular problems are less reported. In infants hives and vomiting are the more common symptoms. Careful monitoring for subtle behaviors such as scratching and drooling can reveal the presence of itching and difficulty swallowing.

The American Academy of Pediatrics has prepared information for the treatment of anaphylaxis which can be lifesaving. If a parent, teacher, camp counselor or school nurse think that anaphylaxis is a possibility they should give epinephrine while awaiting emergency transport. Epinephrine is the first line treatment and it works quickly delivering a dose of medicine directly into the child’s muscle. The auto injectors are especially designed for easy use in nonmedical settings. Delays in giving epinephrine for anaphylaxis can increase the risk of death, long hospitalizations and a second anaphylactic reaction called a biphasic reaction.

Things to know about epinephrine:

• First-line treatment of choice

• Acts where it is needed

• Will make you feel better

• Fast acting

• Delays in administration increase risk of death

• Err on the side of caution and give if any doubt

• Safe medicine

Anyone caring for a child with an allergy that can be life threatening must know how to recognize anaphylaxis and know when and how to give the lifesaving treatment.

Ideally, every pediatric patient (and their caregivers) would have the knowledge of the signs and symptoms of anaphylaxis; his or her allergens and their reaction history; how and when to use their epinephrine auto-injector (EA) and their emergency action plan.

By ages 12-14, patients may be able to share responsibilities for their care. This should be an individualized decision between health care providers and caregivers. Parents should ensure the school has a plan of action that includes treatment support based on the child’s allergy severity. Ensure that the child has two epinephrine injectors available in case of an inadequate response to the first. Ensure that all parties know the proper use of the epinephrine injectors. Place child on his back with legs elevated or on his side after treatment with epinephrine while the EMS is called.

For more information go to and search for anaphylaxis plan.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

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