by Christina Elston
The death of a 7-year-old girl at her Virginia elementary school earlier this year grabbed national headlines and left school officials and others scrambling to explain the lack of a simple little device that could have saved her life.
The girl was allergic to peanuts and died of a severe reaction. The device is an epinephrine auto-injector, more commonly known by its brand name, EpiPen. And with the food allergy rate among American children at around 4 percent (and climbing by many accounts), it isn’t just parents of allergic children who need to know a thing or two about these potentially life-saving gizmos.
Who Needs One?
Epinephrine auto-injectors are designed to allow a person without medical training to easily inject someone having a serious allergic reaction with the drug epinephrine, which should halt the reaction and could save the person’s life. You just remove the safety cap, hold the device against the thigh and push the plunger to release the spring-loaded hypodermic.
Nut allergies account for 85 percent of fatal allergic reactions in the United States, so people with nut allergies make up the majority of the EpiPen-holding population. “Anyone who has a nut allergy needs an EpiPen,” says Roger Friedman, M.D., an allergist with Nationwide Children’s Hospital in Ohio. But people with other types of serious allergies also have EpiPen prescriptions.
If Your Child Has an EpiPen
• Double Down – “Where there’s an EpiPen, there should be two,” says pediatric emergency physician Daniel Scherzer, M.D., also at Nationwide Children’s. Something could go wrong with your first attempt at giving the shot, or your child’s reaction could resume after the first dose wears off (in about 20 minutes), so that you need a second dose.
Epinephrine prescriptions include two injectors. Don’t make the mistake of leaving one in the house and one in the car, urges Scherzer. Get two for each location.
• Replace Yearly – Epinephrine degrades after about a year. Using an expired injector wouldn’t likely be harmful, but the medication might not be effective, Scherzer says.
• Practice – “Things that seem simple usually aren’t when there’s an emergency,” says Scherzer.
Use the “trainer” pen that comes with your prescription, and visualize your way through the process. “Get a sense of what it feels like to push against the muscle in somebody’s leg,” Scherzer advises. Having the process fixed firmly in your mind might help you through the hesitation most people experience during emergencies.
• Train Others – Jane Abel has been living with EpiPens since her 4-year-old daughter, Ellie, suffered a severe allergic reaction to peanut butter in a sandwich at age 2. Now she teaches anyone who will be caring for Ellie to use one – including Ellie’s preschool teachers.
If Your Child’s Friend Has an EpiPen
• First, Practice Prevention – “If we don’t eat a food we’re allergic to, we’re never going to have a reaction,” says Friedman. Ask questions, read food labels, or have the child’s parents send along safe snacks for play dates at your house.
• Take the Time to Learn – If a child with a food allergy is playing or staying at your house, pay attention to what the parents say about the EpiPen. “I can’t overstress the importance of taking the time, if another parent does need to teach you, to really learn it,” Abel says. “It doesn’t have to be a scary thing. It’s a reassurance.”
If You Need to Use an EpiPen
• Know the Signs – An allergic reaction can impact these body systems:
– Respiratory – Wheezing, trouble breathing or swallowing, child complaining that his or her mouth hurts
– Cardiovascular – Appearing pale or weak, dizzy or acting strangely, signifying blood pressure has dropped
– Gastrointestinal – Nausea and/or vomiting
– Cutaneous – Hives or rash on the skin
If there are major symptoms from one body system, or symptoms from two different body systems (e.g., hives and breathing problems), Scherzer says it’s definitely time to use the injector. Find more extensive information through the Food Allergy & Anaphylaxis Network at www.foodallergy.org.
• Don’t Hesitate – The No. 1 mistake people make with epinephrine pens is failing to use them when they’re needed. Experts stress that it’s much worse to withhold epinephrine from a child who needs it than to give a dose to one who doesn’t.
“Epinephrine sounds like a scary drug, but it’s actually a chemical that’s in our bodies,” Scherzer says. It is the same as the body’s natural adrenaline, and side effects from an unnecessary dose would most likely be nothing more than some anxiousness and nausea.
Watching and waiting to see if symptoms get better on their own could make the reaction harder to stop, so act as soon as things look serious. “Don’t wait to see what happens,” says Abel. “Give the shot.”
• Talk Your Way Through It – Scherzer says doctors in the ER think out loud all the time, and advises it for anyone performing an emergency procedure. “It will help you stay organized, and it provides other people an opportunity to catch things and to correct you if you’re going to do something wrong,” he says.
• Sit the Child Down – This will help you stabilize a child who is feeling dizzy, and will help you to keep the child’s leg still for the injection.
• Don’t Remove Clothing – The needle is designed to penetrate easily through a pair of jeans or other pants a child might be wearing. “Don’t waste seconds,” Abel says. “It goes right through.”
• Hold the Device in the Middle – The “safety cap” on an EpiPen is on the end that doesn’t contain the needle, and this throws people off. Hold the injector in the middle while looking carefully at the label. Make sure you position the needle-end against the leg to avoid giving yourself a shot in the thumb. “There are hundreds of cases of that happening,” warns Friedman.
• Call 9-1-1 Afterward – Anyone who has had epinephrine for an allergic reaction – even if they’re now doing fine – needs to be taken to the hospital. Calling paramedics means you don’t have to drive in an emergency situation, and trained personnel are there to help if the child’s reaction resumes or worsens.
Hearing about tragedies like the one in Virginia sets parents of allergic kids on edge. “It keeps me up at night thinking about it,” says Abel. But only about 100 people die of allergic reactions in the United States each year, and epinephrine is amazingly effective against them.
A few months ago, Scherzer saw a 6-year-old boy in the ER who was allergic to pistachios but had managed to get his hands on some. He had hives, difficulty swallowing, and had begun to wheeze. His parents had an EpiPen, but were afraid to use it until Scherzer talked the dad through the process. “And the boy got better within seconds.”
Christina Elston is a senior editor and health writer for Dominion Parenting Media.