Common Questions about Allergies: Answered
I’ll update this post regularly with FAQ’s I get as an allergy mum!
What is Epinephrine (a.k.a. Epi) is it the same thing as an epi-pen?
epinephrine (the medication in the auto-injector) is adrenaline - do not be afraid to use it. Adrenaline is the only first line treatment for anaphylaxis. (Source)
"Epi-pen” is a very well known brand of an auto-injectable device that delivers the drug epinephrine.
The brand we use is called “Auvi-q”.
Reminder: Always carry two auto-injectors.
Should I use antihistamines like Benadryl if someone is having a severe allergic reaction?
“Don't use antihistamines to treat anaphylaxis — prompt administration of adrenaline is the only treatment for anaphylaxis” - Allergy.org
“antihistamines are never a suitable medication for treating anaphylactic shock.”
“Antihistamines can potentially relieve some mild symptoms from an allergic reaction, such as an itchy mouth or hives, but they cannot stop the life-threatening symptoms of anaphylaxis.” - Red Sneakers For Oakley
Why should the Epi be injected into the thigh as opposed to any other body part?
3 of many reasons:
1. the thigh muscle is one of the largest muscles in the human body and has a lot of blood vessels, therefore it has a large/good blood supply - the greater the blood supply, the faster the absorption of the medication (epinephrine/adrenaline). If it is accidentally injected into a smaller muscle (i.e. the arm) the medication may not be absorbed fast enough to do the life saving work.
2. Additionally, there is less fat between the skin and muscle in the thigh. Adrenaline needs to be injected straight into the muscle to be most effective. (Source)
3. The thigh is the safest location for the injection. (Source)
What position should the allergic person be in during administration of the epi?
“There currently is no consensus on the ideal body position for epinephrine autoinjector (EAI) administration.”
-National Library of Medicine
Why do people carry 2 Epinephrine auto-injectors?
In some cases of anaphylaxis, one dose of epinephrine is often not enough. 35% of people may require a second injection.
Autoinjectors sometimes fail to deliver the full dose of epinephrine due to manufacturing defects. If the first auto-injector fails (you can tell if it fails as symptoms will worsen / not get better within 5 minutes after the first one) use the second one.
If there is a delay in administering the first dose of epi, an additional dose of epinephrine may be required. There is evidence that failing to administer adrenaline as soon as anaphylaxis is suspected has contributed to fatal outcomes. Delayed injection of adrenaline can also increase the likelihood of a biphasic reaction.
(Source)
Do I need to know how to use an Epi injector?
We believe that just like knowing how to perform CPR, knowing how to administer epinephrine (and practicing with a trainer!) is critical and can be life saving. Of course, family and friends should be aware of the risks of anaphylaxis, the causes, and how to administer epinephrine, but we believe the knowledge and wisdom to apply this potentially life saving work should be accessible and clear to everyone. Additionally, the correct injection technique is important to avoid unintentional injection into other body parts.
How do I use an Epinephrine auto-injector?
We made this YouTube Video on How to Use an (Auvi-Q) Epinephrine auto-injector and this Video covering some critical steps to take AFTER the epi is injected When Someone is Having an Allergic Reaction
Why do I need to call 911 if Epi is administered and the person is feeling better?
2 main reasons:
Epinephrine is NOT a "fix" to the allergic reaction. While it can stabilize the person for a short window of time, it is a critical window of time needed to get the person to the hospital where more medical treatment and monitoring can begin to keep the person alive.
A second allergic reaction, called biphasic anaphylaxis, can occur between 1 to 72 hours (typically eight hours) after the initial reaction. This happens in 20% of patients experiencing anaphylaxis. (Source)
How do we recognize symptoms of Anaphylaxis or a severe allergic reaction that require the injection of Epinephrine?
“Allergic reactions to food can have many different symptoms, and an individual can experience different symptoms from one reaction to the next. Often, reactions start with skin symptoms, like hives or a rash, but many do not. More serious symptoms like a drop in blood pressure and trouble breathing can be life-threatening.” - RedSneakers.org
“Anaphylaxis is a serious allergic reaction that comes on quickly and may lead to death. We cannot stress enough: epi first, epi fast, then call 911.”
If the person has any SEVERE SYMPTOMS (see left box below) inject the epinephrine FAST as instructed in the video here.
ORIf the person has more than 1 of the MILD SYMPTOMS (see right box below) inject the epinephrine FAST as seen in the video here.
See my previous blog post on “What to Do if Someone is Having an Allergic Reaction” for more details.
FARE's Food Allergy & Anaphylaxis Emergency Care Plan
This is what we were provided by our Allergy Specialist to help us identify if our child is going through an anaphylactic reaction.
What side effects do we expect with the epinephrine use?
Shaking, jitters, and a fast heart rate. Just like we would experience with adrenaline - epinephrine is adrenaline. Do not be afraid to use it!
How long does it take for the epi to work?
For the vast majority it works within 5 minutes. If after 5 minutes upon the first injection she/he is still struggling*, you administer the 2nd epi QUICKLY.
What to Do When Someone is Having an Allergic Reaction: Do Not Delay this Treatment
Step 1
Without delay, administer the epinephrine auto-injector into the person's outer upper thigh (about 1/2 way between the hip and the knee).
Epinephrine is the first and most important treatment for anaphylaxis, and it should be administered as soon as anaphylaxis is recognized to prevent the progression to life-threatening symptoms […]
This is why the statement “Epi first, Epi fast” is a commonly known phrase in the allergy community.
Step 2
Immediately Call 911 and state "ANAPHYLAXIS"
[Pronunciation: ANA - FIL - AXIS]
Note: if there is another individual with you, have the other person call while you are administering the epi.
There is no time to waste.
The medication in the injector can open up the person’s airways but once it wears off the person CAN relapse.
They must be taken to the Emergency Room to be monitored ASAP. A second allergic reaction can occur 1-72 hours after the first reaction.
Prompt assessment and treatment are critical in anaphylaxis, as respiratory or cardiac arrest and death can occur within minutes. It is also important to treat anaphylaxis promptly because it appears to be most responsive to treatment in its early phases, based on the observation that delayed epinephrine injection is associated with fatalities.
Step 3
Lay the patient down in this vital position until Emergency Responders arrive.
FOLLOWING INFORMATION & ILLUSTRATION PROVIDED BY:
"THE UK GOVERNMENT'S 'ADRENALINE AUTO-INJECTOR EXPERT WORKING GROUP’”
Via Natasha Allergy Research Foundation
Have them FLAT on their back
BOTH legs ELEVATED
This promotes blood flow back to the heart, brain, and vital organs where blood is most needed.
*Avoid any sudden changes in their posture and do not allow the person to walk, stand, and sit upright even if they start to feel better due to the risk of cardiac arrest (meaning the heart stops beating)
IF the person is struggling to breathe or is about to vomit in this position, gently help them up for as short a time as possible or lay them on their side - Begin CPR if the person stops breathing
IF the person is pregnant, lay her on her left side
Step 4
Closely observe the person’s breathing and pulse for 5 minutes to determine if you need to inject the 2nd epinephrine into the OTHER outer upper thigh
(the person with allergies should have 2 injectors with them)
5 minutes after the 1st injection, if there is no noticeable improvement in the person’s symptoms or if symptoms worsen, administer the 2nd adrenaline auto-injector into the OTHER outer upper thigh (again, about 1/2 way between the hip and the knee).
NOTE: It is CRITICAL that the 2nd epinephrine is injected in the OPPOSITE thigh!
Here’s why:
When the medication was injected into the first leg, it constricted the blood vessels in that leg.
If the 2nd epinephrine is injected in the SAME leg, the medication will have no where to go and will have no ability to do the life saving work.
TL;DR
Always inject the 2nd epinephrine into the OPPOSITE outer upper thigh
Step 5
Store the used Adrenaline Auto-Injector(s) in a rigid container if available and give it to the first responders when they arrive.
The first responders will want to know what dose of the medication was provided to the person so don’t toss it after it’s been used. Be careful of the exposed used needle.
Share this video that walks you through the 5 important steps you need to execute when someone is having an allergic reaction.
Why did we make this Video?
We believe that like knowing how to perform CPR, knowing how to administer epinephrine is critical and can be life saving. Of course, family and friends should be aware of the risks of anaphylaxis, the causes, and how to administer epinephrine, but we believe the knowledge and wisdom to apply these potentially life saving steps should be accessible and clear to everyone. Additionally, the correct injection technique is important to avoid unintentional injection into other body parts.
Next Up: We’ll be sharing an Allergy FAQ post to answer lingering questions you may have!
Air Travel: What Food Allergy Kids Need You to Know
If you’re new here, welcome! You’ll quickly learn that I’m here to empower non-allergic people to become more allergy-aware so that we can all stand up for people with allergies.
I also created a How to Fly with a Toddler with Food Allergies video to provide tips for caretakers of children with food allergies because while traveling with a toddler is stressful, traveling with a toddler/child with allergies is EXTREMELY stressful.
Air Travel Tips Food Allergy Kids Need You to Know
Air travel causes widespread anxiety among passengers managing food allergies, according to a just-released survey. Ninety-eight percent of 4,704 respondents reported some level of anxiety over air travel.
- Wendy M. in Food Allergy News
“I knew people were stressed when flying with food allergies, but 98 percent is surprising,”
- Lianne M. founder of No Nut Traveler
Here are 7 tips I wish I had been aware of when I had to take on my first flight with my allergy toddler alone:
Tip No. 1
Always pack in your carry-on bag a minimum of 2 epinephrine auto-injectors
(if you have more to pack in your carry on, go on - carry it on board!)
I say pack a minimum of 2 because, unfortunately, the first injection does not always work so being prepared to inject the 2nd epinephrine is wise.
We err on the side of caution and pack 4 epinephrine auto-injectors because what good is an epinephrine injector if it’s not with you when you need it, right?
We’ve had no trouble boarding our flights with the adrenaline auto- injectors even though there is a needle inside. My allergy specialist recommended we be prepared with the prescription in case we are pulled aside or questioned about the medical device being carried onto the plane with us. Feel free to follow suit!
In the occasion an epinephrine injection is needed on the flight, do not delay in using it.
Next week, I’ll post a video on “What to do when someone is having an allergic reaction” video with step by step instructions.
Always remember:
epinephrine is not always a miracle ... epinephrine works more successfully when given early in a reaction ...
-Lianne M. founder of NoNutTraveler.com
Tip No. 2
Get to your gate early so you can speak with the Gate Agent
At least 1 hour before we board, I get to the gate and speak with the gate agent at the desk. I explain that my child has life-threatening food allergies. Usually, the gate agent will ask me to explain the situation to the flight attendant in charge of my seating area. This is when we thank them for that guidance and explain that we need our boarding passes reprinted so that we can pre-board the flight to clean up and rid our seating area of remaining food allergens from previous flights.
I used to be nervous about requesting this, but we have a legal right to request this. The Americans with Disabilities Act (ADA) is a federal civil rights law that
gives people with disabilities the right to ask for changes where policies, practices or conditions leave you out or put you at a disadvantage. Public companies and places must give people with disabilities full access to all facilities, programs, goods and services. They must also give them the chance to enjoy these places and services just like someone without disabilities […]
Source: AAFA.Org
Yes, the ADA applies to people with allergies..
Airlines must permit some parents — or passengers with food allergies themselves — to preboard in order to wipe down seats, federal regulators said.
The D.O.T. considers severe allergies a disability under the act if they impact a passenger’s ability to breathe or “substantially impact another major life activity.”
[…]
Some are so sensitive that merely touching a surface contaminated with an allergen can set off a life-threatening reaction called anaphylaxis, which causes swelling, hives, lowered blood pressure, shock and constriction of the airways. The reaction can be fatal.Source: NYtimes.com - Boarding Now: Parents of Children With Food Allergies
Tip No. 3
Be prepared to pre-board with paper towels & an allergen free cleaning spray
These are the 2 spray solutions we use:
Force of Nature
*Use code: MUMWITHABUN for 40% off a kit
Branch Basics - we use the Travel Kit that includes the Mini-All Purpose spray and Mini Foaming Wash (see Tip No. 7)
*Get $10 off when you use my link
This is your chance to use the few minutes you gain by pre-boarding to wipe down the airplane seats, armrests, head rests, seat backs, tray tables, window, and window shutter in your row. Basically, try your best to wipe down everything you think your toddler/child will touch.
While I wish I could say I’ve peacefully used this time to wipe the area of allergens not visible to the eye… I’ve found large cookie crumbs, whole tree nuts, crushed cheese crackers, and many many other foods pieces containing top allergens. This “pre-board to clean up any possible allergen traces” time is so important and makes a big difference.
My daughter is still in the phase where she puts things in her mouth sometimes without even realizing it. For her, even a tiny tiny piece of her allergen can trigger a life-threatening episode. I don’t think many people realize this. I know I sound like a broken record, but this pre-board & wipe-down time is crucial.
Tip No. 4
Let the flight attendant in your seating area know of your child’s allergy well before take off
Depending on the airline, there will be different responses & policies, but in the best of our experiences, the flight attendant made an announcement during take off and informed the passengers seated near us not to eat the specific foods that could endanger my child. In some flights, the pilot himself made an announcement regarding my child’s allergy and asked passengers to refrain from consuming her allergens so that we could all have a “non-stop” flight to our final destination - nobody wants an emergency landing.
Disclosing an allergy upfront is important so flight attendants aren’t delayed in aiding a passenger having a reaction.
Letting the flight attendant know of a child’s medical condition is sometimes difficult, but take courage. You can do this!
Some airlines request they be informed of the allergy at least 48 hours before the flight. Double check your airline’s website to see if this is part of their policy in the section on allergies.
Tip No. 5
Bring Disposable Plastic Utensils/Cutlery
I’m not a fan of single-use / plastic items but we make an exception during travel. We use plastic gloves and utensils to feed my daughter during the flight and cover her tray table just in case we missed any allergens during the pre-board and wipe down time. In flight, plastic food gloves & utensils are a game changer because even if you instruct your child not to eat with their hands sometimes they just forget/can’t help it!
Tip No. 6
Pack allergen-free, high quality protein & fat rich foods
The nutrition nerd in me gets super excited about this tip because foods high in quality protein and quality fat keep your child satisfied and their blood sugar levels/mood stable throughout the flight. An additional advantage to packing snacks and timing it right is this: having little one’s chew and swallow food during take off and landing could help them not experience that dreaded ear pain post-flight.
Tip No. 7
Bring your own allergen-free SOAP!
Public soaps may contain food allergens in their ingredients. There will be many reasons to wash your child’s hands during the flight so be sure to pack a travel sized soap in your carry-on!
We use Branch Basics Mini Foaming Hand Wash anytime we travel
*Get $10 off when you use my link
Please share this with anyone and everyone.
I hope this helps you and brings you some confidence in flying with your allergy child. You got this.
Have a safe flight!
*Disclaimer: Jane is a participant of affiliate programs designed to provide commission and discounts for those who use her code/link. She does not partner with brands she does not personally use and love.
This post and correlated videos are not intended to provide any medical advice. We create our videos with the intent of providing evidence-based information, and we hope that sharing our personal experiences would shed light on how others can be more allergy aware.