Monday, April 23, 2012

Peanuts, anaphylaxis and the horrible, no good, very bad week...

This post should have been about all the school we accomplished this week and some of the interesting things that we learned. Alas, it is not. Best laid plans...

Anyway, we made it through lunch and  were all poking around for something sweet to eat when I came across a Bumble Bar Chocolate Crisp bar I had purchased awhile back at the bottom of our "sweet tooth" basket. As always with a new food, I inspected the label, front and back, looking for any warning signs and ingredients. The first thing that struck me odd was how small the ingredient font size was on the back of the wrapper. I could barely read it at all. So, I flipped it over and inspected the front again and then looked for the bold-type warning signs. Nothing. No mention of peanuts or nuts at all. It was a chocolate crisp bar which is what they called the bar, and different from the company's "peanut" bar. I opened it and took a small bite of it and told the boys, if Josh could eat it, they could split it in half.

Josh picked up the wrapper and investigated it, as we've taught him to do, and found nothing mentioning peanuts either. As always, I gave him a very small bite as a taste test to make sure he didn't react to it, something we've always done since a toddler because of all of Josh's food allergies, not to mention my experience growing up with an anaphylactic reaction to eggs and fish.

He tasted it and wasn't impressed with it nor did he seem to have a reaction, so he moved on to looking for another treat he could have to calm his sweet tooth. We all settled in to watch our documentary when Josh mentioned his throat felt funny. This was probably 10-15 minutes after ingesting that small piece of the bar to taste test.

He made his way to the bathroom and began reporting what he was feeling inside his body, another thing we've taught him to do. He was having trouble swallowing. His lip was swelling. His eyes became very bloodshot. He said he had a lump in his throat which was growing. I remained calm as I got the benadryl out and his epi-pen. As I was asking him questions, he began to tell me that his symptoms were subsiding. And they were. His lips were not as pronounced and the splotchiness that had crept onto his face was disappearing.

This was not his usual response in a reaction. Typically, his throat itches, his lips swell, and he usually throws up. We then administer benadryl and monitor him and all signs of a reaction go away. This was not happening, though.

For the next 20-30 minutes, his symptoms of reaction would come and go. Literally. Come and go. He would be in a terrorized panic over his closing esophagus with awful wheezing and then 5 minutes later, he'd be calm, cleared up, and wanting to resume the documentary. I was baffled and in limbo for each time it "flared" up, I had the epi-pen out and ready to use it and just when I'd be ready to un-cap it, his symptoms would begin to subside.  So, I'd wait and watch.

Now, there are two camps of opinion when it comes to epi-pens. Because epi-pens carry their own set of problems and side effects there are those in the medical community that adovcate not to use the pen unless it is absolutely, postively, beyond a doubt necessary. Defining "necessary" becomes the blurry part. Treat first with antihistamines, watch and see and then decide before using. Then, there are those that advocate at the first sign of a reaction, use it! Worry about any possible side effects of the pen later (some which include heart problems). Now learning that are three types of anaphylactic reactions, both opinions hold true, depending on which type of reaction is unfolding before your eyes. Up to this point, all of Josh's reactions have been able to be contained with benadryl (as have mine, minus one incident as a toddler involving touching a cracked egg at an Easter egg hunt).

I gave him 1 capsule of Benadryl, as we've done before to stop a reaction, and his body wasn't responding. 5 minutes went by.  10. His body still wasn't responding.  At this point, I began to inwardly panic and told him that I was going to use the epi-pen on him.  By the time I had it ready, all symptoms improved greatly.  So, I watched and waited again.
Within another 10 minutes, he was back to square one and unable to breathe, swallow his own saliva.  At this point, I should have used the pen but was so stunned and baffled by the whip-lash like responses.  I gave him a second dose of Benadryl and knew we'd be going to the hospital one way or the other.  This was too severe of a reaction to NOT go.
I told him that, if he could, he should try to throw up to get it out of his body and prevent his system from having to process this allergen.  He did throw up several times and instantly his eyes cleared up and his swelling reduced.  His breathing returned to normal (no more wheezing) and he seemed perfectly fine. We got dressed (it was PJ day, a rare thing in our house since I make everyone get dressed for school).

Chris came home from work and rushed him to the hospital since his outer throat was swollen at this point.  My biggest regret is not sticking him with the pen and calling 911 immediately.  However, I assumed that this reaction would be like all the others and would respond to Benadryl alone.  I was wrong.

Jake was terrified that Josh was going to die; so, we cried and prayed together.  Both Jake and my emotions  had been riding the wave of this intense reaction - the ups and downs - over the course of 45 minutes.  Jake has seen Josh have reactions before but none have ever been this intense and drastic.  I hope we never have another like this again.

Josh was given an IV of steroids and two different anti-histamines and monitored for 4 hours at the hospital. During that time, rashes, swollen lips and mild reactions would come and go WHILE BEING TREATED WITH MEDS.  Crazy, scary stuff.  The doctors said the adult dosage of Benadryl is what kept him breathing.  What a confusing, humbling, terrifying thought to have a doctor say to you.

He couldn't be left alone until his reactions had subsided because his lungs, despite the medicine, could decides to close up and cut off breathing, so Chris and I began a vigil of watching him.  The first night, we didn't let him fall asleep until 4a.m. and the second night Josh fell asleep around 2.  The remaining nights we let him fall asleep earlier (we were all so exhausted), in the living room, but we still watched him all night.

Josh did not stop reacting to the peanuts that he ingested (on Monday) until Friday morning.  Thursday morning he had a strong reaction again where he began to struggle breathing, his lips swelled up and he began having difficulty swallowing.  We all got dressed knowing another hospital visit was around the corner, and I called the advise nurse.  I increased his dosage of Benadryl but kept his steroid and other anti-histamine dosages the same and that got rid of this secondary reaction.

I shutter to think what Josh's next reaction could look like if he ever gets hold of peanuts again.  We both have agreed that we never want to go through this again.

I learned that there are 3 different types of anaphylactic reactions (Josh hit the most severe) and his pediatrician reviewed them with me. I also learned that to truly treat a reaction (as best as you can), both Benadryl and Pepcid AC needs to be given because Benadryl doesn't address both kinds of histamines our bodies produce.  Dr. Cohen was helpful and caring through all of this.  He says Josh was lucky.  I say God was protecting as I don't believe in luck.  Chris and I couldn't be more grateful for God's protection over that entire day.  May Josh never come in contact with  peanuts again. Amen.


  1. I am so sorry that you had such a difficult time and praise God for watching over you all. Knowing when to Epi, how much to Benadryl and whether to drive or "ride" to the hospital is always challenging. But, although it is always preferable to avoid a reaction, each incident teaches our kids and us what to expect and how to respnd in case there is a next time.... And, there can always be a next time. God bless you for sharing.

  2. Thanks, The Allergic Angel! Going on your name, I'm thinking you have your own set of alleriges that you manage? You understand that juggle of knowing when to go "full force" and when to hold back. Normally, the hold back works every time! Except this one! This one has made me much more jumpy for that next one. Ugh! I know God goes before us, though, and I can put my worries on Him to handle that next time event!

  3. Allergic Angel, I just peeked at your blog and you sure know what I'm talking about!! I'm so sorry your child has such a high amount of allergies. My oldest (the one with the peanut) used to have a lot more but has "grown out of" some of them but peanuts, walnuts and eggs have remained. I, myself, am allergic to eggs anaphylactically (although, I've developed a tolerance to them in baked goods, etc. over my lifetime). I understand the path you are on, as you understand mine, I'm sure. Praying for healing for both of our kids and if that not be in God's will, then prayers for protection are there as well!