Anaphylaxis?!

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During a visit last summer to the ancient walled city of Dubrovnik, Croatia, my 13-year-old daughter

Catherine, who is allergic to dairy and tree nuts, had an anaphylactic reaction. It was her most terrifying allergic reaction to date. How did this happen? And how can I prevent a “next time”? Looking back at my mistakes, here’s what I learned.

1. Make No Assumptions.

What exactly did Catherine eat or drink that caused her system to start shutting down? It could have been the single-serve pack of instant coffee in our rented apartment in Dubrovnik, Croatia. No ingredients were listed.

I was in the shower when Catherine asked me several times how to make instant coffee. My answer was always the same—put the dried coffee into the mug and pour boiling water over it. Her repeated questioning should have been a warning bell but my first mom alarm went off when she said, “Mom, this coffee is really sweet! Yum!” Um, what? What else is in that coffee? Let me come take a look—but it was too late. She had already swigged half the cup down.

Later she told me the coffee had been extra foamy. Had there been dairy creamer in it? My husband and I don’t buy or use instant coffee, so it never occurred to us to question the contents. We just assumed that instant coffee was coffee and it wouldn’t be an issue.

Dubrovik

©THINKSTOCK/ISTOCK/BERTI123

2. When in Doubt, Do Without.

It could have been the meal we ate later that morning at an Indian restaurant within the walled city. Sure, the waiter/owner spoke English and yes, he assured us there was zero dairy and no nuts in the food served. But maybe the non-English-speaking cook poured cream in the sauce or forgot to wash his hands after chopping some nuts. If you don’t know the place, they don’t speak English and you can’t read the ingredient labels, find some other place to eat. Don’t be afraid to walk away. We’ve done that dozens of times over the years when we didn’t know for absolute certain. Why not this time?

3. Be Aware of Underlying Relationship Dynamics.

Unbeknownst to us, my daughter had taken Benadryl at the restaurant when she started feeling ill, about five minutes after eating. She didn’t tell us about the Benadryl because she “didn’t want to worry us.” Oh no, my sweet child! Not only were we not paying attention, we clearly have relationship issues to address.

My husband and I have always assured Catherine that her food allergies and reactions are no trouble. Apparently, she felt otherwise.

Over the past year, Catherine had been fighting us about her milk allergy, tasting dairy here and there in tiny doses to show she was no longer allergic. She so wanted to believe that she was outgrowing the allergy—but was she? Teenagers’ tendency to take risks can be especially dangerous when food allergies are involved. Catherine’s behavior was not only risky, it was a set up for keeping important information from us (like taking a Benadryl). Looking back over the past year, she’d been having a lot of stomachaches. Hello.

 Croatia

© THINKSTOCK/ISTOCK/KAORI KAJIHARA

4. Pay Attention.

Leaving the restaurant, Catherine told us she felt ill and wanted to go back to our apartment. And so we did. She seemed better there (maybe it was the Benadryl, working unbeknownst to us). As she showed signs of improvement, we pressed on. Our desire to experience Dubrovnik was stronger than her complaints about a stomachache. An hour later as we were wandering on top of the walled city, more serious symptoms developed. She became pallid and lethargic and was leaning over the edge of the 100-foot wall. She loudly insisted that we return to our apartment. I finally realized what was happening. Beginning to panic, I was practically carrying her back to our place when she threw up and suddenly became far, far worse. Her face began to puff up and her eyes nearly swelled shut. It was then that she informed me she had taken a second Benadryl a few minutes earlier on the top of the wall. How on earth had I missed that—and the first one? I felt deaf, selfish and afraid. Very, very afraid.

5. Know Your Emergency Exits.

Dubrovnik, Croatia, is a gorgeous walled city. The few gateways in and out are difficult to find unless you’re familiar with the town and know where to look. Did we have anything planned? Did we practice our fire drills? Did we know where the emergency exits were? Heck, no.

I didn’t know where the gates were but I knew that we needed to get to a hospital. Half carrying Catherine, I began running toward anything I thought would get us closer to medical help—but we kept hitting dead ends. Finally, I burst into a museum, hoping they’d speak English there. “We need a doctor! Now! She can’t breathe!” The lovely woman in the museum called an ambulance and personally escorted us to the Pile Gate where the ambulance was fast approaching. We got right in.

6. Act Quickly.

Catherine had been clutching her EpiPen but we had yet to use the thing. Her phobia of needles overrode her survival instinct. Could I grab the EpiPen from her? Absolutely. And I did, holding it over her leg on several occasions before climbing into the ambulance. Did I use it? No. Why not? I let her dictate the situation. Why? I was absolutely terrified the EpiPen wouldn’t work and that she’d really stop breathing at that point—and then what would I do? We had only one EpiPen with us; the second was back in our room. Talk about poor planning and parenting! Epic fail!

In the ambulance, the medic took no time for pleasantries. We were properly schooled: “Next time, you use the thing!” I swear I heard him mutter “idiot” in Croatian.

One of the most important things I learned from this experience was this: When a loved one is having an allergic reaction, take action. Nothing else matters. Stab your child with the EpiPen. Do not delay for any reason. It does not matter where you are, what you are doing or what you think is happening. Epinephrine cannot hurt someone, unless they have heart issues, and it very well will save a life during an allergic reaction. It’s better to be preventative and proactive than to look in the rearview mirror with despair and regret.

7. Know Yourself.

U.S. medical guidelines clearly state that the early administration of epinephrine is the most critical step in effectively treating anaphylaxis. Antihistamines like Benadryl are not considered appropriate treatment. The guidelines also state that people should carry two epinephrine auto-injectors at all times. Yet a recent study published in the Annals of Allergy, Asthma and Immunology found that half the kids who needed epinephrine didn’t get it before a trip to the emergency room. And 65 percent of the youngsters in this study had a known history of anaphylaxis. Just like Catherine. So, yes. It’s not unusual for parents to delay or avoid using an EpiPen. The question is, why?

I knew it was time to conduct an honest self-assessment. Do I make sure we always carry two EpiPens? Do I have a working phone in case of an emergency? Do I know which number to dial in a foreign country? Am I okay walking away from a questionable restaurant situation, no matter the inconvenience or the cost? Am I comfortable using an epinephrine device even when my daughter resists or forbids it? Have I practiced dozens of times in non-emergency situations so it’s second nature? Have I had an honest discussion with my daughter, telling her that I will overrule her needle phobia to save her life? Every parent of an allergic child must honestly ask themselves questions like these.

8. Be Grateful.

In the United States, we have so much to be thankful about. 911 is the universal number to call for help. Assistance is often available within minutes. We have high-quality medical care in emergency rooms.

When traveling to distant places that don’t offer this level of care, be prepared for absolutely anything. EpiPens? Take four. Assume nothing. Be aware, pay attention, be prepared and listen to your food-allergic child. Tell your kids they are amazing and that you want to hear all of their concerns, no matter how trivial. Then listen carefully. Take complaints seriously. If you think it’s anaphylaxis, act quickly. Know where to go and whom to call.

Be grateful for any help you’re offered, especially the kindness of strangers. To the woman at the museum, to the ambulance medic, to the hospital staff in Dubrovnik—thank you!

Jennifer Ward is owner of Be Free Family Farm, an organic urban farm in Kansas City, MO.

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