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   Epi Pen, Anaphylaxis
          & MedicAlert

Your allergist will likely prescribe an EpiPen® Jr. for your child if your child has experienced anaphylaxis, has scored very high (4+) on a skin prick allergy test or Immunocap RAST blood test to a specific substance or is believed to be likely to experience anaphylaxis in the future.

EpiPen ®Jr. is a prescription of epinephrine in a lightweight “pen.” The pen contains one dose (.15 mg) of epinephrine for a child. The EpiPen® is the prescription for older children and adults. Once your child is approximately 60 pounds, you will probably receive a prescription for an EpiPen® rather than the Jr. The pen contains the same amount of fluid at a higher concentration of epinephrine.

The EpiPen® Jr. is an auto-injector for allergic emergencies (anaphylaxis) only. Before an emergency occurs, you and anyone else who takes care of your child should practice on a tester. A tester is available with the dual kit of EpiPens®.
 
There is a new product on the market called a Twinject which has two injections of epinephrine available. I have received a sample of this product and have found it to be cumbersome and confusing, especially if I have to ensure that I can perform the series of steps correctly in an emergency for the Twinject to fire. Some physicians may prefer to carry a Twinject in case of an emergency, and with their familiarity with shots the cumbersome aspect may not be an issue. Also, there is the benefit of having two doses of epinephrine in one shot.

Health Canada issued an advisory in July 2008 alerting the public that it had received 30 reports of malfunctioning Twinjects since the product was introduced in Canada in August 2005. The malfunctioning products could have been caused by errors by the operator or by the product itself.

Regardless of which device you prefer, you will want to keep the medication out of direct sunlight, and it should not be refrigerated. It should also not be left in a car due to temperature extremes! Additionally, once a pen has expired we dispose of it by practicing administering the shot on an orange. This is good practice so that you know the amount of time it will take to administer the medicine, the strength with which you need to push and the sound of the ‘click’ upon injection.

You must keep the “pen” in close proximity to your child at all times. (However, be careful of curious siblings! You will need to explain to them the seriousness of the epinephrine kit.) The highest incidence of death from anaphylaxis occurs when a child having a reaction doesn’t have the prescribed epinephrine with him/her.

Some children are mature enough to carry their own EpiPen® Jr. with them in a lightweight fanny pack or other carrying device. The child must understand the medicine they are carrying and that showing it off or playing with it is not appropriate. Some states do not allow a child to carry their own medicine to school, and therefore the EpiPen® Jr. would have to be stored with a teacher or school nurse.

Other states, such as Colorado, have passed legislation allowing children old enough to self-administer the EpiPen® to carry it with them at school. Inhalers would fall into this category also. For most children, this would be at the age of middle school. Wondering if your state allows for self-carrying of this lifesaving medicine? Click here to find your state’s legislative efforts.

The only way to obtain an EpiPen® Jr. is through a pharmacist with a prescription. You will want to obtain several EpiPens®. During elementary school, when our son was too young to self-carry, we had one in my son’s classroom at school, two in the school office so that one EpiPen® traveled with the playground monitor to recess. He also had two EpiPens® in his fanny pack for nights and weekends. You may even want two in every location that your child goes, just in case one EpiPen® fails or there is a misfire.

When you pick up the prescription at your pharmacy, check the expiration date. Some pharmacies have older EpiPen® Jr.’s on the shelf. In other words, they expire within 6 months. You should be able to obtain a kit that has an expiration date 12 to 14 months out. Once the expiration month has been hit, you will need to obtain a new one. Of course, if you should use one, you will need to replace it with a new one preferably before you leave the hospital.

In 1998 there was a massive recall of EpiPen® and EpiPen® Jr. products due to a potential malfunction. Some people were left without one functioning product, which is a scary place to be. If you purchase your prescription from different pharmacies at different periods of time, you are less likely to have the EpiPen® Jr.’s expiring on the same date and to have them from the same lot. Keep a calendar of expiration dates and watch for recalls of any EpiPen® product to check the lot number of your various prescriptions. You can also register your expiration date and receive reminders here.

You might want to comparison shop for the best price on an EpiPen® Jr. The Internet offers various sites to purchase prescription drugs. However, we’ve found that mail order pharmacies are not careful at keeping the EpiPen® heat/cold protected. We therefore purchase our EpiPens® from a local pharmacy. The pharmacies in your area may vary widely in their prices charged for this product, so it’s worth shopping around.

Should you have to use an EpiPen®:

If your child suffers a severe allergic reaction, it will necessitate using your EpiPen®. Your child will be suffering more than just hives, more than just vomiting, but rather a combination of several factors:
  • Hives
  • Swelling of the throat continuing down to the lungs
  • Vomiting/diarrhea
  • Difficulty breathing

What can then follow is a dangerous lowering of blood pressure and loss of consciousness. All of this can occur within 2 minutes. The optimum time to administer the EpiPen® is within 15 minutes; however allergic reactions can progress much quicker.

If your child is experiencing only hives, for example, a dose of antihistamine may be sufficient to curtail the allergic reaction. If you aren’t sure whether to give an antihistamine or an epinephrine shot, our allergist has told us to err on the side of caution and administer the shot. There is no harm done if the shot is given and it wasn’t necessary. There could be real harm done if the opposite occurs. Your allergist should create a health care plan delineating what medication should be given for what symptoms. An example of such a plan is here.

Our daughter was showing Morgan how to train others on the use of his epinephrine kit several years ago. She put the shot to her thigh, removed the gray cap, and to her surprise gave herself a real shot! She thought she was using the trainer. She shook like a leaf for 15 minutes, and then was fine. No medical attention was necessary, and she learned to ensure that she was using the EpiPen® trainer in the future!

If your child is experiencing anaphylaxis, our allergist told us to administer the EpiPen®, followed with 1 teaspoon of liquid Benadryl®; to then call 911 and tell them our child is having an anaphylactic reaction and more epinephrine needs to be brought in the ambulance.

In the December 2007-January 2008 Food Allergy News, published by the Food Allergy & Anaphylaxis Network, they stated,” Unfortunately, in some states the risk still exists that emergency medical personnel (EMTs) responding to a 911 call will be unequipped with epinephrine and/or unauthorized to administer the medication. Generally, the risk involved EMT-Basics, who are the vast majority of EMT’s in most states. Since 1999, FAAN has worked with physicians, state lawmakers, EMS agencies, and parents of children with food allergies to improve the situation. More than 30 states have adopted new policies expanding the ability of EMT-Basics to carry and administer epinephrine; South Dakota, New Jersey, and Texas joined their ranks in 2007. Coverage is still far from seamless across the nation. There may be a chance that EMTs arriving at the scene may not be fully equipped or authorized to administer epinephrine.” For more information about this important legislation, please click here.

Your child will need to remain at the hospital for observation following an anaphylactic shock for 4 to 8 hours. The shock can return after an initial dose of epinephrine – called a biphasic reaction. It is always best to have a medical doctor observe your child, and to have additional doses of epinephrine when you leave the hospital!

We have a listing of written steps to take should an anaphylactic reaction occur. These steps were also given to my son’s school, and are outlined for any caregiver. The organization, Food Allergy Initiative has this information here.


Why should your child wear a MedicAlert® bracelet?

If your child’s allergy to a specific food, several foods, a drug or bee sting is life threatening, your doctor will probably suggest that your child wear a MedicAlert® bracelet. In other words, your child is at risk for anaphylaxis.

We have found that the bracelet creates a conversation that allows people to ask, “Why do you wear that bracelet?” My son then gets practice acknowledging what his allergies are in conversation. People who are meeting him for the first time sometimes share stories about someone else they know who has severe allergies. They generally remember his allergies when they meet him again, and that is the intent of the bracelet.

Our purpose for the bracelet is to let everyone know about his severe allergies. If people are aware of it, there is less chance for an offending food to enter his world. When my son has gone to the Emergency Room (for stitches, for example), our experience is that the nurses and doctors immediately check the MedicAlert bracelet.

Should your child be anywhere without you and have a reaction, any person can read the bracelet and pass this information on to a 911 operator. Also, there is a 1-800 number on the bracelet for people to contact MedicAlert and find out the complete medical information on your child. Your child should have an EpiPen® with them, in this case, and hopefully be able to self-administer it or be with someone who can administer it for them.

Enroll today by calling 1-888-904-7629 and mention code 5560 to save $5!

The bracelets can be ordered from MedicAlert at appropriate sizes to fit your child’s wrist. We have the bracelet on my son’s non-dominant hand. We ordered the stainless steel model because it is more durable. I have heard of children having reactions to stainless steel in the bracelet itself. The bracelet does come in silver and gold also if you’re willing to pay a higher price for it. There are also other types of wrist bands available on the MedicAlert site.

There are necklaces available also. For a child, we felt the risk of catching a necklace on a piece of playground equipment was too dangerous. We therefore opted for the bracelet.
Should the red on the MedicAlert emblem wear off, they will replace the bracelet. Our son had this happen after a summer in the swimming pool. It is possible for your child to lose the bracelet, although this is unlikely with the clasp. My son has lost his, however! In that case, a new bracelet will need to be purchased.

If you find out your child has more allergies than what was originally indicated on the bracelet, you can order a new bracelet (at a charge). We have only my son’s life threatening allergies listed on the bracelet because of a small amount of space.

 



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