Should the GP prescribe an epi-pen while waiting for allergy referral

[Lolypoly14]

DD seems to have developed a nut allergy. It’s not just if she eats nuts, it’s if she’s near nuts as well.

It started a few months ago she was away for a weekend with friends and was at a street food/market and nuts were being roasted - she said the smell made her feel weird and she ended up with huge, red, itchy blotches across her chest, her lips and tongue felt ‘weird’, her throat hurt and she felt really breathless. Took anti-histamines and left the market and it passed. Next day she ate an ice cream with chopped nuts on (she didn’t really think about it) - same thing happened

She had a telephone appointment with our GP who referred her for testing.

We’ve removed all nuts at home and none of us eat nuts at the moment, but there has been a few times where she’s accidentally come into contact with nuts - motorway services on the M25, nibbles on tables at a wedding. someone eating nuts at college, someone eating nuts on the bus, etc.

I chased up the allergy referral and we’re looking at an 8 month wait (we’re 2 months in). Their advice was to call an ambulance every time it happens and to ask our GP to prescribe epi-pens.

GP won’t prescribe an epi-pen as she doesn’t have a diagnosis yet and “just stay away from nuts”.

She’s managing ok with normal antihistamines at the moment, but the reaction is quicker, and more severe each time it happens.

Thanks!

Hi OP

IME the GP won't prescribe epipens initially, the consultant makes the call about whether they're needed and issues the first prescription. Any chance you can afford to go private? We had to as it was a two year wait on the NHS.

The consultant will make the decision based on a range of factors including her previous reactions and other history (our peanut-allergic DD hasn't had anaphylaxis but has epipens because she has a history of viral wheeze).

For now, be very strict about avoiding all nuts and peanuts. You can discuss may contains with the consultant, our DD has them all the time without issue but for now you may want to avoid.

The antihistamines and epipens are backups, the main treatment (as it were) is to avoid the allergen, so get in the habit of being very strict about that now. That's likely to be a permanent measure you have to take anyway. Read up on cross contamination - ice cream shops and bakeries for example are places that require extra care due. We allow may contains for our DD but we only go to the ice cream shop in our town that doesn't have peanut toppings and opens a new container and uses a new scoop for her.

Likewise, loose nibbles are likely to be a no go, certainly for now. If you don't know the ingredients, she doesn't eat it.

It's very unlikely she's reacting to nuts just being in the vicinity, nut proteins don't really get airborne, so keep an eye on that. It may be contact reactions, cross contamination or a reaction to something else you haven't considered.

Also, there's a current issue with peanut cross contamination in mustard, so anyone with a peanut allergy is being advised to treat that as a mustard allergy also for the time being so if you're avoiding peanuts as well as tree nuts you'll need to avoid mustard for now as well.

Get a second opinion. My gp prescribed me epipens following my first anaphylaxis incident (mosquito bite - so obviously not something that will ever be tested) and they refill them annually or when I remember.

They generally won't prescribe them unless there's been an anaphylactic reaction. Just make sure she's extra careful and that you all know the signs of anaphylaxis.

Are you UK based? If you can’t go private - look up right to chose, if you can travel there will likely be a hospital around with shorter wait list. But GPs can prescribe…

Thanks all!

To be honest, I’m pretty confident that on the last few occasions where the reaction happened with me present, she hadn’t been in contact with nuts or anything else before hand.

With the services, we’d been in the car for about 2 hours, she hadn’t eaten or drunk anything, stopped at the services for a wee and to grab a drink, and within a few minutes of us being there she complained of feeling breathless and her tongue and lips feeling tingly and big red blotches on her chest. She hadn’t touched anything, other than we walked passed a stall right in the entrance selling noodles and stuff - when I looked, they had satay chicken.

At the wedding, it was the bit after the ceremony while they were taking photos. She’d been fine, hadn’t eaten or drunk anything since breakfast, walked into the room where they were serving drinks. Sat down at a table, I clocked the pot of nuts and nibbles on our table and took them back to the bar and a few minutes later she was breathless.

We don’t have any nuts at all at home, we check labels carefully (I have another DD who is coeliac), she is avoiding nuts herself - apart from the first time where she forgot herself, she has been very careful.

The issue we have, since the reaction at college, they don’t want her back in without an epi-pen but the GP won’t prescribe one until she’s had her allergy appointment - which is at least another 6 months away. They’re putting all her stuff on canvas and she’s doing assignments from home at the moment, but she’s doing a practical course so is going to struggle to finish it without going into college at least some of the time

Could you go private for a skin prick test? The test on its own isn't too eye-wateringly expensive. We did the same as the NHS waiting list was a couple of months and we were very nervous to wait. Once the allergy was confirmed by the private clinic they sent the results to our GP who was then happy to prescribe the EpiPens. We did then attend the NHS appointment which I would advise you to do too as the allergy teams are very thorough and it ensured continuity of care if her allergies develop.

I have an anaphylactic nut allergy and wasn't prescribed an epi-pen until tests and formal diagnosis had happened.

For me using an epi-pen is horrible, the adrenaline rush and subsequent 'withdrawal' is awful. It can last into the next day.

Adrenaline isn't guaranteed to work so fastidious care is always needed. Check all beauty products, cosmetics and medication for nut oils.

I'm another one saying if you can afford a private referral then please get one.