at what point do you use an EPipen?

[QwertyQueen]

Just been reading some other posts, and do carry an epipen for DS but have never had to use it (touch wood).
When would you use it? Would you try give Piriton first? Or would you not have time?
Would you wait to see if breathing became difficult even if their face was swollen??

idealy this should have been explained to you by a medical person.
But , UK being such a poor provider of allergy support, I suspect that you were given an epi pen prescription by your GP and then left to get on with it. or you allergy clinic was so rushed and busy they dont have time for such life saving info as this.

This situation makes me so crosss and bitter (please ignore my anger, am SOOOO PMT at the moment)

anyway,

if you were told to use piriton first and then see if symptoms improve, this is ok.

my sons treatment plan has this as a first step.
For many young children studies have shown that the quicker you give them antihistamine, the better. and it halts a great many allergic reactions.

But what you are looking for in a allergic reactions are the signs of inner body reactions that are serious.

So, diffculty breathing (asthma for e.g)
diffuculty talking in sentances.
unable to swallow, ( throat closing up)
coughing. constant trying to clear throat, (again throat closing up)

signs of lowing blood pressure, feeling faint, dizzy, white faced/lips etc.

These are all serious signs and need an epi pen.
(at this point, feel free anyone to add anything I have forgotten on this list)

there is this sense of doom, or panic, which is something that you should really take notice of, the body is saying that something big is going to happen, so use the epi pen. prefebly before you get to that stage.

other signs that indicate that the reaction may be progessing is very large hives, esp those lager than a 50p or that join others.

with every allergic reaction, close observation is required, as some reactions are slow to change, and then suddenly speed up.

bascially what happens during a reaction,
is that little white mast cells, link on to nasty proteins, like for instance peanut.

They relase histamine , which has two main effects on the body. It causes the tubes in lungs and throat to close.
and it causes the small blood vessels to release blood.
This means that blood is being diverted from major organs , like the brain heart etc.

so,
during a reaction,
you dont walk or run,
you ask others to get you your meds , or you as a parent have them with or on child.

you dont go to the toilet on your own.

you sit down on floor ,
sitting up if asthmatic ,
laying down if having lowing blood pressure , with feet raised to keep heart full of blood.
you use your piriton, epi pens, and other meds if prescribed.

You stay on the floor and DONT get up , let the amublance sort you out.

Always call an ambulance , every time you use an epi pen, because of bi-phasic reactions.

be assured that if you use an epi pen , and it wasnt really requried it wont harm the person. you still have to go to the hospital, and call an ambulance,

and you mustnt leave hospital without another set of epi pens. (very important)

most report an imediate relief from allergic reaction as soon as epi pen given.

Adults I have met that have used one in emergency state that although frightened , they do now feel confident about using an epi pen , and wouldnt hesitate again to use one.

confidance is improved using trainer epi pens and ana pens.
using grapefruit or oranges, ( they are firmer, and skin does remind me of my thighs.........)
have an all family practice, get everyone to have a go, and sit down and assume body posisitions,
give everyone a role, so for instance , pretend you are in the high street and reacting, who is going to call for help , who is going to help the person sit up, is the allergic person going to give the epi pen? or is someone else going to do it?

etc etc.

this should keep it real and fresh in your minds. as well as making the children and you more confidant.

have a look at the allergy charity sites for info on this subject, the anaphylaxis campaign has a database which can be useful.
even the bbc website has a medical section on this.

i hope my waffle is of some use.

What WM says sounds completely right to me. Just wanted to say I agree you should talk it through with medical professional who knows your child, as different kids react differently.

I know with my DS he vomits and then gets itching type symptoms, at which point I give antihistamine straight away. We also have soluble prednisolone which I would give pretty quickly. If he has a bit of asthma I give ventolin. I've never had to use the Epipen, but wouldn't hesitate to do so if he was struggling to breathe etc (he did have to have adrenalin the first time he reacted as he'd had a whole bowl of yoghurt, but the other reactions have been to very small amounts so not nearly as bad).

A question for you WM: what is the difference between an anapen and an epipen? We live in France and have only ever been given the anapen, but at the moment the factory has apparently burnt down and they're no longer available, so we have something called "anahelp" (basically a syringe) which we have to keep in the fridge and then I'm scared to take it out and about with us as it won't be refrigerated...

the difference between and ana pen ( british invention) and the epi pen, ( dutch/american invention) is in the instructions for use.

epi pen is simple in the fact that you remove the grey cap, hold the pen in your fist with out thumb on top, press end in to middle upper thigh. hold for ten.

the advantage of the epi pen is that it can be administered through clothing, although not through seams, like jeans, or pockets ( so no combat trousers for allergic people!)

The ana pen requires a safety cap to be removed from both ends, and top cap has to be pressed down when adminsitered to upper middle thigh.

disadvantage is that ana pen can not be administered through clothing, jeans trousers need to be pulled down.

joint disadvantage is that both pens can be accidently fired in to thumb/fingers and can lead to loss of digit if not treated in hospital.

both types come in junior and adult sizes, this is based on weight to get correct dose of adrenaline. There also may be an issue on needle length, because of size as well.
I think adult needle is slightly longer.
also both pens should not be exposed to extreme heat or cold, and shouldnt be left in cars for that reason or in fridge.

useless fact of the day,
epi pens invented at first to inject soilders during the afganistan war, to arm agains chemical warfare. previously needles and syringes were used by severely allergic people.
this meant that a great deal of time, and practice and promise of a steady hand was required to assemble and admitister during a reaction.

spring loaded injectors are now widely used in different forms of medical areas, biopsys etc etc.

am full of boring stuff with regard to allergies. and a bit of asthma, and hint of intolerances, and a lot on IBS.
sad, but true.

we have always given piriton first. In the one reaction where I had to use an epipen it was very rapidly obvious that piriton was not going to work. They stopped being able to talk and had their hand to their throat. At that stage I used the epipen, another time I would hopefully get the allergic person to do it. There may be no rash/hives until later, if at all.

The effect of an epipen is pretty rapid.

I need to stress one thing, though - a brave doctor has deliberately injected his fingers with adrenaline and not sought medical treatment. He did not lose his fingers. Although it is better to go to hospital if you accidentally inject into the wrong person (because it may hurt and they can inject something else to counter the effect) most people who inject a finger will recover without medical intervention. A bowl of warm water will help any pain in the accidentally injected finger.

thank you so much for the replies.
I was given a brief talk about it with the nurse, but they had no trainer pens available.
I pray I never have to use one cos the thought terrifies me.
We had an allergy scare yesterday, but luckily he is old enough to talk and told me his tongue was sore, so I gave him Piriton and he was OK... wheeeeeew.

DO you ever become relaxed about it?

tatt, I was told by a anaphylaxis campaign nurse that hospital treatment is ALWAYS required after injecting a thumb or finger.
As you can completly stop the blood supply and get gangrene.
It certainly is something that is explained on the youth workshops.

who wants to loose a thumb!!

( oh, and the drug they give you in the hospital does have tempory side effects that arent very nice apparently, and they keep you in the hospital for 24 hrs to make sure its worked.)

I know they say that - but as with so much medicine it isn't evidence based. Overstating risks means that that people become frightened of their epipens and places like nightclubs refuse to allow them inside. It's better to go to hospital because the finger will probably be sore - but the first reference below says they've never found a report of a finger (or thumb) being lost.

www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2526033

www.medscape.com/vie warticle/431601_3

www.pulsus.com/journals/abstract.jsp?origPg=abstract.jsp&sCurrPg=abstrac t&jnlKy=6&atlKy=4130&isuKy=505&isArt=t&&HCtype=Consumer

you know , people are frightend of thier epi pens/ana pens, but thats not just because of the fear of getting a finger stabbed.

which is why epi pen practice , at home and at the youth workshops helps.
being informed and the practice does give a person confidance.

I too have not heard of a finger being lost, but have heard from two allergic adults whoose friends ( one a nurse) ended up in hospital being treated for injecting the nerve in their thumb.

In both situations the adults in question didnt ask for clear instuctions , one was on her own when she practiced with an out of date epi.

So a finger may not have been lost, but people do end up requiring treatment.

As for nightclubs, thats just because of the general rule of not letting needles in, which is understandable with regard to drugs.
and most people have no idea what an epi pens is, or does, or what its for if they see it without explanation.

There are ways to get in to nightclub with your epi pen anyway.

Anything that suggests epipens are dangerous adds to the fear factor and to the reluctance to use them when they are actually needed. Many people are fearful because they are given duff information about risks. We were given rubbish information by our gp, fortunately the consultant was quite explicit about how wrong it was.

It's worth repeating that you are unlikely to suffer any serious damage if you accidentally inject. People often recover perfectly well without any medical treatment at all.

Practise is desirable to ensure that you can inject when you need to. The less fearful you are the more likely you will use your pen when needed.

coughing, wheezing ( signs that small tubes and muscles in throat are closing)= epi pen.

and yes , reactions can be have a slow build up.

Hi Williamsmummy,
Thanks for the "boring stuff"...its not boring when you have a DD who carries an Epipen.

Just read this article:

www.chicagotribune.com/health/sns-rt-us-health-epipen-obese-20131017,0,2831884.story

On Epipen website it says:
"Both EpiPen® and EpiPen®Jr should be injected intramuscularly into the outside of the thigh, through clothing if necessary..... The extended needle length after activation is 16.5 mm for the EpiPen® and 12.7 mm for the EpiPen®Jr

So now I'm really anxious coz DD (aged 14) is a little plumper than she ought to be (my fault I guess) and I'm not sure her Epipen needle is long enough to get into the thigh muscle. I didn't realise it was even an issue until I read that press report.....If Epipens are too short for the majority of women, why don't they just put a longer needle in?

I asked my GP practice nurse what length needle she would use for injecting into the thigh muscle and she said a "blue 25mm - minimum"...coz she has to follow some special UK Guidelines (?).