Dr won't prescribe Epipen

[MissusT]

Hi
My son has various allergies, which haven't showed up with skin prick testing, but are still pretty strong as far as i am concerned-ie once he was touched on his bare skin by someone who had just eaten cashew nuts and he came up in welts... He has peanut allergy, dairy, eggs,flavourings preservatives etc etc etc. typically if he eats something he shouldn't he comes up in welts, itching, and has a bad sleep that night. Anway, my point is, he hasn't come in contact with peanuts since he had his reaction at 1 year old, and i know that the severity of a reaction can change each time they are exposed... I have totally lost my confidence to travel overseas since all these allergies, and now i have finally plucked up the courage to book an overseas holiday, i know i sound pretty neurotic but i want to take an epipen just in case everyone on the plane breaks out their own personal stash of peanuts, despite the flight being peanut-free.

My GP won't prescribe an epipen because she says he doesn't need it - his peanut allergy was treated with oral steroid and an antihistamine. I NEED IT FOR MY PEACE OF MIND!! GIMME IT! I know the plane carries 'an epipen' but is this a junior one or did some bright spark only include an adult one in the first aid kit. AND WHAT IF ITS OUT OF DATE???? As you can see this is causing me to lose some sleep and i wish i had just decided to stay at home.

And just to really set me off, i read on this website in the allergy sections that severe reactions can happen any time afterwards, not in the immediate 20 minutes after ingestion as my paediatrician said....!?!? Anyone got any soothing words of reassurance or fab advice??
Thanks!!

Sorry i forgot to mention that he has just turned 3 yrs.

You do sound a bit neurotic tbh. Sorry.

I know how worrying allergie are, but anaphylatic reactions are not that common.

How old is he now? How old was he when he had the skin prick tests?

How old was he when he had the skin tests? I don't understand why they were negetive if you say he has these allergies.

No, please you tell me what you really think simon cowell!

I've got no idea why they came up negative, but tested for tree nuts, dairy, fish and not peanuts cause i couldn't see the point - it was already obvious he was allergic to them. Even now, if he sips a cup of milk he'll come out all red around the mouth, so why that wouldn't show up in a skin prick test beats me.

He was 1 yr old when he had the skin prick tests and he has just turned 3.

Why don't you get him tested again and have the tests done for the foods that you suspect he is allergic to?
This is so he can be diagnosed as being allergic then you'll get the support and advice you need.

Please calm down. if your sons allergies can be managed by antihistamines, then having an epipen "I NEED IT FOR MY PEACE OF MIND!! GIMME IT!" isn;t needed. I know, I carry one, I have severe allergies........you only need an epipen is previous reactions haven;t been dealt with just with antihistamines.

plus, if you do use said epipen on the flight, how the hell are you going to cope afterwards?? You then need pretty prompt hospital treatment after using one (it contains pure adrenalin(sp)), and so has an effect on the heart............you cannot, with the best will in the world, get to a hospital while in a plane, unless the plane flies into it (not recommended, believe me[wink).

if you are that worried, don;t go, that is my only advice. otherwise, fill him up with all the antihistamine he is allowed before the flight, and ensure that no-one touches him bar you.

by the way, I go into anaphylaxis with milk, I need to ingest in to so that.......touching alone has never sent me into shock. I might welt, (I certainly come up in hives and itch when splashed with milk, or icecream gets on me when cleaning my children), but that is a bad as it gets.

please please stop fretting, you will give yourself an anurysm!

never been called Simon Cowell before.

Agree, you need to get him tested again. I'm sure I've read those skin prick tests are not reliable under the age of two. But if he is now three, then I would get him tested again. You really need to be absolutely sure what he is allergic to especially if he goes to nursery or plays a lot with other children. It's possible that he has outgrown some allergies.

Thanks, yeah, ur all right - and sorry simon.
I know it must sound ridiculous to those of you with the need for one.. but he is just so precious you know?? I don't want to get caught out and think if only i had been better prepared!?!?

but having an epipen really won;t be preparation, it will just be a 'safety net', and not a good one while on a plane. really....

yes allergies are scary, especially in our children as they really are all precious to us, but you are doing everything properly already.......he hasn;t reacted badly enough yet has he??

there are enough things in our lives with our children that are going to panic us, this is one for you, and now you can calm down again

If you have managed to keep him away from peanuts for the last two years, I'm sure you will manage on a plane.

My ds has only ever had an 'adult' epipen and he had one from earlier than 3yrs, iirc.

Many flights are 'nut free'. BA, I think, ask for prior warning if there is someone travelling with a severe nut allergy. It does not sound as though your ds has this.

When you get on the plane, wipe down all the surfaces he might touch (arm rest, table, window, etc). Take all your own food for him too.

If you do get re-tested for any alergies again, ask for blood/rast testing too. This, togther with the skin prick tests, will give a better picture of an allergy.

My Ds has multiple allergies and the allergy specialist wouldn't prescribe him an epipen for two reasons.

Firstly he has never had an anaphlactic reaction.

Secondly the minimum weight for an epipen is 15kg.

He has had quite a severe reaction to sesame which resulted in swollen lips etc, but that isn't an anaphlactic reaction.

Despite no epipen it has never stopped us travelling abroad.

There's no way the epipen on the flight will be out of date and if the flight is peanut free then there should be no problem.

I do think you're being a bit neurotic and should just go and enjoy your holiday.

well I don't think you're neurotic - but then I've sat with my child wondering if help will reach us in time after a reaction.

Still, some reassurance - reactions on planes are very rare, serious reactions even rarer. Serious reactions to touching nut are very rare, it's normally ingestion that causes the problem. Your child hasn't had an anaphylactic reaction and may even have outgrown the allergy. You don't mention asthma and if he isn't asthmatic its less likely he'd have a serious problem. So the chance of anything serious happening on the flight is pretty remote if you wipe surfaces and feed him your own food. Even if it did he'd probably be fine with antihistamine, especially if you're watching carefully and dose immediately with piriton. You could ask if you take an oral steroid rather than an epipen for extra comfort - or see if your gp will do a private epipen prescription, although you're unlikely to need it.

Reactions can happen later than 20 minutes but normally it goes pear-shaped rapidly. Children often vomit up whatever has caused the problem. The epipen won't be out of date and could be used in extremis. Although getting to hospital is recommended when we've been they haven't done anything useful anyway.

Skin prick tests aren't totally reliable, are less reliable in young children and clinical history matters more than tests. But in your place I'd want to see a consultant and have him retested so you know what the issues are.

I think you should go back and ask for blood and skin prick tests , and current history to be taken in to account.

also mention that things change , your child is older, and could mention to doc that you want to be further reasurred that allergies havent come back or gone.

list all current reactions since last date, when skin prick tests were negative.

when are you going on holiday?

if soon, just ask doc to write letter about antihistamines, take your childs food to eat on the plane.
use baby wipes for seat arms etc, and things should be ok.

I agree, get retested.

I always found that if you ask the cabin staff nicely and explain the nut allergy situation they do put a call out over the tannoy (sp?) asking people to refrain from opening packs of peanuts. I never cared that some people got upset, i don't think it is much to ask when I child is at risk. I would never ever open peanuts on a plane.

I also agree with everyone about the level of reaction. A pen given when it is not needed can have an effect on the heart. Pens are only needed for anaphylactic reactions. Now I know these also present differently but if your DS responded to antihistamine then just give that.

Please try to have him tested before you go and then I hope you have a lovely time.

Thanks everyone for your advice, the wiping down surfaces was particularly good, i hadn't even thought of that. I was a bit wound up last night, as he suddenly got a streaky red face and i couldn't figure out what he had touched/eaten that had caused it, which always scares me and puts me on edge. He responded quickly to Phenergen.

I guess i have heard so much about this '2nd exposure' thing that i figure, yes i have kept him away from nuts etc for the past couple of years, but what happens if he is accidentally exposed on the plane, and that is the whole 2nd exposure and we get a nasty reaction.... i just feel out of control because allergies are such a grey area and no one can give you black and white answers.

I will try to enjoy the trip, and probably (hopefully?) will be so relaxed on our return that it will be peanut butter sandwiches all round...hmmm...
ps i'm curious, why are reactions on planes rare? Is it the altitude or what???

I would assume that it is because they take precautions of not serving nuts on most flights and those who are allergic are very careful about what they eat and have their emergency medication with them 'at the ready'.

No it's not the altitude, serious reactions in those who know they have allergies aren't very common anyway. Children have more chance of a road accident than an allergic reaction. Obviously on a plane you don't run any risks as you might if you were a teenager eating out with friends.

We were told piriton was the fastest acting antihistamine so its the one we always carry. If phenergen is newer it could be better but our gp tried to give us clarityn because its longer lasting, not what we needed.

Sorry, but the reason your GP won't prescribe and epipen is because your ds doesn't meet the criteria for one. Usually (though exceptions are made occassionally) the reaction has to be accompanied by respiratory problems for an epipen to be prescribed. Furthermore, if an epipen is overused the patient can stop responding (as the body gets used to the dose of adrenaline given) and they are not without their downsides - remember you are injecting with adrenaline and this can cause a racing heart etc. There always has to be a weigh-up of risk/benefit before a drug is prescribed and the reactions you describe for your son sound like the risks of the epipen would outweigh the benefits.

I should also point out that my ds1 is RAST grade 4 and 5 for all nuts, but does not carry an epipen, we simply don't give him nuts. DS2 will have an evaluation for an epipen next week, but he has had an anaphylatic reaction to milk - now that is a seriously scary one as you can't stop people drinking milk, eating cheese, eating yoghurt or even eating biscuits, cake, bread etc with milk in them . This has never stopped us flying (both dp's and my family live overseas) - they are just as likely to have a reaction in the UK as when overseas.

Ds' consultant recommends Piriton too.