Too small for an epipen - help please

[Whelk]

dd2 is 14 months and about 20lbs and allergic to dairy and egg. Her nursery have said that they would like her to have an epipen.

I have asked her specialist (by email, we don't have an appointment until November) about whether this is required/ appropriate.

First he wrote a response about how egg is easily avoided and so an epipen would not be necessary , then I emailed back saying Ok but obviously in a nursery setting dairy is not easily avoided (not that this is particularly the point imo).

he has now replied saying 'if you feel a epipen is required you must ask your GP to prescribe one'. She is under the licesable weight for this. He is not aware of a training protocol for this in our area.

So, should I push for an epipen with the GP? My dh is strongly of the view that if one is used on a child below the appropriate weight, this could kill her or damage her.

My view is that if she is having an anaphylactic reaction then you want the appropriate treatment.

What I don't know is how likely it is that a reaction would be anaphylactic.
He skin prick tests are 4mm for milk and 6mm for egg.

Doe anyone have any experience of this. I'm really worried and don't know what to do.

This is Australian info, but the Epipen Jnr can be used at 10 kg.

However, it says that a positive skin reaction is not in itself a reason to have an epipen, and that only with previous anaphylactic shock is one recommended.

If she doesn't have anaphylactic reactions to the allergens so far then I would think that an antihistamine at the setting would be enough for now.

How does she react when she is in contact with dairy and egg?

Thank you for that lou. The epipen website says that Epi-pen Junior is appropriate from 33lbs which is a big difference.

Thank you Olihan and Pixie too.
because dd1 has food allergies was very cautious giving dd2 milk i.e. I gave her a tiny bit of formula mixed with my breastmilk and she reacted by swelling of her eyes, hives on her skin (face and neck) - she wasn't used to a bottle so it went eveywhere.

She has never had egg.

So her reaction wasn't anaphylactic but could it be much worse if for example she was given a bottle of formula (by mistake, worst case scenario)?

dd4 had an epipen when she was 8.8kg. the ideal weight for an epipen jnr is 10kg. her consultant only issued her with one pen though, because if we had to give the epipen then we need to call 999 and the hospital would be better equipped to deal with an OD. dd4 will be given a second pen once she hits 10kg, hopefully by her next apointment.

dd4's was perscribed as she has allergies to milk, egg and peanut and was hospitalised over winter several times with breathing differculties and is treated as being asthmatic. the asthma, couple with the allergies leaves her at an increased chance of anaphylatic shock. if she had the allergies on their own, then she wouldnt have the epipen

Hi, Have you ask for a RAST test ? This gives a much clearer indicator of how likely an anaphylactic reaction would be, you get a result from 1-6. My son's first test was a result of 5 & he weas given pens at 18mths.
Hope this helps if you didn't already know about this test.

Thanks 3sweetpeas I had heard of it but didn't know that that is what it does.

Thanks babybarrister- thats interesting.

It seems very mixed.

I have emailed the consultant to ask him to advise us about the balance of risk of potential overdose of adrenaline (from overzealous nursery staff - dh's worry) v not having the correct medication in case anaphylaxis occurred (my worry)

He has agreed to meet us in between appointments. I feel pathetically grateful!! Will let you know how we get on.

Thanks all! This board is so helpful!

Hi, any news from your consultant? My allergist gave me an epipen junior today, dd is 17 lbs, 8 months. She said that it can't hurt her, but my pediatrician said it'd be really bad for her, and now I read it can kill her? Scary. Please let me know what you've been told...

Allergist also said to give her benadryl (antihistmain here in US as soon as hives show up, to supress maybe anything worse...oh GOD. Am totally freaked out now...)

The wee girl I used to look after had tiny tubes of adrenaline and syringes and needes I had to carry about for her as she was too small for the epipen junior. She had an anaphylactic reaction at about 10months old. Is that not an option? Took a bit of training to feel confident but I can say that when she eventually did get the epipen it seemed like the easiest thing in the world compared to that!

My ds2 has an epipen junior and has had from about 12 months when he weighed just 8 kg (around 17 or 18 lbs I think). He has had an anaphylactic reaction to dairy though and he possibly has a nut allergy too, which is another time when reactions are likely to be worse.

I think the usual criteria are: previous anaphylactic reaction or co-existing nut allergy (peanut or tree nut) or co-existing asthma (or ant combination of these) as I think these are conditions under which a future reaction is likely to be more severe (if that makes sense).

I'd be cautious of giving nursery staff an epipen though as they might see it as a replacement for safe allergy procedures (and allergen avoidance). This is something we were warned about with ds2. They may also over-use it which can lead to tolerance of adrenaline and needing bigger and bigger doses to get the same effect.

Hi we had similar issues to yours OP.

Dd2 allergic to cmp, egg, sesame, peanut and milder reactions to other foods.

When her peanut and sesame results came up I asked for an epipen but got told no/gps discretion until she got to 13kg.

She was under 9kg when we got that result.

I made an appointment with gp ready to fight but he said 'How silly of course I'll prescribe you one' then said to return when she starts nursery and they'll prescribe her a spare.

Glad we got one as her egg challenge showed the beginnings of an anaphylactic reaction and they would've prescribed her one then if we didn't already have one. (still only weighs 9.5kg)

Your doctor obviously hasn't tried going around the supermarket shopping for a dairy and egg allergic child if he thinks they are 'easily avoided'!!

kerrymumbles we had similar reaction from a&e when I went there with dd after her eye ballooned, lip swollen, took her ages longer than normal to drink bottle. 'Not a food allergy as only affecting one eye, not anaphylaxis as would be more dramatic' I complained..

Ds was precribed an Epipen at 6 months old after an anaphylatic reaction to egg at home. Our GP was more than happy to prescribe an additional pen for nursery.

Nursery were rather concerned at first as DS was the first child they had that had an analphylatic reaction. They got in touch with the local health team who sent a HV/ Community nurse to the nursery to train the staff and who went through allergic reactions and how to use an epipen. They invited me to be there too - I learnt stuff about anaphylaxis that the hospital hadn't had the time to go through. It was very reassuring for all of us.

Perhaps this could be an option for your nursery, if they are unsure about allergies and how to deal with them.