The reason why there are so many different types of treatments given are because most parents are extremely cautious (which is fine by me) but the first sign of their kid with a red bump and they are reaching for the epi-pen. What parents need to do is learn how to watch their kids for signs of progression rather than giving their kid an injection any time they sneeze.
Patronizing, much?
Thanks, but most of us here have gotten this SAME nasty attitude from friends and family. Make that
former friends and
estranged family. We really aren't totally loony. A fair number of us see physicians who are leaders in the research associated with this field clinically, by the way.
How many times have you WITNESSED food anaphylaxis from start to finish? Not many, I'm guessing.
Now I'll report to you what MY allergist has had to say on the subject of early epinephrine and first responders such as yourself: basically,
I should know better, since YOU most likely won't have a clue if my child isn't COVERED in hives and struggling to breathe. At least not until she arrests, and even then you'll most likely be arguing with me about how with no cutaneous symptoms, this can't
possibly be anaphylaxis... in other words, don't waste time arguing when time is brain function-- preempt the entire conversation with DIY before they show up.
If you'd read the link about Natalie Giorgi's fatality, you'd know that her
father was treating her on the scene-- her father being a PHYSICIAN. Wait and see
is dangerous.
The vast majority of parents and adults who post here have experienced anaphylaxis firsthand, often more than once, and more than a few of us have been LUCKY to survive grade IV-V reactions. With all due respect, our risk here is a little bit higher than that "enjoyed" by most people just crossing the street. My teenaged daughter can probably (best case scenario) expect to experience another 8 to 14 episodes of anaphylaxis in her life.
Statistically speaking, I mean. Given her history, her odds of experiencing a life-threatening reaction that requires a 911 call are... almost
inevitable.Some additional enlightening reading on this subject:
No, actually-- epinephrine "over-use" is not really a thing.Dr. Jacobsen's team surveyed 3500 nationally registered paramedics in the United States and found that 36.2% of responders felt there were contraindications to the administration of epinephrine for a patient in anaphylactic shock.
"They also had challenges in the recognition of atypical presentations of anaphylaxis and determining the correct location and route of epinephrine administration," he said.
Only 2.9% correctly identified the atypical presentation, 46.2% identified epinephrine as the initial drug of choice, 38.9% chose the intramuscular route of administration, and 60.6% identified the deltoid as the preferred location (11.6% identified the thigh).
We have the same issues in the United States that were found in the Canadian study.
"Our study also revealed that 40% of paramedics believed that diphenhydramine was the first-line medication for a patient suffering from anaphylactic shock," added Dr. Jacobsen.
Well, well. Now perhaps it is clear why my own allergist feels the way that s/he does about first responders and atypical presentation, eh? It's ON US as patients/parents to treat with epinephrine before an EMT rolls up, because the odds are far too high that they WON'T. Until it's too late, I mean.
No, over-use
really isn't a thing-- I promise.
Underutilization most assuredly IS, however. I'm printing John's posts out for the next appointment with allergist showing in the words of an EMT what he thinks of the EAP, carrying and administration of epinephrine. Then I'll finally get that letter on practice letterhead from allergist to give to EMTs I've been asking about. He didn't believe me that rift between allergist and EMT exists. Got proof now!
Indeed. Well, he knows. He just overestimates the ability of mere mortals to GET THROUGH TO THEM, because he happens to actually have those magical letters "M.D." behind his name, and forgets that it matters, even if he's acting in the capacity as "dad" at the time. But it's why he's given me the advice that he has. Epi early and often-- before the "pros" show up and dismiss everything that you know (that they don't).
John-- PLEASE consider carefully reading the following:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096462/