A
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Epinephrine Or Benadryl?
"fm a school nurse, One of my
parents insists that Benadryl is the
first line of treatment if her child
accidenta{ly eats a peanut.l can't
convince her otherwise. What do
you suggest?"
I'nr gla,l rhat ir',tr hr,rtrslrt rhi, up,
it's a ver1. important rssr-re. lr,{anr'
parellts are hesitant tLr gi\-e epiirephrine
after rheir chiid iras eaten a for'rd to
u lriclr iie trr' :lre is allergic. Ther- ,rtten
cite fear of uaumati:ing the chii.i (or
tIreurselvcs) as tlrr' 1-1i11'1p1-r' i errsrtn, ial itrg
that the child l-ras neler had n-l-rar thel
consiJere\l rt' 1.c a.iartgcrorr. reacti()lr
Lreciruse
Lrefole.
Parents oiien *'ant to use al.r antihrstamine such as Bena.lyl as tire first
rfcafrrent, rhinkins it
is tl nr,rre gerrtle
apploach and u'.ruid tr-ork u'ell for a uouiifb threatening reaction. Tire prohlem
with th:rt, hoq"eret-, is that ANYBODY
s'irh
a fot),-l allergv can have a senous
reactitru, er"en ii prer-ion-s reactions har,e
been mii.l.
We also krr,tri' tlrar ,lelat iu tivure epineprl-rrine greath: iucreases the chauce ,.'rf
aLi
reqr-riring h,rstr itali:atior-r aiter ftrrd-
indr-rced ar-rap1-ry'1axis (severe allergic
rcactiorr), irrt.l that fatai reactiorrr are
often associated u'ith either a iack ofor a
delaf in using epinepirrine. if 1'or.r n.ait
until ir's slrf isr.rs rhat the chiid is l-rating
a serious reaction, it rnai'be too late.
I'm a firrn heliever in usir-Lg epinephrirre as rhc' fi|st Lreatnrent f,rI an1'sigrr ,rt
arr ailer"gic reaction ro foocl. In allergic
emergencies, epinepirrine sar.es lir-es, br-rt
Benadrll u'on't, antl },,:tr celtainh'don't
\1'ant to ri'ait turtil a child st,rps Lrreathirrg
or loses consciilrrsness ro provide lifesa\'ll-ig tfeatinent.
\,1\' f ar iL'lt t s antlltrr t he ir 1-a re111' |12q rice trri rtq t he epi11s1.ht.itre at tf tr- itrjectnt'
in m1 office, and i oiien ralk t'irh drem
r:n dre phone then rhey're irsing the
der-ice f-ol tl"re first time. Within ninutes,
rl-re cliild is usnal11, hack to nonnal, and
rhe parent,. are grateful an.l reliete.l.
I can't Lhirrk rrl-a siuglc parettt rr'1t,.
i-ias t,-rltl me that d-re1 felt l:acl alrnt
giving a ,-lose oi el.iuephrine. AfteL all, if
gile a ri-rse of epiue!.hr ine t, tr ri'har
-t,or.r
rnir! tlu11 out to lre a relatilell- miLl t-eacti,.-rir, the n',-'rt'se 1-.ru'11 likel-v cltr is u'irste ;t
.1ose of epinephrine an.1 a little lnonel'.
Horler-er, if i'ou FAIL tr: gite epi'
nephrine tbr rvhat tums olrt to be a
se\:ere reactiou, the results could be
Lu-rd'rinkalrle. If l ou think of it as a choice
beftteen a little courage ari*-l a i-eu, tean
versus the potential for a lifetime u'ithout
r,our chikl, the ansu'er is oi-.r'ious.
So, as a scirooi rturse, ri hat do vor"r dol
\totr're in a tough position. Address ttour
concerns rvith the chlLl's doctrrr, continue to u.ork'ir,ith the rnorn, and suggesr
patient education organi:i-rtions strch as
AANIv{A to her.
Silme states irre passing iegislauon
requiring pr-rblic schoois estalrl ish po licies
to stock and aclminister epinephr ine. I
ap.plaud those eilor ts.
Martha White, MS, is a board-certified
allergist at ihe lnstitute of Asthma and
Aliergy in Wheaton, Maryland, a member
of AANMA\ Board of Directors, and a
medical edrtor of The MA Reporl since
1 985.
Do you have a medical question you'd
like to ask? E-maif [email protected]
or write to Ask Dr. White, AANMA,
8201 Greensboro Dr.. Suite 300,
Mclean. VA,2Z1A2.
Anaphylaxis Answers
When tbod allercv accidents happen, are students aurl educators preparerii Shoulcl
state poiicv r-etluire schoois to stock ep-rinephrine ar.tlrr-injectotsl Doe.s "Lreanrtt'lt'ee"
mean safe at schooll
AANMA addresse-t drese qtrestioru an.{ lrlrre as part of the 2012
Anapl-rylaxis Cornmtrnitl, Ex;.g115 (ACE) internet uaining progranr "Epi
Everlt'hele1 Er,ery Dir]rI I tt Scho.rl-Based Anapllr'latls Preparedness:
Policies In Practice-"
The program is now avaitable online by visiting Al\NMAs YouTube channel at www.youtube.com/hreatherville.
AANVTA collalroiared n,irl-r rhe Ame rican Sch,'lol Health Association and the National Association .rf Sch.rol Nttlses
on rhe pmgrall'r, n"hich origlnalll aired on Juh. 31. It is tlie fitth in a series that tregan in 2010.
ACE is a partnershi;-, p1'ograrl der,eltrf-ed trr fu{NivtA antl t}re Americau College of Allelgv, Asrllma & lmmuuologl' and sptrn'
sor:edh1')v{y1irrrSpeciait1',I-P.Visitt|11t|1|?.d{ll1l1lf.0]3/arrcplr1lrrr.i.r
Nlanager, at l:.silr,[email protected]
6
September 2O12
.
The
MA Report. Allergy & Asthma Network Mothers of Asthmatics
aanma.org . 844.878.4403