A Little Bit Can Hurt (12 page)

Z
ach was diagnosed with multiple allergies to eggs, peanuts and tree nuts when he was about a year old. Now 10 years old, he has suffered several food-allergic reactions which included a severe allergic reaction to peanuts when he was at preschool before age three. Despite his tender age at the time of the reaction, his memory of the crisis remains vivid and frightening. Zach recalls, "I suddenly felt like I couldn't breathe. I had all these red spots on me, hives the size of quarters. It was a really scary time for me."

The preschool staff knew about Zach's food allergies, but a volunteer who had not been informed gave Zach a peanut butter cookie. He quickly developed allergic symptoms involving hives and breathing difficulties. He also became quiet and subdued, a distinct contrast to his normal talkative and energetic behavior. A staff member phoned his pediatrician who gave instructions to dose Zach with Benadryl
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and watch him closely for symptoms of an allergic reaction. He was already exhibiting those symptoms, but the staff did not recognize them. They erroneously judged him to be fine and decided not to administer medication, neither Benadryl
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nor his epinephrine auto-injector.

In accordance with Zach's usual carpool arrangements, his neighbor arrived to drive him home but was alarmed by the enormous welts all over his body. On the way home in the car, Zach vomited several times. In addition, he was pale and lethargic. His symptoms were beginning to snowball and spiral him downward toward shock.

When Zach arrived home, his mother Tammy immediately judged his condition as life threatening and rushed him to a nearby emergency room. She assumed the preschool staff had followed Zach's food allergy action plan and administered both Benadryl
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and the epinephrine auto-injector. Operating under that assumption, Tammy didn't give him either medication. At the hospital, he was given two back-to-back injections of epinephrine and observed for several hours. Fortunately Zach recovered. Tammy later found his medications, unused, in his medication bag.

In hindsight, Tammy admits that whenever she dropped Zach off at preschool, she had "this gut-wrenching feeling because the [staff] never watched where I put the EpiPens
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..." Though she had informed them about her son's food allergies, they "never actually paid close attention." Tammy was new to managing her son's food allergies at preschool, and because the program had been highly recommended, she "didn't want to be one of those [insistent] parents."

The preschool director phoned Tammy the evening of Zach's allergic reaction. They had a lengthy conversation, but Tammy got the impression the director "was not listening too well [but] focusing on liability..." Tammy quietly withdrew Zach from the program and never heard from the director again. Several weeks later, Tammy's neighbor informed her that the preschool had revamped its entire food allergy safety program. Tammy derived some comfort from knowing that food-

allergic children would be better protected at the preschool. However, she did not re-enroll Zach. He was scared to return, and she respected his fear.

Though by far the most severe reaction, Zach's preschool experience was neither his first nor his last food-allergic scare. At home, shortly after he was diagnosed, Zach took a bite of a peanut butter sandwich after Tammy had prepared it for a playmate who was visiting Zach's older brother. She made sure she put the sandwich well out of Zach's reach, but somehow he got it anyway.

Tammy made an immediate attempt to administer her son's epinephrine auto-injector but failed to remove the safety cap. She never saw the needle, but when she pressed the auto-injector against Zach's leg, he began crying. Tammy assumed she had correctly administered his epinephrine. She then took Zach to an emergency clinic associated with her HMO where she learned she hadn't administered the emergency medication properly. The emergency clinic staff injected Zach with epinephrine and showed Tammy how to do it correctly.

At age four, Zach attended a summer camp. Tammy was careful to alert the staff regarding his food allergies, pack safe snacks for him, provide his epinephrine auto-injector and ensure the staff knew how to use it. Camp staffers were usually careful about snacks, but one day, a counselor accidentally mixed up some snacks, one of which contained peanut butter. She gave them to Zach and his best friend who is also allergic to peanuts. Zach's friend suffered a severe reaction, and the counselor prepared to administer epinephrine. However, she held the EpiPen
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upside down and accidentally injected her own thumb instead of the child's thigh, a mistake requiring immediate medical attention. Fortunately, the camp staff had a second epinephrine auto-injector that was administered correctly.

During the crisis, Zach began to have difficulty breathing. The paramedics dispatched to the camp weren't sure whether Zach was having an allergic reaction or responding to the stress of his friend's reaction. Nonetheless, they opted to treat Zach as well in light of his severe allergy.

Not surprisingly, Zach has been affected socially by his food allergies. He recalls fellow students threatening him to "stop doing that or I'll spread peanut butter on your face." Some people have made fun of him for wearing a MedicAlert
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bracelet which provides emergency personnel vital information about his life-threatening allergy as well as his parents' contact information. At times, Zach has been
excluded from playing at the homes of friends whose parents were frightened by his severe food allergies.

He has sometimes refrained from playing football or basketball out of fear of coming into contact with food allergens on the ball from other players' hands. Although skin contact with a food allergen may cause a localized reaction, it is unlikely to cause a severe reaction. However, the potential risk of a contact reaction is something Zach and his family take seriously in light of the fact that he plays catcher for his baseball team. Rather than share the team's masks and helmets, he uses his own equipment to avoid contact with any of the food proteins to which he is allergic.

Despite such discouraging experiences, Zach remains resilient and upbeat about having food allergies. He explains, "It's not that you get treated special by everyone. It's that you're noticed. It's not being noticed like being famous; it's just being noticed that you're different from others. You have allergies and you're proud of it."

Zach advises others with food allergies to "find good friends who can speak up for you and don't take anything from other kids that fool you about your allergy. I stick up for myself, and my friends stick up for me. I don't get into any fist fights because of my allergy. I walk away. Don't get down on yourself that you have allergies. I do, and I get mad at myself for doing that. Don't think of it as a negative. Think positive. It hasn't kept me from doing anything, not from having friends, playing sports or anything!"

POSSIBLE NEXT STEPS:

1. Does the staff at your child's daycare or school understand how to recognize the symptoms of an allergic reaction and implement your child's food allergy action plan?
   
2. Do you know how to administer your child's EpiPen
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   or Auvi-Q™? Ask a member of your physician's staff to demonstrate the proper technique for you.
   
3. Do your child's caregivers at school, camp and elsewhere regularly practice how to administer an epinephrine auto-injector?
   
4. Do you know that you should seek emergency medical help if you accidentally inject your thumb or finger while attempting to administer epinephrine? Epinephrine constricts blood vessels and may restrict blood circulation if injected into a thumb or finger.
   
5. Is your child being bullied at school about his food allergy? Speak with your child's school principal about enforcing "no bullying allowed" polices for your child's safety.
   

Section 4

ADOLESCENTS

11-21 years old

"Children are likely to live up to what you believe of them."

~ Lady Bird Johnson

A
dolescence conjures up feelings of both excitement and confusion. The physical changes of puberty as well as developing new relationships are challenges adolescents face. Experimentation, risk taking and trial and error are paramount at this age. Increasing independence with less parental and adult supervision during trips, activities and events may concern both the food-allergic teen and parent. Teens must rely on themselves for identifying and initially treating an allergic reaction, possibly involving friends. Preparing for higher education and the work force is stressful enough without the additional challenge of incorporating food allergies into a teen's social and academic pursuits.

Section Four explores the stories of two food-allergic teens who manage food allergies in high school and in increasingly independent situations. You will meet:

• Conor who, despite additional health challenges, has excelled in many aspects of life while managing his food allergies; and
  
• Teddy who admits that, while it's often hard to stay vigilant about one's food allergies, safety is ultimately the responsibility of the food-allergic individual himself.
  

13

CONOR

Unstoppable

Fifteen-year-old Conor is a straight "A" student who admits that French IV has been challenging this school year. He is an active teen who enjoys swimming, kayaking and sailing. His sailing skills helped him secure a spot on the local sailing team. A true Renaissance man, Conor also enjoys the arts and has been involved with plays. Between watching movies and hanging out with his friends at the mall, he also plays the violin in a jazz ensemble.

F
rench IV isn't the only challenge Conor has faced. When he was 17 months old, he underwent brain surgery that adversely affected his entire left side. As a result, his left leg is slightly smaller and weaker than his right, requiring the support of a leg brace. In addition, Conor has severe asthma and food allergies.

According to his mother Deb, Conor had a lot of skin rashes as a baby. She suspected these were food related but wasn't able to pinpoint a specific cause. Because her son's rashes weren't severe, Deb didn't pursue her suspicions. When
she began to introduce solids to his diet, however, she specifically remembers when she tried to feed him egg yolk, he immediately spit it out. Deb thought, "Oh well, he doesn't like it. There are plenty of other sources of protein, so I'm not going to worry about it."

When Conor was nine months old, a daycare staff member fed him a bite of a peanut butter sandwich, and immediately his lips and mouth began to swell. The daycare owner, a mother of two sons with food allergies, was on site and recognized Conor's allergic symptoms. He was treated with Benadryl
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alone, and fortunately his reaction resolved.

Within a few months of this incident at daycare, Conor underwent formal allergy testing, which revealed egg and peanut allergies. His parents were told that, although he would probably outgrow his egg allergy, it was unlikely he would ever outgrow his peanut allergy. Deb recalls, "From that point forward we just let everybody know that he needed to avoid those [foods], and it seemed to work." Unfortunately, this was easier said than done.

When Conor was about three years old, his grandparents came to visit for Christmas. His grandfather was shelling walnuts for a cookie recipe, and Conor eagerly wanted to help. As he was handling the walnuts, he told his parents that his throat was itchy. They immediately recognized he was having an allergic reaction and removed him from the kitchen. Once again, Conor was successfully treated with Benadryl
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alone. Not surprisingly, subsequent allergy testing revealed he was also severely allergic to tree nuts.

Years later while shopping with his father for a Valentine's gift for his mother, Conor developed hives on his abdomen. To this day, he's not sure what caused that reaction. He recalls visiting a card shop, bagel shop and chocolate store. He did eat a bagel and also remembers a strong nut fragrance in the card shop. His father took him to an immediate care facility, and Conor was treated with hydroxyzine, an antihistamine.

Fortunately, all of Conor's allergic reactions have been mild and successfully treated with antihistamines. Nonetheless, he takes his food allergies seriously and carries two epinephrine auto-injectors with him in his backpack. Conor states, "If I ate any nuts, basically, they'd have to take me to the hospital right away...The EpiPen
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might hold me over for about 20 minutes..."