Spotting and Treating an Allergic Reaction

A few tips on how to prepare.

After my son’s first reaction, I remember feeling overwhelmed and anxious about this happening again. What helped immensely was learning all that I could so that I could be prepared.

A few important notes:

Reactions may not occur immediately. While some reactions can happen immediately or shortly after contact or ingestion of the allergen, some reactions occur over the course of a few hours. Because of this, it’s important to keep watch over your child, especially if a new food has been introduced. For infants and younger children, this is why experts recommend introducing only one new food a day in small amounts, and to do so in the morning.

Reactions can look different each time. One misconception that I’ve heard from several moms is that they thought their child just had a mild allergy. Unfortunately, the way allergic reactions manifest each time can be unpredictable in the sense that it may be mild one time and severe another time. Because of this, it’s important to know the signs so that you can spot an allergic reaction when it is happening. It’s also important not to assume that an allergy is just mild, as a second or third exposure to an allergen can usually increase in severity.

So what does an allergic reaction look like?

By far the best reference guide I’ve found thus far is the FARE Emergency Care Plan sheet. It breaks down mild vs. severe reactions in a pretty clear way. What I like about this sheet is that it breaks down the symptoms by different organ systems. For example, skin is a separate organ system from the lungs, which are separate from the gut. One key way to think about it is if the reaction is more mild, it tends to be a little more local (mild symptoms affecting only one system). But if it is more systemic, meaning that it’s spreading to or affecting more than one system, it’s likely signs of a more severe reaction either starting or already happening.

So how to read this sheet:

On the right, it lays out what to look for that would constitute as a mild reaction. To be considered “mild”, it would be symptoms from just one of those systems…so either symptoms affecting the nose, or a few hives affecting the skin, etc.

However, if you see symptoms that match what you see in the right column but from more than one system, that is a sign of a potentially more severe reaction and should be treated as such.

On the left, it lays out symptoms of more severe reactions. On this side, if any symptoms match, even if it’s in one system only, it should be treated as a severe reaction.

What’s if it’s something in between?

Now, where I’ve run into some confusion is when the reaction seems like it’s not quite as severe as what’s on the left side, but more severe than what’s on the right side. For example, my nephew was having an allergic reaction and it immediately manifested as hives on the lips. When I looked at this sheet, under “mouth”, it was more than the itch mentioned on the mild side, but not quite as severe as “significant swelling of the tongue or lips” on the severe side. But because it was definitely more severe than just a mild itch, to me, it was an indication that this was a sign of a more severe reaction. It turns out that it was the right assumption, as the reaction later progressed to the symptoms of the lung (repetitive cough) and later, severe vomiting. From our experience, it’s always best to err on the side of caution and if it falls in between the symptoms as laid out on the mild vs severe side of the sheet, err on the side of it being a severe reaction and treat it as such.

Overcoming emotions and confirmation bias

The other surprising aspect is that sometimes, in the moment, there may be a tendency to want to downplay the reaction. There have been moments when my son seemed to still be in good spirits even though a severe reaction was developing that made me second guess myself. We also had other friends and family go through similar experiences with their own kids. It’s hard to think about stabbing your child with a huge needle. Or it may be difficult to come to grips with the idea that something life threatening may be taking place. Or perhaps it’s not wanting to seem like an overly paranoid parent.

Whatever it may be, there are often reasons that predispose us to want to look for signs that everything is actually OK when it may not be. This phenomenon is a flavor of confirmation bias, when we try to interpret what we are seeing in a way that fits with what we’d like to believe. In fact, one of my physician friends has commented that in certain cases, they’ve sometimes tested themselves by thinking how they’d answer this if it were in a test or textbook situation vs. how they may be feeling in the moment, and a few times, the answer has been different, often due to the emotion or even external pressure they may be feeling in the moment. For this reason, I’ve found that it’s better to try to take the emotion out of it and to go as “by the book” as possible. When in doubt, refer to the sheet.

Finally, practice – and preparation – make perfect

Finally, the key is not only to be prepared, but to make it easy for yourself. A few key tips here: 1) Run through and memorize this sheet, and 2) Post this up everywhere.  In the moment, you don’t want to be scrambling to search for a list of symptoms. I’ve run through the list a million times to try my best to memorize it, but even so, it’s a lot to remember. So what we’ve done is to print out multiple copies of the FARE sheet, and we have it posted up on the wall in various areas of the house, such as the kitchen wall and our children’s play area. We also give a copy to all of our caregivers, whether it is a teacher, babysitter, or grandparent. In times of emergency, when the adrenaline and emotions may be running high, you want to make it as easy for yourself as possible.

On that note, knowing how and when to use the epi-pen is also critical, which I’ll be posting about next.

Note: The above is not a substitute for professional medical advice and is meant to be just one perspective. Always consult and seek the advice of your doctor.