Monday, March 9, 2009

Our First Trip to the Emergency Room

I had visions of our first trip to the ER with Sebastian being one of a broken limb from falling out of a tree or needing stitches after falling off his bike. I did not expect it to be due to him smearing food on his face. Here is what happened (Sebastian's view of the events can be found here).

Our family was sitting down for a lunch of mostly leftovers. I decided to have a peanut butter sandwich and gave a small piece to Sebastian. He ate the first couple of bites normally and then began to play with and mush the pieces. About 10-15 minutes later he started his usual "I'm ready for a nap" motions including rubbing his hands and whatever is on them all over his face. I proceeded to wipe him clean and then go lay down for a nap. I noticed that his face was a little red at this point but figured it was just from the washing. We had been lying down for about 5 minutes when I noticed that he had developed hives all over his face and the backs of his hands. I quickly sent Brian to the store for some Benadryl and more thoroughly washed him off and eventually put him in the tub. When Brian got back we got him out of the bath and dosed him up with the Benadryl. The reaction was limited to the skin that had come in contact with the peanut butter and he never developed any respiratory symptoms. Even though the reaction seemed to be taken care of by the Benadryl we decided to go to the hospital just in case.

When we arrived at the ER the swelling had gone done considerably but it was still very noticeable and red. We were checked in and triaged fairly quickly and sent to the waiting room. About 20-30 minutes later his face was started to get redder and the swelling increased so we went back to the triage nurse who got him in to a room. The nurse came in and checked him out and a few minutes later the doctor came in to examine him and get the history of the event. He was given a dose of steroids to further manage the reaction and finally the swelling started to diminish and redness started to fade. We were discharged with instructions to continue to give the Benadryl and steroids for 3 days, to avoid all products containing peanuts and carry and EpiPen at all times.

This was the last thing I ever expected to happen. Neither Brian nor I have any history of food allergies or any other allergies except poison ivy and hay fever. The most current research indicates that early exposure is protective against allergic reactions.

1. He is actually allergic to peanuts or to some other substance in the peanut butter (Smart Balance)? I guess we won't know the answer to this until we take him to an allergist.
2. Why did he only react once he 'applied' it to his skin? He had been fine for while after ingesting and only broke out where he had speared it. He had no swelling of his mouth (except bottom lip) or throat.
3. Is it possible that he has only a topical allergy and ingesting it would not pose problems? I have heard anecdotes from people who report getting rashes and/or hives when getting other foods (tomatoes, mangoes, some meats) on their skin but they are able to consume them without any problems. Are stories like this not common with peanuts because it doesn't happen or because people freak out with the skin rash that ingestion is never attempted again?

With the diagnosis of 'peanut allergy' there comes a lot of decisions that have to be made. Do we have to take this to the extreme of avoiding anything that was manufactured in the same place as something that contains peanuts? After he stops nursing do I have to continue to avoid peanut products as well? Do we need to be a peanut free house? Will he need to sit at a peanut free table at school? Can we take him to the circus or baseball games where others will probably be eating peanuts? How do we proceed with this without it taking over every decision we make? Right now it is easy because at only 1 year old we control everything he eats but as he gets older how do we make him aware of it without making him scared?

These are only a fraction of the questions and thoughts churning through my mind right now and the information out there is either purely speculation or inconclusive at best. What is a mom to do?

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