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Using Epinephrine to Treat Allergic Asthma

epinephrine for allergic asthmaI confess. I’m scared of epinephrine. Yes, I know, I know. It can save my son’s life, so for this I’m grateful. And I will use it if needed, as I have done before during his first anaphylactic experience. But I still am fearful of using it. There are many reasons, which I won’t go into, but ultimately I know it’s super critical to use it at the first signs of anaphylaxis.

But here’s my problem.

Today my son’s allergist told me that I should use epinephrine ANY time my son starts to show signs of breathing distress after exposure to a known food allergen. And I should use it first, before Benedryl or Ventolin. And if he’s going into an asthma crisis unrelated to food, to go ahead and use epinephrine as well.

I was totally shocked. I mean, everything I’d ever heard or read was that epinephrine should be used at the first signs of anaphylaxis, which technically means two bodily systems are compromised after exposure to an allergen. So, trouble breathing and hives or vomiting and itchy skin. But to use epinephrine if only one bodily system is involved, wow. Ok, I needed some time to wrap my mind around that. The doctor went on to say that he’s never liked to be a negative nellie or to strike fear in his patient’s parents, but the children at most risk for a severe or truly life threatening allergic reaction are those that are asthmatic. And especially those with chronic asthma, as my son has been suffering lately. You can read more about that here.

Given my son’s history with asthma and allergic reactions, I’d say epinephrine and I are about to get more personal. I’m not sure I’m ok with this, but what are the alternatives? I just don’t want to go there.

So, yes, I’m scared of epinephrine, but our lives have crossed paths and there is no going back. We’ll surely be forced friends for live. If you’re like me and have a fear of epinephrine, first it’s good to admit how you feel as it will help you move past that fear and secondly, take a look at this post from my friend Elizabeth over at Easy Breezy Food Allergies. I hope it will give you the courage to look past your fears and use epinephrine without second guessing yourself.

20 Comments Post a comment
  1. Kiya #

    I am studying to be a respiratory therapist and im not sure if this info will be helpful here or not but here goes, ventolin is albuterol it takes 3 to 5 min to begin working and it must reach a certain depth in the airways in order to be effective, it is derived from epinephrine as many asthma medications are, but epinephrine alone is used to preserve the airway by not allowing swelling, and inflammation to close it in the first place, and it takes effect in as little as 1 min. If the airway closes for any reason albuterol no effect because it cannot get into a closed airway anymore than air can. This is what you must keep in mind with the epi pen, if there is any risk of the throat closing thenuse it, better safe than sorry.

    Like

    December 28, 2013
    • Thank you Kiya! A very great explanation. Thank you so much! This is very helpful!

      Like

      January 6, 2014
  2. Jaime #

    I have been struggling with this issue myself and glad to see I’m not the only one. My 5 year-old daughter is a severe asthmatic also. She has a peanut and sesame seed allergy. She has gotten one epi pen from an allergic reaction before from eating a smudge of peanut butter (she also had reactions before we new it was a peanut allergy). Her lips swelled right away and her face became red and blotchy immediately after. After giving her benadrly I called my pediatrician and he said “you don’t want her to get into trouble, give her an epi pen”. We just saw her allergist and she said you probably would have been ok with giving the Benadryl , but if you feel more comfortable giving her the epi pen then do it. I replied Benadryl even when her lips swelled up immediately? She said yes, like no big deal. Well yes I may be a little paranoid but I can’t imagine risking her life that way. I have read the story about that little angel in California and they had given her Benadryl first. I am sure those parents really have a difference in opinion of giving benadrly before the epi pen. Friday night we were at a reLatives and she was given a chocolate covered pretzel, turns out it was a peanut butter chocolate covered pretzel and she got about half of it down. Now this is where I am so torn, I know she got straight up peanut in her, so do I just sit and wait for a reaction to start and “hope” it doesn’t spiral out of control, or do I just go with the epi pen? I went with the epi pen. I think that parents need to have a plan, be confident in your decision, and know the facts. I kick myself for the whole incident because our first plan of action is I taste all her food first, but I just forgot. So for now, I taste first, if she knowingly ingests peanuts then I will administer the epi pen first, because of her asthma and her past reactions. I pray it will not have to happen again, but that is the reality of allergies our children our at such high risk.

    Like

    November 26, 2013
    • Hi Jamie – You absolutely did the right thing giving your daughter epinephrine first. I hope that if my son experiences anaphylaxis again, that I will remember the right thing when is doubt is to go with epi right away. There is absolutely no harm in it and it can mean the difference between life and death, as we see way too often.

      Like

      November 26, 2013
  3. Jennifer Elizondo #

    After seeing epinephrine on an asthma action plan in California, I asked my allergist (in Virginia) why its not on our asthma action plans. I had once heard at a talk that epinephrine is like albuterol on steroids so I assumed that it would be helpful in an extremely severe asthma attack. My allergist said that epinephrine for asthma would only be useful in cases of allergy induced asthma so not all cases would be helped by epinephrine. I tell everyone caring for my son, that if he is having an asthma attack and his inhaler is not helping, to administer the epi.

    Like

    October 20, 2013
    • Jennifer – that’s a good point – go for the epinephrine if the inhaler doesn’t work. And definitely go for the epi first if the child has food allergies and consumed a food they are allergic to and begin to show signs of breathing distress.

      Like

      October 24, 2013
  4. Yes! I was told that before inhalers, epinephrin was used for asthma attacks. I have used an Epipen once for my daughter when we were not sure if it was “just” a severe asthma attack, and the albuterol inhaler was not working. I have a freind who used it for her son’s asthma as well. In both cases it stopped the asthma attack and then the kids were rushed to the ER. Another allergy mom I know has used an epipen for her son’s asthma at least three times! And we live in a tiny town, so I am guessing it happens more often than we realize!

    I was told to use the epipen, and take my daughter to the ER if her albuterol inhaler does not stop her coughing/wheezing attack, allergy related or not. Iit is good to know that epinephrin works for both asthma and anaphylaxis when our kids suffer from both, and it is hard to tell the difference.

    I read that in 20-30% of anaphylaxis cases there were no hives or swelling, and only airway, and blood pressure issues! We have experienced that with a reaction to cross contaminated chocolate. My daughter ended up with just one tiny hive that came and went in 5 min… And then the coughing, stomach pain, and wheezing started. If I had not seen that short lived hive, I may not have realized what kind of reaction it was.

    Thanks for shedding light on this issue by sharing your story!

    Like

    October 19, 2013
    • Hi Ms B. – Yes, I think it’s a good idea to administer epinephrine if the rescue inhaler doesn’t work. Thank you so much for your helpful comment and for stopping by!

      Like

      October 24, 2013
  5. Jennifer #

    My father is a really bad asthmatic, he carries around what he calls his shot bag. My father asthma is so bad that he be giving him self shots of epinephrine many times a week sometimes a few times a day for the last 25 years. It is the only thing that will stop a really bad asthma attack. I grew up with this so for me to see this post I wasn’t surprised that many didn’t know that this a treatment for the worse case scenario. He doesn’t use an Epi pin. He is prescribed the vile and uses needles like a diabetic would to give them a shot of insulin. If you are ever in a situation with an asthmatic and nothing is stoping an asthma attack I would use your Epi pen.

    Like

    October 17, 2013
    • Wow, that’s incredible Jennifer. Does he know what his triggers are? Does he live in a home with animals? Has he tried any other form of medication like singulair?

      Like

      October 18, 2013
  6. We too now have an EPI pen with us at all times. The doc said that after using it to also give a dose of Benedryl and then call 911. I can deal with the pen…but the whole calling for immediate medical help is the part that freaks me out!

    These kids better be grateful for all that they put us parents through! ; )

    Like

    October 15, 2013
    • You’re too funny! I’m sure they will be grateful! It’s funny because we’re opposites – I’m more scared of the pen, but have no problem calling 911 🙂

      Like

      October 16, 2013
  7. We were told this too within the last year. No more waiting to see and we were told to stop carrying Benedryl so that we’ll be pushed to using the epinephrine. My doctor said we need to be like BoyScouts, prepare for the worse and we’ll have no regrets!

    Thanks for discussing fears—we all have them!

    Like

    October 15, 2013
    • Oh, plenty of fears right here for sure! Caroline, interesting you were told the same as it seems there is a lot of conflicting information out there about this. Go figure – welcome to the world of unknown regarding allergies, asthma, eczema. So frustrating.

      Like

      October 15, 2013
  8. This was a specific subject that I asked an allergy specialist at the AANMA US Anaphylaxis Summit just a few weeks ago because I saw another site post that it was a fact that epinephrine can be used to treat asthma. The doctor stated that epinephrine can be used in conjuction with an asthma attack that happens during an anaphylactic episode but not to treat asthma as a first line of defense. I also consulted a representative from Mylan Specialty (makers of Epipen) and their answer was “EpiPens are not indicated to stop an asthma attack.” Needless to say, I am as confilcted as you are. It’s great that you have such a proactive doctor but what is the true, correct line of attack for asthma? I DO know that in the case of anaphylaxis/known or suspected ingestion of an allergen, the answer is epinephrine and no antihistimine first but I feel we need a completely clear answer on this one.

    Like

    October 15, 2013
    • Hey Tracy – It seems like there are no clear answers when it comes to any immune disease or allergic condition – it’s a world of unknowns and as parents that’s not comforting. It seems we are on our own to weed through the half truths and discover what really is best for our child. So hard……

      Like

      October 15, 2013
  9. I know what you mean, it’s all so confusing. My son has a peanut allergy, and I have never used one so it scares me to have to do this during a stressful situation. I have on the to-do list that I need to sit down and talk to my son once again on how we both need to behave during an emergency. Thanks for your links.

    Like

    October 15, 2013
    • I think that’s a great idea, Robin. Talking to your child about a worst case scenario would be very helpful. Maybe role playing a bit could also help reinforce what you discuss. Let us know how it goes!

      Like

      October 15, 2013
  10. annieboisvert07 #

    Wow! I’m so surprised by that!!!! But in a way, I guess it makes sense that epinephrine would help with an allergic asthma spell, it just seems like such a drastic measure compared to a little puff of Ventolin!!! Thanks for sharing, I’ll definitely have a word with T’s allergist about that!

    Like

    October 15, 2013
    • You know, the doctor also told me that Ventolin is in the same drug family as Epinephrine apparently. So, he was trying to comfort me that Epinephrine is just a stronger more necessary dose.

      Like

      October 15, 2013

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