January 17, 2021 started off like any normal Sunday. Well, any normal Sunday given Covid 19 restrictions. We got up, we ate, we prayed, we played. We like to have a family breakfast together at least once a week. This week it was homemade apple cinnamon pancakes. We had some good laughs at the breakfast table and then we spent a lazy Sunday morning just hanging out.
Aiden had his first "Jesus Journey" in preparation for his first reconciliation. The church worked hard to make it covid safe for the kids and the families. We had a nice time with a few friends from school, reflecting on the special times that are coming up as the kids prepare for the sacraments of reconciliation and First Holy Communion.
Aiden and I got home from church and we were getting ready for spending the rest of the afternoon with some friends across the neighborhood. We have been very careful with keeping our circle very small during covid and we planned on watching a movie, ordering some takeout from a local business and enjoying the warmth of a fireplace on that cold January afternoon.
I grabbed a quick snack from the pantry which was a bar that prided itself on only four ingredients: cashews, dates, chocolate chips and sea salt. Ethan asked me for a bite which is not unusual...he can smell food a mile away! I reluctantly shared with him and the bar was so tiny anyway, I broke off a piece for him, handed him another whole bar (because I knew that one bite didn't constitute a snack in his mind) and then told him I had to grab something from upstairs and I'd be right back down to the kitchen. When I came back down, he said "my mouth is burning..."
I honestly didn't think too much of it. Dates can have a weird aftertaste so I told him to drink some water because we were leaving in a minute. I ran back upstairs to grab something else that I forgot and when I came back downstairs, he had the other full size unopened bar in his hand. This time, I noticed he had five red splotches around his mouth and nose. They weren't hives, but bright red marks. I was starting to realize that he must have had a reaction to the bar. I took the other one out of his hand and encouraged him to get his shoes on. I didn't have any benadryl on hand so I figured my friend did. When we got to their house, she didn't have any benadryl but offered to drive to the pharmacy with me. Eugene stayed behind with the kids, her husband and baby. The pharmacy is five minutes away. We ran in, grabbed it and ran out. We were in the store less than five minutes. In that short amount of time, Eugene was calling me saying Ethan felt like there was a "lump" in his throat and he felt "itchy." According to him, he didn't seem to be having any difficulty breathing though. When we got back, we gave him the antihistamine immediately and I placed a call to the pediatrician. The nurse on call said that he needed to be seen. I asked her if I could just take him to the Children's Urgent Care in Wexford before they closed at six pm. She said that was fine. In the meantime, he was lying on the couch, curled up, complaining that his "belly hurt." Again, I thought it was something completely unrelated , maybe he was just a little constipated. I told Eugene I was going to call the Urgent Care to make sure they weren't really busy and would be able to see us before they closed. As I was on the phone with the nurse, I relayed his symptoms which were red spots (that had disappeared), itchiness, and throat scratchiness. He had no difficulty breathing. He had no difficulty swallowing. He had no swelling and no hives. I told her we would be there in twenty minutes. Her last words were "drive safely and if he vomits, pull over to the side of the road in a safe spot and call 911 immediately." My mind was racing and I quickly said, "ok thank you, see you soon." I didn't even think to ask her what that meant. My friend went to help Ethan up off the couch and he started projectile vomiting everywhere. Not to be graphic but it was just SO MUCH. At that moment, my friend yelled "Call 911!".
We were having a hard time processing what exactly was happening but EMS was on the way. It was like that scene from "Home Alone" the night before the McCallisters left for vacation and everything was chaos and everyone was running amuck. But the truth was, Ethan was having an anaphylactic reaction to SOMETHING. Most likely something he had eaten many times before because he had had nothing new to eat that day. We were trying to clean Ethan up before the EMS came. His clothes were destroyed and my days of carrying extra outfits in the car are gone. Eugene had no keys, ID or insurance cards on him. He drove home to get his belongings and some new clothes for Ethan and arrived back as EMS pulled up. I gave them a quick report and got into the ambulance with my 4 year old, headed to Children's Hospital of Pittsburgh. I felt like I was leaving Aiden behind but luckily these neighbors are like family and they, without a blink of an eye, just took him in, made him feel safe and went about their night, checking in with us while they made Ethan "Get Well" cards.
During the ride to the hospital, I stayed in the back with Ethan and the paramedic, Kevin from Shaler/Hampton EMS. He kept Ethan calm and made the ride less scary for him. He answered all of our questions and tried to put us at ease. I told him I wasn't quite sure how all of this happened. I mean, I'm a nurse. How could I NOT have put all of this together? I guess because I have never dealt with an anaphylactic reaction. In all of my years of nursing, I have never had a patient with a severe allergic reaction. I know how to use an Epi Pen and we have them at work, but I can honestly say that I have never had to use them. When I think "anaphylactic", hives, swelling of the throat, face, eyes, and lips come to mind. But he educated me that nausea, vomiting, anxiety are all signs of anaphylaxis as well. As long as two body systems are involved, it's considered anaphylaxis. That day, Ethan had three systems affected. He was in full blown anaphylaxis.
When we arrived at the hospital, a team of nurses and doctors were waiting for us the minute we came through the door. By the time we arrived, Ethan was actually feeling a little better and I told them I felt a little silly for calling 911 but that's what the pediatrician's office instructed us to do. The doctors assured us that we ABSOLUTELY did the right thing in calling for help. For the time being, they believed he had a a reaction to the cashews from the bar. He will need further testing this month to determine exactly what causes his allergies.
Ethan was given a series of medications including prednisone, more benadryl and pepcid. They wanted to monitor him for four hours because the chance of a rebound reaction is most likely to happen in the first four hours. I can't praise the techs, nurses and doctors enough at the hospital. They offered support and a ton of education. They treated Ethan like a prince and spent time making him laugh in a crazy situation.
Luckily, four hours had passed and there was no rebound reaction. We were able to go home with orders to continue to medicate him with benadryl, prednisone and pepcid as well as set up an appointment with his regular pediatrician and an allergist. We were instructed on the proper use of EPI Pens, when to use them and how to use them. We were educated on avoiding all foods that contain tree nuts or are made in a tree nut facility. It had been an extremely long night and Ethan was so tired that he fell asleep in the car and we put him right to bed. He wasn't due for another dose of benadryl until midnight. I set my alarm to get up and wake him thinking the worst was over, but he woke up first, vomiting in bed. I immediately called the pediatrician back and they said to monitor him and if he vomited one more time, we were to go back to the ER. He seemed to quiet down after that last episode and took his meds and went back to sleep.
The next day we followed up with our regular pediatrician and the day after that, the allergist. I can't say enough wonderful things about this woman. She provided support, comfort and education when we most likely had the "deer in the headlights" look for most of the appointment. She discussed so many things we didn't even think of. She gave us gentle warnings of types of foods and restaurants to avoid until we figure everything out. She told us "I only expect you to retain half of what I'm telling you today. It's a lot." It IS a lot. But I feel like we have been empowered with knowledge. Knowledge to do better, to know more. We now have a new appreciation for food labels. We screen things for any sign of a potential allergen. I spend my time reading the food allergy website that she recommended. I joined a facebook group for allergens that offers support and education. We are so blessed that if this did have to happen, that Ethan is no longer a non verbal toddler and is old enough to know that he has to ask someone before he eats anything. He tells everyone "Don't forget to read the yabel (label)" and "I can't have nuts!"
Just to review: symptoms of anaphylaxis are not always hives, itching, swelling and trouble breathing. Nausea, vomiting, diarrhea, anxiety, dizziness, pale/bluish skin and lethargy can be subtle but important signs.
We still have a lot to learn. A LOT. Everyday, we learn something new about this new lifestyle. We are diligent in reading food labels. We are careful when ordering food from a restaurant. I don't even rely on their websites, I will call and speak with a manager first. We travel everywhere with Epi Pens and benadryl, even the grocery store. If there is one take-away from this post, I hope you have gained some helpful tips, some education on the dangers of food allergies and how to react to them. When in doubt, call 911, you could save a life!