Allergy reactions

Published

When you have a possible allergy but not anaphylaxis symptoms (just mild symptoms-red patches around mouth and itching after lunch but no tingling or itching inside the mouth) and no history of allergies...are you administering 12.5 mg or 25 mg of Benadryl to a child who is 70 pounds? Of course I'm also monitoring and calling parent...

Up Vote Up Vote ×
Specializes in Pediatrics Retired.

If you have all the paperwork in order, and have a choice, I'd go 25 mg for a 70 pounder with actual "signs" of allergic reaction. Are you referring to the label that says, 1 to 2 tsp, for 6 - 11, or something like that?

Up Vote Up Vote ×

Yes!! My thoughts exactly, just wanted a confirmation from another nurse!

Up Vote Up Vote ×
Specializes in ICU/community health/school nursing.

Do you have doctor's orders? Or parent orders if you don't need doctor's orders for OTC medication?

If neither...I agree with Old Dude. If all I had was Benadryl, I'd be tempted to use it and ask forgiveness later.

But - real story from the trenches: Benadryl may mute the reaction enough to make EMS think they DON'T need to transport. And when the reaction comes roaring back, you need EMS.

Up Vote Up Vote ×

I hate Benadryl and I'll tell you why...it will mask anaphylaxis. It treats what's happening on the outside, but what's happening on the inside will continue, and you won't know until it's too late. I'd rather have a kid under my care uncomfortable and be able to give epi faster than cover the symptoms and have it be too late. Google Natalie Giogri's story. Still breaks my heart and scares the heck out of me.

Up Vote Up Vote ×
Google Natalie Giogri's story. Still breaks my heart and scares the heck out of me.

So awful. Everything about the story is sad. They used the two epi pens that her family brought with and then her dad had to break into a cabinet and severed a tendon to get to the camp's epi which should NEVER BE LOCKED UP. It's unimaginable.

I think of this when I work at the camp in the summer. Our EMS response time is 15-20 minutes. We are nut-aware and nothing in the dining hall has nuts/peanuts but sh!t happens. An employee may eat a snickers on their day off and the wrapper may fall out of their pocket. A camper might sneak in cookies.

Up Vote Up Vote ×
Specializes in School nursing.

See red patches and itching in the mouth area - that is Epi for me and my plan says so as well. Mild reactive for me is more like a few hives not on the face - I see that more often with some exposure to touching an allergen vs ingesting it.

But that being said with no history, I'll likely grab my stock epi to have it close and monitor. I had two examples of this last school year. One was a kid with mild hives move right into full body hives and stridor as I had a parent in the school ready to pick them up. I used benadryl with the initial localized non face hives and monitored - did have epi on stand by but with no history I admit I was hesitant prior to additional symptoms.

Parent did not speak English so I was calling out for a translator, grabbing an Epi pen, and trying to figure out how to get parent to understand 911 was being called. Outcome was great (EMS response time is average 6 minutes) but it taught me a few things. One, thank goodness for stock Epi. Two, be ready to use it and don't second guess yourself.

Up Vote Up Vote ×

Holy smokes! I'm so glad I read this... What are your suggestions for parents who want us to give Benadryl and sign med forms stating to do so???

Up Vote Up Vote ×

Holy smokes! I'm so glad I read this... What are your suggestions for parents who want us to give Benadryl and sign med forms stating to do so???

Up Vote Up Vote ×
Specializes in ICU/community health/school nursing.
Holy smokes! I'm so glad I read this... What are your suggestions for parents who want us to give Benadryl and sign med forms stating to do so???

If the order says Benadryl first then Epi...and assuming I had Epi...and in the presence of exposure to allergen....I would say wait until the mild becomes more severe. It will in a hot minute. If the reaction does not progress, benadryl away. But I believe I read this summer that best practice is moving away from Benadryl.

Up Vote Up Vote ×
Specializes in Pediatrics Retired.

It's kind of an "imaginary" threshold that you can't quite put your finger on as to the capacity of the benadryl so you just have to wait and see; which of course is different in each person.. An allergist frequently works at Urgent Care and the times kids have presented with "signs" of serious allergic reactions he only orders epi. You can watch the monitor and see the immediate tachycardia associated with the epi and watch the effect fade back to normal over the next 10 to 15 minutes; hence the possible need for another dose.

Up Vote Up Vote ×
Specializes in NICU.

very scary story tragic with both parents there and the father a doctor.

Up Vote Up Vote ×
+ Join the Discussion