Epi pens and stomach pain

[schoolnursenewbie]

Hello all...

I have not yet had to give an epi pen, but I have a question for you. 

I am in elementary and kids complain of stomach pain often. I have a few anaphylactic kiddos and I know anaphylaxis can present with symptoms such as stomach cramping, vomiting, diarrhea.

How have any of you differentiated between stomach bug, constipation pain and anaphylaxis? In your experience, does a gastro reaction usually include obvious/severe pain/symptoms?

Taking into account exposure is unknown or child/teacher deny exposure? 

Our parents let us know their child’s typical symptoms and all of ours are respiratory or hives...which for me is pretty clear and obvious, so maybe this situation will never present itself...but what if.

Gastro presentation possibility has me wondering “How do you know?” What if a kid says their stomach hurts and it’s an anaphylactic reaction, not just a stomach ache?

I’d love to hear any experiences you all have had, if any with gastro symptom presentation. 

[JenTheSchoolRN, BSN, RN]

So, I've had one. Kid came in with a stomachache (with mild stomach cramping, 4/10) during his lunch period. Nothing else. Hx of walnut allergy, but also long hx of digestive issues (constipation, IBS). Do not ingest any nuts per him (kid doesn't even really eat much at school normally).

Vitals normal, nothing else out of the ordinary - tried to use the restroom, voided only. Sitting in my office chatting with me as I observed him for about 5, 10 minutes.

Then stomach cramping increased and kid started reporting his mouth was super itchy and swallowing was "rough." Something clicked with me and I grabbed an Epi-pen. Before I even had a chance to get close enough to him, kid broke out into hives on his neck.  Epi-pen deployed immediately, 911 called.

Student observed in ED for about 12 hours, then was fine after that. Doc there thought it was not the walnut allergy and referral sent to have full allergy panel done. Of course, this all happened just before COVID went down, so allergy panel got super delayed. 

[schoolnursenewbie]

8 minutes ago, JenTheSchoolRN said:

So, I've had one. Kid came in with a stomachache (with mild stomach cramping, 4/10) during his lunch period. Nothing else. Hx of walnut allergy, but also long hx of digestive issues (constipation, IBS). Do not ingest any nuts per him (kid doesn't even really eat much at school normally).

Vitals normal, nothing else out of the ordinary - tried to use the restroom, voided only. Sitting in my office chatting with me as I observed him for about 5, 10 minutes.

Then stomach cramping increased and kid started reporting his mouth was super itchy and swallowing was "rough." Something clicked with me and I grabbed an Epi-pen. Before I even had a chance to get close enough to him, kid broke out into hives on his neck.  Epi-pen deployed immediately, 911 called.

Student observed in ED for about 12 hours, then was fine after that. Doc there thought it was not the walnut allergy and referral sent to have full allergy panel done. Of course, this all happened just before COVID went down, so allergy panel got super delayed. 
 

 

Ahhhh...so, eventually some of the more typical symptoms presented. Interesting!

I’ve always read that something like 90% of reactions will involve urticaria or itching, respiratory issues, etc... in addition to the gastrointestinal symptoms.

It’s good hear others’ experiences. Thank you for the reply! ? 

 

Hopefully the allergen has since been identified! Covid sucks. 

[Jedrnurse, BSN, RN]

Tough one as stomach aches are such a common complaint. I guess I'd look at keeping a kiddo who also has a serious allergy in the office for awhile for observation. I don't see myself giving a pen just based on the one symptom.

Very tricky...

[BrisketRN, BSN, RN]

Almost all of my allergy kids have GI symptoms first (typically stomach ache followed by vomiting within minutes of eating allergen).  Honestly, they usually tell me if it's allergy even when they're young.  I had a third grader vomit last week.  First question I asked was "do you think you ate something that had egg in it?"  He says yes, this feels just like the last time I ate something with egg.  He's never had an anaphylactic reaction, so as long as he vomits within a few minutes of eating the allergen, the orders are oral Benadryl.  

[raebabelvn, LVN]

One of my allergy kids presents first with a stomach ache. One presents first with a red, itchy eye. Most others have itching, rash, drop in o2 sats...

If a known allergy kid comes in with a stomach ache, I observe them. Obviously if it progresses, its an epi and 911. But most kids I've epi'ED have 2+ symptom involvement, with one being respiratory.

 

[ruby_jane, BSN, RN]

My experience was that the kid had almost projectile vomiting as the GI response. Stomach ache - not so much BUT it's not impossible. But if the kid denies ingestion...what do you  do with this? In a perfect world I'd monitor. Covid has messed with my perfect world.

[Jedrnurse, BSN, RN]

2 minutes ago, ruby_jane said:

 Covid has messed with my perfect world.

^T-shirt logo for sure.^

[ihavealltheice]

Always look for the involvement of a 2nd body system. Yes, 90% of your allergic reactions are going to present with hives/rash/throat issues first, but there's always that odd outlier.

The first time I gave epi, it was on a girl who ate something made in the same facility as her allergen. She came in complaining of bad stomach cramps right after lunch, I asked her what she ate and kept her for a little while. About 10 minutes later, she started complaining of a sore/itchy throat. I had to epi her and call rescue. 

I wish they all came with little billboards8 attached to their foreheads that would tell us what was going on. That would make our jobs so much easier ? 

[Flare, ASN, BSN]

So, let me start out by channeling @OldDude by saying "BAM!  Another student rescued by the icy jaws of death" yesterday here.  The student came in saying she had a stomach ache and told me she was allergic to peanuts when she was little and that she had shared a granola bar with a friend. I had nothing on her h & p about an allergy.  When I dug through her prior school records, I found the allergy paperwork along with a MD note that she no longer required an epipen.  

Within about 5 minutes she began clearing her throat and when she pulled down her mask, her lips looked really full.  I gave her the epi and sent her on to the ER.  

She said through the whole thing that her stomach was the worst part.  

[tining, BSN, RN]

On 2/9/2021 at 8:17 AM, BrisketRN said:

Almost all of my allergy kids have GI symptoms first (typically stomach ache followed by vomiting within minutes of eating allergen).  

This, most times

[schoolnursenewbie]

You all are amazing! Thank you ?