s/o--why are some drs reluctant?

[Therese's Mommy]

I have read so many times on this board about moms who are refused an epi by their drs. Why is this? Why the reluctance by some drs? What is the harm with erring on the side of caution and prescribing one (provided the parents know when/how to administer it)?

[sbgrace]

I don't know for sure but I think a lot of it is lack of awareness of anaphylaxis. Most pediatricians rarely see it and they really don't have a good grasp of it. I think because they don't see it often they underestimate the risk. My bil is a pediatrician at the largest children's hospital in our state told me he couldn't think any of his patients with anaphylaxis allergies. This is actually (even more scary) true of ER doctors as well. When my son had anaphylaxis they gave us benadryl, steroids, and a steroid prescription but told me I needed to see an allergist for an epi pen! There is a lack of awareness.

It's interesting. I had requested an epi pen from our pediatrician because my son had asthma and food allergies and there is a family history of anpahylaxis. I was worried about what would happen if he ate nuts/peanuts. Two pediatricians told me not to worry about it. They weren't wrong in our case as there was no reason to assume my son would have an issue. Unfortunately, he went into anaphylaxis last summer. The pediatrician in our case wasn't out of line not prescribing (though I wish she had and the outcome could have been tragic). After that, though, the pediatrician prescribed one without hesitation. I had one before we got into the allergist even though the ER wouldn't prescribe.

[sbgrace]

Anaphylaxis doesn't seem rare when you're in that world of experience. We see it here, you see it on dedicated allergy boards a lot, our allergist said they see anaphylactic patients very often.

But that's a skewed perspective. I think the statistics are around 1 to 2% of the general population. Think of all of the children represented on the mothering board and how few have anaphylactic kids (even those with allergies). I don't actually know any other kids in real life here with anaphylactic allergies. The elementary told me they had never had a child with anaphylactic food (i.e. nut in our case) allergies. So while it's not an excuse I think this is why pediatricians aren't more informed and don't see the point in prescribing just in case. I don't either unless there is a nut/peanut/sesame type allergy or other reason to suspect a child is at high risk--the pens are expensive and have to be stored carefully, replaced every year, etc.

Fortunately most kids are going to survive anaphylaxis. It's a gamble you don't take willingly and not all of them will but most of them are going to survive even when the reaction was serious (my son was biphasic to cashew which has a higher than average incidence of death). When I was a teacher all the epi pen kids I knew of had bee sting anaphylaxis. I think it's safe to assume they didn't have an epi the first time they went into anaphylaxis either. Most kids won't. Most kids will live to have an epi pen for the next reaction.

It's when a child has anaphylaxis and a pediatrician suggests benadryl or a child has a known peanut reaction and the pediatrician doesn't give an epi and referral--those are the times when it's not excusable in my mind.

[IngaAnne]

I don't think most doctors have a very good understanding of allergies in general. My son started suffering from Eczema at around 3 months old and I started asking a lot of questions at our doctor's visits. Her answers were never very clear or helpful. Essentially, I was told to give him Zyrtec and Hydrocortisone and not worry about what I was eating because I'd drive myself nuts restricting my diet. What really drove me nuts was watching my son with his bright red and peeling face always trying to claw his own skin off. At 8 months, we saw an allergist and finally got answers and some much needed relief for my son. His allergies have only been skin related so far, so the allergist didn't really think we needed an epi-pen. However, he had high blood test scores and his reactions have been due to second-hand exposure through breast-milk and skin exposure, rather then directly eating food, so I convinced the doctor of his need. With little effort on my part, she agreed the epi-pens would be a good idea. She clearly explained how to use the pen, what symptoms signaled a need for the pen, etc. Without insurance, the pens would have been very expensive, but having a little more security is more than worth the money. If you don't feel your doctor is listening and responding to your concerns, definately seek another medical opinion. It's made all the difference for my kid.

[chlobo]

Originally Posted by sbgrace

Anaphylaxis doesn't seem rare when you're in that world of experience. We see it here, you see it on dedicated allergy boards a lot, our allergist said they see anaphylactic patients very often.

But that's a skewed perspective. I think the statistics are around 1 to 2% of the general population. Think of all of the children represented on the mothering board and how few have anaphylactic kids (even those with allergies). I don't actually know any other kids in real life here with anaphylactic allergies. The elementary told me they had never had a child with anaphylactic food (i.e. nut in our case) allergies. So while it's not an excuse I think this is why pediatricians aren't more informed and don't see the point in prescribing just in case. I don't either unless there is a nut/peanut/sesame type allergy or other reason to suspect a child is at high risk--the pens are expensive and have to be stored carefully, replaced every year, etc.

Fortunately most kids are going to survive anaphylaxis. It's a gamble you don't take willingly and not all of them will but most of them are going to survive even when the reaction was serious (my son was biphasic to cashew which has a higher than average incidence of death). When I was a teacher all the epi pen kids I knew of had bee sting anaphylaxis. I think it's safe to assume they didn't have an epi the first time they went into anaphylaxis either. Most kids won't. Most kids will live to have an epi pen for the next reaction.

It's when a child has anaphylaxis and a pediatrician suggests benadryl or a child has a known peanut reaction and the pediatrician doesn't give an epi and referral--those are the times when it's not excusable in my mind.

I guess where you live really makes a difference. I was in the nurse's office at my DDs school and there was a whole cabinet full of epi pens for the various kids are ana. It was frightening to me how many there were. Had to be 10-20.

[sbgrace]

Originally Posted by chlobo

I guess where you live really makes a difference. I was in the nurse's office at my DDs school and there was a whole cabinet full of epi pens for the various kids are ana. It was frightening to me how many there were. Had to be 10-20.

Maybe there is more awareness among doctors in your area (let's hope). I would assume the stats don't vary much from area to area (at least with similar socioeconomic/lifestyle factors which I do think influence allergy incidence in general). I did google pediatric specifically and the incidence in 2 to 8% for kids I believe so my stats were under above.

What's frightening to me about what you wrote is that the school doesn't have a policy that the child have the epi on their person. Going to the nurses station to get the epi pen out of the cabinet would be too long for some kids.