The little peanut can have none

Thursday, June 23, 2011:

I love peanut butter. Let’s just start with that.

During this particular afternoon, I decided I really wanted peanut butter cracker sandwiches as a snack after work. I pick Ian up from daycare on Tuesdays and Thursdays, so Ian was home with me at this time while Miles was still at work. Since he’d had peanut butter for the first time about 6 weeks ago with no signs of an allergic reaction, I didn’t think twice about giving him some. Actually, I thought twice, but my first thought was “He shouldn’t have any issues” and my second thought was “He definitely shouldn’t have any issues.” Since it was not long before suppertime, I had about 3 of these and Ian had 1 cut in half. He ate the first half quickly and chased it with lots of milk from his sippy cup. (That’s my boy!) The next half he took the cracker, opened it, touched the peanut butter with his fingers and then put it back together and ate it.

5:30 p.m.

He started itching immediately after finishing this half of cracker. This in itself is not unusual as he will often itch during meals (perhaps a sign we should have picked up on problems sooner). But he was also refusing milk, something I think he’d definitely want after a peanut butter cracker. (Yum.) Then I started seeing some red spots on his face. It also was not unusual for him to have red spots, especially when he’s itching, but this is what raised a red flag to me because his skin had been pretty clear the last couple of weeks and especially that afternoon. One spot in particular, under his nose, looked a lot like an inflamed pimple to be honest. I knew that hives can be red with a white spot in the middle. Since I’m a worst-case scenario planner, I then decided what I would do if it indeed became clear he was getting hives.

  1. My first instinct was to call acute care and talk to the nurse because that’s always what I do when I don’t know what to do about something medically related. I decided she’d tell me to go to the E.R.
  2. I was not comfortable driving to the E.R. without Miles or someone else with me. If he was having a reaction, I had no idea whether or not it might affect his breathing and there was no way in ‘H’ I was going to be driving in 5:30 traffic to the E.R. with a baby rear-facing in the back seat and no one next to him to watch for respiratory distress. (At this point I did not consider my options with neighbors. Our 80-something neighbors would not have moved fast enough for me, but our 30-something neighbor would have been an option had I thought of it. I’m not sure if they were home at the time either, actually.)
  3. Therefore, I decided my only option would be to call 911.

In those few seconds when I was planning my worst-case scenario, Ian developed hives all over his face and he began to swell. He kept itching his face and I noticed he had hives on the back of his hands.

5:33 p.m.

I called 911. The dispatcher asked several questions (Has he ever had a reaction to peanut butter before? No and this is the second time he’s had it. What are his symptoms? I told her his symptoms. Is he breathing normally? He seems to be. Is he responding to you normally? Yes. Has he vomited? No.) She told me paramedics were on their way and if he has problems breathing or throws up, I should lay him on his side and call back.

5:34 p.m.

I called Miles. “I had to call 911 because Ian is having an allergic reaction to peanut butter and I need you to come home right now.” I started to cry in the middle of that sentence. “Okay, I’ll be right there.”

I knew I had to calm myself down because I didn’t want Ian to sense how scared I was. He was still itching and I realized that he probably still had peanut butter all over his hands. We went to the sink and I ran the water and he enjoyed putting his hands under the cool water. I imagine the water also helped soothe his inflamed skin, in addition to calming us both by listening to it. Anxiously, I watched the street in front of our house looking for the ambulance.

I checked his belly to see if he had developed a rash or hives there, as I’ve read they might when it’s a food allergy. He had a spot or two, but it could have just been his normal eczema.

We went outside. I was afraid the ambulance got lost, even though we live in an established neighborhood. Ian crawled around a little but mostly wanted to be held. He’d occasionally pick up a rock or two. I wondered if I should call 911 again, but I didn’t.

5:51 p.m.

Miles got home. I told him the ambulance was not here yet — I suspected he figured they’d come and gone already. Ian’s swelling and hives had already gone down a tiny bit. Miles sympathized for his son and comforted him and played with him while we waited some more.

5:57 p.m.

The ambulance arrives. No lights or sirens were on. The two paramedics came up to us and asked us some questions. (Did he have anything else new to eat today? I checked his daycare sheet, everything on the list he’s had before. Anything new to his environment like soap, etc.? No. I was a little bit annoyed because they weren’t doing anything for him and it felt like they were questioning whether or not it was a reaction to the peanut butter. But eventually I convinced them that his symptoms started within 30 seconds of finishing the cracker sandwich. Is it different brands of peanut butter from the first time he had it? Maybe. I might have given him “Simply Jif” the first time, and this time it was Skippy.) They said they could either give him a ride to the ER, we could drive him to the ER or we could go to acute care. They suggested he be looked over and given a shot to help his symptoms. We chose acute care, as it is about 5 blocks away. I ran inside to get the diaper bag, my wallet and turn the oven off, which was cooking dinner.

6:05 p.m.

We arrive at acute care and wait in line to be helped by the receptionist. The paramedics had instructed us not to give him anything to eat or drink until he’s looked over by someone. I brought his sippy cup and a snack bowl so we’d have it when we were allowed to give him something. Since it was supper time and I didn’t know how long we’d be away from home, I wanted to have something on hand. He saw the sippy cup in his bag and threw a huge tantrum in the waiting room because we wouldn’t give it to him. Finally it was our turn and I explained the situation (the receptionist thought it was odd that the paramedics did not give him the shot). Apparently Ian’s sippy cup tantrum was interpreted as extreme discomfort and pain because we were the next ones called back. At this point though, I think his crying and sensitivity was just being overwhelmed by everything happening and when he finally let loose about the sippy cup, he couldn’t hold any of it any longer either.

We saw a nurse practitioner who looked him over and ordered a shot of Benadryl. She also was surprised that the paramedics did not give him anything. She said he could have his milk and snack. This pleased him. The Benadryl they gave him was dosed at about twice as much as we would give him at home so she said he might get drowsy. We stayed in the room for about 20-30 minutes so they could monitor him and he was very sleepy.

Below is a blurry camera photo of Ian at the clinic, waiting for the shot. He has only a couple of hives and his swelling has greatly reduced. The thought crossed my mind to take a photo while we were waiting for the ambulance, but I decided it was more important I hold my baby than to take a picture. In the Dr.’s office I wished that I had taken one so I could show them how bad it was, but no one questioned the existence of a reaction.


Below is a blurry photo of Ian one week after the reaction. Clearly, you can see the difference in his complexion, swelling around the eyes and mouth and healing of scratch marks.

6:50 p.m.

We were able to go home. They said Ian may or may not be interested in eating supper. I offered him some chicken from the alfredo lasagna and he ate a bite but would not eat more. Before Miles and I finished eating, he did end up throwing up. We got him ready for bed and put him down. He went pretty easily, but I checked on him often to be sure he was breathing OK.

Friday, June 24, 2011

Playin' I stayed home with him because I thought he might have some intestinal pain and some d-word so I figured he might be more comfortable at home with mommy than at daycare if he’s not feeling good. He was a little moody, which may have been from the shot or may have been from being off his routine but he seemed to be OK. We had an appointment with his pediatrician who was pretty sure he had an allergy but we did the blood test panel anyway. He said usually the allergy presents itself upon the second exposure because now the body knows how to react to it. We also discussed how much we love peanut butter. He’s a crunchy kind of guy. I’m creamy.

The nurse at this appointment seemed surprised it took the ambulance nearly 30 minutes to arrive at our house. This, combined with the nurses’ reaction the night before to the paramedics not treating him had me growing concerned over the next several days. I decided I should let someone know and try to get some sort of explanation to what I thought was strange. I asked Twitter for help in contacting someone, but everyone mostly just speculated as to how to get a hold of the ambulance company (no one knew the name of it or how to find it). After a little Googling, I was able to find a contact for both the 911 call center and an ambulance company that contracts to 911.

Contact with 911 Metro and Rural/Metro Ambulance

I made contact with the operations manager at 911 Metro. She listened to my 911 phone call and reviewed the dispatcher’s actions and got back to me within an hour. She found that the dispatcher did everything correctly, and she explained to me the process. Through the series of questions the dispatcher asks, he/she determines whether the call is an emergent situation or a non-emergent. Our call was a Code 1 which is non-emergent and it tells the paramedics to arrive with no sirens or lights. A Code 1 is also used for situations like a possible broken ankle. Since Ian was not having respiratory distress and was responding normally, his allergic reaction was a Code 1. She confirmed that Rural/Metro Ambulance is who responded to the call. I feel better in knowing that had he been having breathing problems, my call would have been coded as an emergency and we would have received more urgent care. (Just an aside for sharing information’s sake: the operations manager also said they have a “Citizen 911” class that anyone can take to learn more about the way 911 works behind the scenes.)

I made contact with the operations manager of Rural/Metro Ambulance. He looked further into the situation and got back to me a couple days later. He explained the 24-minute delay between the call and the arrival of paramedics. Due to the high volume of calls at the time I called 911, all ambulances that were in our area were responding to emergent situations. The ambulance that was assigned to our call was in northwest Sioux Falls — we live on the east side and are more central/south. Since it was a Code 1 (no lights or sirens) and it was a high traffic time of day, that is why it took 24 minutes for the ambulance to arrive. He explained the procedures the paramedics follow as well as the options that should be presented to us. However, he said the paramedics have the ability to treat allergic reactions and the desire to offer this service to all patients. He also said the first option they offer should be “transportation and treatment by ambulance to the ER”. This part was not made clear to us. Both Miles and I understood their offer as being transportation ONLY to the ER. Had I known that we had the option to be treated immediately, we may have gone that route even knowing there’d be a high price tag. (Just an aside for sharing information’s sake: the operations manager also explained that transferring by ambulance is the only option in which their services are reimbursed. I take that to mean that we shouldn’t expect a bill since we didn’t go that route.)

Overall, I’m happy to have been able to make contact with both parties involved and to get processes explained to me as well as some answers to my questions/concerns. Though we were not offered treatment by the paramedics, I feel better about the whole experience. My expectation was to receive services within 5-8 minutes — this was based on my incorrect perception as to how the process works. I now feel confident again that in a true emergency, we will receive quicker paramedic service.

Results of the allergy test panel

The results came in that Ian is indeed allergic to peanuts and only peanuts. He scored a 2 out of 5 (though as I understand it, the scoring system is a little misleading and doesn’t translate to how we interpret a 2 out of 5 score. It’s more like he’s a +2 and the highest number you could be is a +5.) This means he has a mild-to-moderate allergy to peanuts. He can have nothing with peanuts in it and we also have to read labels to avoid foods that may have been cross-contaminated. (We’ve given him some Rice Krispie treats this week, however and I just read the label on the cereal box and see it’s a no-no food. Great.)

I hope for his sake (and also selfishly for my sake, did I mention I love peanut butter?) that he eventually grows out of the allergy. But he might not. We can have peanut butter in the house, it’s not so severe that he’s sensitive to airborne particles but I know we’ll be eating less peanut butter in the household because he’s at the age where he wants to eat whatever we are. No more peanut butter cup Blizzards, peanut butter/banana sandwich, Charlie Brown pie, puppy chow. OK, maybe a little of each of those, but only when he’s not around and we shouldn’t kiss him afterward.

Loungin' We’re considering seeing an allergy specialist — our Dr. has offered a referral. Mostly because he’s so itchy and because of his eczema, it’s possible he’s got some other allergies or sensitivities that the blood test did not catch (it’s not as accurate as the allergist’s tests.) We’ll for sure get him tested again in a year by an allergist — the question is whether or not we will now. I’ve read that those tests will pick up a sensitivity on many things that you’ve never reacted to (I had one at age 8 and was allergic to milk, corn and peanuts — all of which I had never knowingly reacted to. Maybe I was a +1?) and the best indicator is having a reaction to a food PLUS having the test confirm the allergy. I don’t really want to go through this again, so right now we’re also avoiding strawberries because I can’t remember how many times he’s had them (was it just once? or was it 2 or 3 times?) and since they’re a known baby allergy, we’re staying away for now.

Thanks to everyone who’s expressed concern. Ian’s much better now and hopefully we don’t have any more scares like this one.