Can I buy an Epipen even if I don't have a script?

Yes. These can be purchased over the counter for about $120 each. It is more cost effective to buy them using a prescription. All people who need an adrenaline auto injector device are now able to have a prescription for 2 devices at any time, to be subsidised by the PBS (Pharmaceutical Benefits Scheme, which is part of Medicare). If using a prescription, you would be able to buy 2 of the devices for the price of a normal prescription. ASCIA recommendations on the prescription of Epipen adrenaline auto injector devices can be found at http://www.allergy.org.au/images/stories/anaphylaxis/
ascia_guidelines_for_adrenaline_autoinjector_prescription.pdf. There is also a good section on the ASCIA website, detailing the various resources available to aid in understanding and treating severe allergic reactions, which can be found at http://www.allergy.org.au/content/view/10/3/

My baby has eczema. What can I do to make it better?

Eczema is very common in babies. If it occurs before the age of 6 months, it is often associated with food allergy. If it starts after the age of 6 months it can be due to food allergy but may also be due to food chemical intolerance. My usual advice is that if the child is breast fed, the mother should stop eating nuts and egg, and minimize the amount of milk and other dairy products she consumes. In many cases, soy products are a good substitute in the mother’s diet. If the mother does not take soy, she needs calcium supplementation in her diet. Two Caltrate tablets a day should be sufficient. The mother should also decrease the amount of tomato and citrus she is taking, and cut back on dried fruit, stone fruit, melons and berries. These can all worsen eczema in a breast fed baby. The mother will need to eat something else to replace these foods, and increasing the amount of meat, and bland carbohydrates, such as rice and potato, would be one way to do this. It would be appropriate to consult a Dietitian if the mother wants to change her diet in this way. If the baby is bottle fed, consider changing from a milk-based formula to a soy-based formula. It is worth noting here that if a baby is less than 6 months old, and reacts to milk based formula, that baby will likely also react to soy, so changing formula should be done with the help of a Paediatrician. If the child is taking solids, the amount of tomato, citrus, dried fruit, stone fruit, melons and berries should be decreased. Other foods will need to be substituted, such as bland cereals and meat. Again, seeing a Dietitian would be wise. In all children with eczema, I recommend decreasing the child’s contact with house dust mite, by decreasing the contact with carpet, and the use of good quality dust mite covers for bedding on all beds the child gets into. I recommend avoidance of soap, and frequent use of good quality skin moisturizer. Steroid creams and ointments are very safe and useful treatments for eczema. They have been used for many decades and do not cause any serious side effects when used appropriately. Cream should be used twice a day until the rash has completely settled. The amount of cream to use is 2cm of cream to cover the area of 2 adult palms. It is better to continue treatment until the rash is gone, rather than stopping early and having the rash come back over and over; less cream overall is used by treating adequately the first time rather than half treating many times. The use of a sedating antihistamine is often useful as this allows the child to sleep well and not scratch, and lets the skin heal and regain its normal barrier function. Sedating antihistamines should be used for short periods only, and if the child is less than 2 years old, medical advice should be sought before using these medications.

I also recommend stopping the use of all hand and nappy wipes and all hand sanitisers, as these all take the oil out of the skin and make it more open to irritation from the environment.

Does the size of the Skin Prick Test reaction relate to how bad a reaction to an allergen is likely to be?

No. The size of the skin prick test is recorded so the doctor can have complete records of any testing undertaken. Many studies have looked at this issue, and all have shown that there is absolutely no link between the size of the skin reaction and the severity of the reaction a person would have if they eat that food. Roughly speaking, the bigger the skin prick test result, the bigger the reaction that would happen. It is not possible to compare the severity of an allergy between one food and another on the basis of the size of the skin prick test. Nuts are much stronger at provoking allergic reactions than other foods and comparing the size of a nut skin reaction to that of egg, for example, cannot show which allergy is worse.

When can I have allergy testing done on my child?

Skin prick testing can safely be done at any age, but is more reliable when performed after age 6 months. Even at that time, there can be false negative results, meaning that there could be a real allergy, but the skin prick showed no reaction. Generally, all skin prick tests for foods should be reliable by age 12 months.

If the Skin Prick Test is positive, does that mean that my child has an allergy?

No. A positive skin prick test only means that the body has formed IgE antibodies against that substance. It does not necessarily mean that this will trigger an allergic reaction. Diagnosis of allergy means that the person should have had a reaction to exposure to that food or other substance, and has a positive skin prick test, or positive blood test (capRAST test) for that substance.

Sometimes it is useful to confirm that there is a real allergy to a particular food, by doing a food challenge under medical supervision.

Are blood tests more reliable than Skin Prick Tests in diagnosing allergy, or in predicting the severity of any reaction?

No. Skin prick testing is more accurate than blood testing. Both can be useful in the management of a person; I generally would use blood testing in a person who was not able to have skin prick testing (perhaps due to severe skin rash at the time I would want to do the skin testing in the office, or if the person lived a great distance from specialist medical care. I usually reserve blood testing for situations where I feel the person is likely to be outgrowing his allergy, and I am considering supervised oral challenging with that food. The results of blood testing do not correlate with the kind of reaction a person would have if they ate that food; researchers have analysed the results of large numbers of oral challenges compared to blood and skin prick test results, and have drawn up charts showing the likelihood of a reaction of some sort, compared to blood test results, but were totally unable to predict the severity of a reaction.

Should my child have an oral challenge with the food he is allergic to?

I generally do not perform oral challenges to confirm a diagnosis of allergy, as most children have already reacted to the food before coming for an appointment.

I may suggest food challenges to confirm a diagnosis if there is any doubt, and also if it appears that the person may be outgrowing the food allergy.

Food challenges are not a treatment to make a person outgrow an allergy.

Does breast-feeding prevent allergies?

No. There is evidence that children who are breast-fed can become allergic to foods that the mother eats, as small amounts of many foods are found in breast milk. This does not mean that mothers should or should not breast feed their babies; rather, if they are to do so, and there is a family history of asthma, eczema or hay fever/sinus disease, the mother should consider modifying her diet to avoid bingeing on nuts, shellfish, eggs or chocolate in her own diet. It is not useful to completely avoid any foods in the mother’s diet. Research performed at the Allergy Unit at Royal Prince Alfred Hospital in Sydney has shown an 80% decrease in the rate of allergy and asthma in children to age 5, when the mother adopts this approach.

What do you think of "alternative medicine" diagnosis and treatment of allergy?

Investigation and treatment of allergic disorders is best done with scientifically proven methods such as Skin Prick Testing and cap RAST testing, both of which detect the presence of IgE antibodies specific to certain foods or other allergens.

IgG testing for foods is not scientifically valid, and should not be part of the diagnosis of any food allergy. Scientists investigating how to induce tolerance to allergens (“desensitising” a person against a food to which they are allergic) measure the presence of IgG antibodies to foods. The presence of IgG antibodies tends to indicate protection against having an allergic reaction,

Food intolerance can only be investigated and treated with dietary exclusions and challenges.

A full explanation of this can be found at ASCIA information sheet unorthodox investigation of allergies

Why is there so much more allergy these days than there used to be?

There is no single answer for this. In any individual there are many factors, which contribute to the development of allergy, including a genetic predisposition (family history), and exposure to the substance in question. Many theories are being put forward including “the hygiene hypothesis”, which says that people are not getting sick with infectious illnesses so frequently and therefore are immune systems attack food instead of germs. I think the western diet we eat has a part to play, as we are eating more processed foods. Some researchers have looked at the issue of processed foods and have made a link between this and increased rates of allergy in remote populations in New Guinea villages.

The is a lot of research at present about the role of various germs in our intestines and the way they influence our tolerance or allergy to foods.

Is eczema caused by foods? What should I feed my child who has eczema?

Eczema is not in itself caused by food but can be made worse by it. If a child has eczema, there is a much higher chance than average that the child will have allergy to egg, and possibly to peanut, so I generally suggest the child with hard to control eczema should be investigated for these allergies. Children where the eczema is easily controlled with occasional use of topical steroid creams do not need this testing. Before testing is done, avoiding nuts in particular is wise. If there has been a reaction to a food then that food should be avoided until testing is done and discussion of the results is completed. I suggest that if a mother is breast-feeding, the mother avoids eating egg and nuts (especially no chocolate), and if this does not improve the situation, she should also decrease her consumption of citrus and tomato products. The child himself should eat a bland diet, without egg and nuts, and the parents need to talk to a properly qualified Allergist and Dietitian for further advice.

What do I do if I think my child is reacting to the colours, flavours or preservatives in medication prescribed by my doctor?

I suggest that if a medicine is not strictly necessary, it is better not to take it. If the child does need medication, for example pain relief or antibiotics, then the child can be given the appropriate dose using an adult capsule (broken open) or tablet (crushed up). If this is done then the parent can mix the medication with soft food and give it to the child. It is best not to mix it in the baby’s milk/ formula or juice, as the complete dose may not be taken or the fluid in which it is placed may inactivate the medication. If the parents are keen then medications can often be made up into syrups without colour, flavour or preservative. A Compounding Pharmacist does this. You will need to talk to your local Pharmacy about where to access your closest Compounding Pharmacy.

If my child is allergic to egg, are vaccinations safe?

Yes. The only reason for the GP not to vaccinate an egg allergic child is if there has been a severe allergic reaction (anaphylaxis) to egg, requiring the use of Adrenaline. The use of the MMR vaccine and Influenza vaccines has been shown to be very safe for egg allergic children. If the GP in unsure about vaccination, there are Adverse Events Vaccination Clinics at the major Children’s Hospitals and the GP should consult these units for advice.

Can we eat out at restaurants?

It is possible to eat out at restaurants, providing you carefully explain to the staff about the allergy and choose carefully from the menu. I usually advise that you go to a restaurant with which you are familiar and where you feel you can communicate well with the staff. If in doubt, leave the restaurant without ordering. I also suggest that when the food arrives at the table, the allergic person touches the food to the tongue and then waits for a few minutes (you may need to have a distraction for the hungry child, such as colouring in or something else to eat); if there is no tingling in the mouth or swelling of the lips in a couple of minutes after touching the food to the tongue, then it is likely to be safe to eat that food.

Should my child with nut allergy avoid traces of nuts in his food?

This is a controversial question. The answer depends on the degree of risk a person is willing to take. In my experience, chocolate is the most likely food to cause reactions due to hidden traces of nuts. This also includes chocolate as an ingredient of foods (chocolate chips, and chocolate coated biscuits). My advice is that if a nut allergic person wants to eat chocolate then the person should choose a nut free chocolate product. There are plenty of these available. The other foods likely to cause reactions due to hidden traces of nuts are muesli bars or muesli cereal. The more highly processed a food is, the more likely the chance that nut traces will be found contaminating the food.

Is eczema caused by foods? What should I feed my child who has eczema?

A person cannot be allergic to something they have never been exposed to. This means that a person will not be allergic to foods they have never eaten (but in the case of babies, they are exposed to foods through breast milk, and before birth, across the placenta).

Many children with eczema become allergic to traces of foods in the home environment. If the child has broken skin, it is important to treat this properly, so that peanut, in particular, does not get absorbed through the broken skin.

If the eczema is hard to control, I suggest the child does not eat egg or nuts for the first time, before getting skin prick tests performed; the results should be discussed with an Allergist as they can be difficult to interpret, and not all positive results mean there is true allergy.

If my child with allergies refuses to eat what I give him, should I force him to eat?

If an allergic child refuses to eat something, he or she should never be forced to eat that food. One of the first symptoms of an allergic reaction is a tingling or itchy feeling in the mouth, which is so unpleasant the child usually spits the food out and starts to rub at the mouth. Making a child eat something they are unhappy to eat may be forcing them to have a bigger allergic reaction. I recommend that if a child refuses to eat something, the child should be watched carefully for the next hour or so as they could go on to have an allergic reaction. The caregiver should make the medications on the Allergy Action Plan available to use if the child does go on to have a reaction.

Which people should carry an Epipen?

This question does not necessarily have a clear answer, which would apply to everyone. The foods most likely to cause a severe allergic reaction are nuts. Largely speaking, children with asthma are at slightly higher risk of having a severe allergic reaction, requiring the use of an Epipen, in comparison to children without asthma. Other factors to take into consideration are whether the child has had a previous severe allergic reaction, if the child is allergic to many foods as well as nuts, and if the nut allergic child is also allergic to dust mite. There is a blood test that has recently become available in Australia, which allows a prediction of the likelihood of having a severe allergic reaction to peanut (not other foods or other nuts). It has been used in research in other countries and more work will need to be done in Australia to see how accurately the test can predict such severe reactions.

My baby is unsettled. What should I do?

It is very common for babies to be unsettled. There are many different reasons that a baby could be irritable. Some babies have reflux, meaning they have heartburn type discomfort, and some babies have difficulties settling into routine, or are over stimulated. I suspect food may be an issue if the baby has a rash on the face or on the bottom after eating certain “acidy” foods (either the breast feeding mother or baby eating these). These foods include tomato, citrus, berries, stone fruit, melons and dried fruit. Other hints are if the baby has difficulty sleeping, has vomiting, or has diarrhoea or constipation. If there is a combination of these symptoms, then I suggest the mother cuts back on the amount of these foods she eats, or that she feeds to the non breast-fed baby. These foods do not need to be completely avoided. Avoiding dairy and soy in the mother’s diet can also be very helpful, particularly if the baby has blood stained loose stools. If the mother changes her diet, it is important for her to consult a Dietitian experienced in the management of food intolerance, to ensure the best possible nutrition for both the mother and the breast fed baby.

Why do you use Histamine as part of the Skin Prick Test?

Histamine is used as the positive control for the test. This means that you can only trust the results of the test if the Histamine result is positive. If it were negative, I would suspect the person may have taken antihistamine medications, and all the negative skin prick tests may be false negatives (meaning the whole skin prick test would be unreliable on that occasion). Histamine is used as a “pilot light” for the test. If the “pilot light” does not work, the rest of the test will not work.

What if another child does bring peanut butter to school?

This is not an ideal situation but I suggest that the child who brings the peanut butter to school is taken to a safe area to eat by himself, and then the child has his hands and face washed before he is allowed to rejoin the rest of the children. I do not like the allergic children to have to sit by themselves to eat as the allergic child should not be made to feel different or excluded.

If one child in my family has allergy to a food, will the other children I have be allergic to the same food?

Not necessarily. The child who is predisposed to allergy will become allergic to the thing they are exposed to most, and won’t become allergic to something to which they have never been exposed.

How long do I have after a reaction starts before I have to give the Epipen?

This is different in each person, but most children will have some kind of reaction within a few minutes of eating the food to which they are allergic. As soon as you see any sign of a severe allergic reaction (within a couple of minutes) it is important to give the Adrenaline. The longer you wait, the less effective the Adrenaline, and the child will feel sicker for longer. I liken it to trying to stop a train before it gathers too much speed; if you wait for too long the train is too fast and is harder to stop.

You can find information on first aid for allergic reactions at http://www.allergy.org.au/health-professionals/anaphylaxis-resources/first-aid-for-anaphylaxis

Is allergy inheritable?

The tendency to develop allergy is genetic in some cases, and can be inherited in families where there is a history of hay fever, “sinus”, asthma, eczema or food allergy.

This does not mean that the person will be allergic to the same things that the other members of the family are allergic to.

Is airline travel safe with a nut allergic child, and how do I protect my child from a reaction when we are travelling?

Most children with food allergies travel very safely on airplanes. I advise that families travel early in the morning, as planes are cleaned overnight and therefore the planes are likely to be cleaner for early morning flights. I suggest discussing the child’s allergy with the airline company, to see what the staff will be able to do to accommodate the child’s needs. It may be necessary to take sufficient food and drink for the air travel period, to ensure the child only has safe food and drink. I suggest that children are not allowed to walk around the plane alone as they could pick up food or rubbish from the floor of the plane, or could be offered food by other passengers. I also suggest that the child is given a dose of antihistamine for each of the 3 days leading up to and including the day of any plane trip, to make sure that any reaction which may occur, is less severe. Parents should make sure they take all of the medications they might need to treat an allergic reaction, in the hand luggage so it can be easily accessed during any travel on a plane. You will also need to take all appropriate covering letters from your doctor, to make sure you can take the medications through customs and security onto the plane.

You can find information on safe travel with allergies and asthma at http://www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-travel-plan-anaphylaxis

Is disinfecting surfaces any better than soap and water for protecting my allergic child?

No. Using a wet cloth, or a baby nappy wipe, is sufficient to clean surfaces before they surfaces are touched by the allergic child.

What is an oral food challenge?

Oral food challenges are done with medical supervision. The aim is to see if a person has a reaction to eating a particular food. In my practice, I use food challenges to establish that a person no longer reacts to a particular food (“has outgrown the allergy”). If there is some doubt about the diagnosis of food allergy in the first place, it is sometimes appropriate to do a food challenge, but only under medical supervision. In most cases it is obvious whether a child has true allergy or not, from the history supplied by the parents. Blood testing can be helpful in deciding whether a food challenge will be appropriate in showing the absence of allergy.

You can find information on food challenges at http://www.allergy.org.au/images/pcc/ASCIA_PCC_Food_Allergen_Challenge_FAQs_2014.pdfhttp://www.allergy.org.au/images/pcc/ASCIA_PCC_Food_Allergen_Challenge_FAQs_2014.pdf

My child has behaviour problems, and I think he has ADHD. I don't want to give him medications for this. Will changing his diet be enough to help him?

Behaviour problems are occasionally caused by food intolerance. In the majority of people, changing the diet will not be effective. If you want to change the diet, many people start by avoiding all additives (colours, flavours, and preservatives) in foods the child eats. If you want to make other changes to the diet, it is best that you consult a Dietitian experienced in the use of an elimination diet as these can be very restrictive and can lead to poor nutrition. These restrictive diets should not be continued long term, and should always be followed by food challenges to see what exactly affects the child in which way, and will allow a fuller (more complete or nutritious) diet in most children.

What if the Epipen does not "go off" when I use it?

You should make sure you have removed the blue safety cap from the end of the Epipen, and make sure the orange end of the Epipen is applied firmly to the child’s upper outer thigh, and then pressed firmly into the thigh until a loud click is heard. The Epipen should then be held in place for 10 seconds to allow all of the adrenaline to be injected into the child.

Make sure you call an ambulance to take the child to hospital immediately after using the Epipen.

I think my child reacts to Paracetamol syrup. What should I do so I can give my child pain relief?

A child can be given paracetamol (the same active ingredient as Panadol syrup) by dissolving a white Paracetamol tablet in water, then giving the appropriate dose to the child, by mouth. If you crush a single 500mg paracetamol tablet and mix it in 10ml of cooled boiled water, you can give a dose of 2ml per 10kg body weight, every 4 hours as needed. On average, this means that a 12 month old person would have 2ml every 4 hours. A 2 year old weighing 15kg would have a dose of 3ml every 4 hours as needed. A 4 year old, weighing 20kg, would have 4ml every 4 hours as needed. The appropriate dose for your child can be calculated according to weight. You can also get a Compounding Pharmacist to make up unflavoured colour free Paracetamol suspension.

What if my child won't take the special formulas the doctor suggests?

The special formulas made without milk or soy taste very different from normal baby formula. They look “thinner” than normal formula and smell very different. It can take several weeks for some children to take the formulas so the parents need to be very persistent in giving them to the baby. It is best if they are given cool (too warm makes the taste stronger) and best if they are mixed with 2 heaped teaspoons of icing sugar in each bottle. This will not be needed forever. As soon as the child accepts the formula, the parent should slowly start to wean the child off the sugar. I liken it to a teenager starting to drink coffee. As coffee is bitter, the teenager will probably want sugar in the coffee for a while but as his taste “matures” the sugar can gradually be removed. It can be useful to mix small amounts of the new formula into the child’s usual formula and gradually change the balance, increasing the new formula and decreasing the old formula over a few weeks. This will not be appropriate if the child is actually allergic to the old formula (hives or swelling when exposed to the old formula). In that case, the old formula needs to be stopped altogether.

What side effects can I expect if I have desensitisation treatment?

Desensitisation is given in two different ways. There is a chance of side effects with both methods of giving the therapy. Injectable immunotherapy carries a higher rate of reactions in comparison to the sublingual (“under the tongue”) method. The most common reaction to the injections is an itchy lump at the site of the injection. There are some people who have more severe reactions, including a feeling of faintness and some shortness of breath or wheeze. For people who take their treatment by the sublingual method, the most common reaction is some itch under the tongue and perhaps some nausea. It is very unlikely that a person would have a severe allergic reaction to taking their immunotherapy under the tongue. In both methods of immunotherapy, I recommend taking a dose of antihistamine about 30 minutes before the treatment; I also ask that the patient does not exercise for 2 hours after each injection, and I get them to stay under my observation for at least 30 minutes after each injection.

Why shouldn't the other children at school bring peanut butter sandwiches?

If there is peanut butter brought to school, there is a small chance that small amounts of peanut butter will be spread around the school on surfaces. If the allergic child touches some peanut butter, it is likely the reaction would be a skin rash. More severe reactions usually only happen in certain children, if the peanut butter is actually eaten. Smelling peanut butter is not likely to cause a reaction.

What is Eczema?

Eczema is a skin condition, which causes itch, and rash, and is often associated with allergy to dust mite or to foods. In small babies, it often affects the face and the neck. As children get older, the skin in the fold of the elbows and knees is likely to also be affected.

If a person is allergic to Peanut, will they automatically be allergic to other nuts? Why should they avoid eating other nuts?

Children who are allergic to one nut are not necessarily allergic to other nuts. In general I recommend that young children less than 12 months old avoid eating all nuts, even if they allergic to only one nut, as there is a chance of developing allergy to other nuts. There is also a cross reactivity between many nuts, meaning that the body sees the nut proteins as looking similar to each other and in some cases people react to foods they were not known to have been allergic to. It is also not good enough to pick the “bad nuts” out of mixed nuts, or to pick them off cake or other foods. There are still some traces of that “bad nut” left on the food even if the “bad nut” has been removed.

The other problem is that people other than the parents can sometimes get confused about which nuts are safe and which are not, so if a child is allergic to some nuts and not others, it is probably safer to only eat the safe nuts at home, and to avoid eating any nuts when people other than the parents are making the decisions about what is safe to eat.

Will the Epipen work?

Adrenaline always helps to control a severe allergic reaction. In some cases more than one dose is needed. The main thing to remember is that there is less chance of the Adrenaline working well enough if there is delay in giving it. If there is even one symptom of a severe allergic reaction (you need to look at your written Allergy Action Plan) you should give the Adrenaline without delay. IF IN DOUBT, USE THE EPIPEN OR ANAPEN. THERE IS MORE HARM IN NOT GIVING IT THAN IN GIVING THE ADRENALINE EVEN IF IT IS NOT NEEDED.

What causes allergy?

Some people are prone to developing allergy. He reason for this is not fully understood, but it is likely to be due to several different factors in any one person. There is a genetic component in many people (a family history of asthma, eczema, hay fever, “sinus” or food allergy) and if these people are exposed to certain foods or other substances, the body recognizes these substances as “foreign invaders” and sets up a reaction against them, to “fight them off”. These reactions then start to damage the body itself. It is not possible to be allergic to something the body has never been exposed to.

What are antihistamines?

Antihistamines are medications which stop the effect of histamine in the body. Histamine is a “poison” which certain blood cells make. It is released when these blood cells are provoked by exposure to something to which the person is allergic. Antihistamines help to control symptoms of allergic reactions. Some have better effects on itch (mostly the sedating antihistamines) and some are non sedating and better for people who need to continue to work or go to school despite having the medication.

How often do you need to buy a new Epipen?

There is a use by date on the side of each of these devices. Make sure you know when the device expires and get a new prescription before that date. Each of the companies that provide these devices has a “loyalty club” for you to join (“Epiclub”) which will register your auto injector for you and will send you a reminder when the expiry date is getting close.

How do I know when my child needs to go from carrying the Epipen Junior to the adult dose Epipen?

ASCIA recommends that a child should change to having an adult size Epipen when their body weight is 20kg or more, as the Junior Epipen dose would be too small for those weighing more than 20kg.

What is an Epipen?

An Epipen is an Adrenaline auto injector device. It delivers a preset single dose of Adrenaline; it is used for the treatment of severe allergic reactions, prior to the patient being taken to hospital. Each auto injector unit can only be used once and then needs to be discarded. In some cases a person needs to be treated with more than one dose of Epipen.

What is an Epipen?

An Epipen is an Adrenaline auto injector device. It delivers a preset single dose of Adrenaline; it is used for the treatment of severe allergic reactions, prior to the patient being taken to hospital. Each auto injector unit can only be used once and then needs to be discarded. In some cases a person needs to be treated with more than one dose of Epipen.

What is Asthma?

Asthma is a common respiratory illness, involving inflammation and tightening of the small lung passages. Often people with asthma have cough and wheeze with exercise or with colds and flu like illnesses, but children can have asthma without wheeze. I become suspicious that a person may have asthma if they have cough in the middle of the night for a few weeks at a time, or if they cough with exercise, particularly in the late afternoon if it is cold. Some children will limit the amount of exercise they do so they do not have symptoms, so looking at their ability to keep up with the other children at school when they exercise can often give a hint the child may have asthma.

Should I have more than one Epipen for my child?

This question is difficult to answer as every child and every family is different. It very much depends on the history of the person in question; if they have required more than one Epipen to be used to treat any one allergic reaction, then the child should have at least that many Epipens available to treat future reactions. There has been a suggestion that children with difficult to treat asthma should carry more than one Epipen, as there is a risk of around 20% that the child will need to have treatment with 2 or more adrenaline injections in any one allergic reaction. Nonetheless, the Federal Government Pharmaceutical Benefits Scheme allows for the subsidised purchase of only 2 adrenaline auto injectors to be held by a family at any one time for any one child (one for home and one for school). If the parent wants to purchase more then the family will need to buy the extra auto injector devices privately form the Pharmacy, at full cost.

Why do I have to go to hospital with my child if I have given him or her an injection of Adrenaline with the Epipen/Anapen? Why can't I stay at the GP's office?

There is a chance the person will need more than one injection of Adrenaline, or other treatments for any particular severe allergic reaction. For that reason a person should be observed carefully in hospital for at least 4 hours after any reaction to ensure they are not becoming sick again, or needing any extra treatment. Staying in the waiting room of the doctor’s office does not give the proper amount of direct observation, and does not allow for the person to lie down and rest. More equipment and staff are available at a hospital to treat a person with a severe allergic reaction, than at the average GP’s office. I recommend that if a person goes to a GP to have treatment of a severe allergic reaction, the GP should call an ambulance to transport the patient to hospital as soon as practical after the appropriate emergency treatment has been administered.

If my child has asthma, and needs to be treated with Adrenaline, how long should he or she stay in hospital?

A person with asthma has a 20% chance of needing a second dose of Adrenaline to treat any severe allergic reaction. I recommend that these children stay in hospital for a full 12 hours observation to ensure there is no need to treat them again with Adrenaline, for a rebound or “late phase” reaction.