Friday, November 4, 2011

The Milk Incident of New Year's Day 2011

I've posted this elsewhere, but it definitely has a place on this blog.  It's a cautionary tale that, thankfully, has a happy ending.  It's a long one, so get comfortable.  (I guess I don't ever have short posts, do I?)

On New Year's Eve, I made my daughter (who was a little over 2 years old, at the time) a loaf of bread in the bread machine.  I wanted her to have a nice treat for the next day.  We didn't get to celebrate Christmas with my husband's parents, the previous week, because we were all sick.  New Year's Day was to be the "redo" day.  So, that morning, I gave my daughter a slice of her "special" bread and a while later, she was acting clingy and fussy and itching all over.  She had been itchy these past few days, but when my husband lifted her shirt, I saw a familiar-looking rash on her side.  He asked what we had given her that was different and I said, "nothing..."  He asked about the bread and said it was the same kind I used a while back.  I went and dug around for the box in the trash and realized that I had bought the same brand, but not the same variety.  This time, I got the "sandwich bread" mix, and right there on the ingredients list, like a slap in the face, the words "whey (milk)" and "Contains: Milk" are staring at me!  I felt like a complete idiot.  I had read the directions on the back, which call for eggs and I used egg substitute, of course, but I didn't even read the side panel, since I thought it was already cleared as "safe".  My poor girl was itching and itching and whining and moaning.  The last time she had milk, it was in the form of goat's milk yogurt, and it made her throw up.

I was waiting for her to hurl, any moment, but instead, she was very fussy and began crying/screaming.  She was scratching at her neck/throat and I asked her if her if there was something wrong with her throat and she said "my throat itches".  I started to panic a bit, on the inside, and went to the cabinet and got the Benadryl.  As I said, usually her milk allergy manifests in vomiting/eczema, so I wasn't sure if the skin on her neck itched, or if something was going on inside.  I gave her 1/2 tsp. of Benadryl (which should have been 1 tsp. for her weight, but I didn't know that, at the time) and did her "puffer" (Flovent).  I sat with her and watched her like a hawk.  She was crying/screaming, still, and I was trying to get her to stop crying, because her nose was already stuffy and she was very snotty and couldn't breathe out of her nose.  Then, in between loud cries, she lay herself on the floor and grabbed at her neck and was wheezing a little.  I grabbed her and got the diaper bag and some of her milk (hemp milk) and told my husband we had to go to Pediatric Urgent Care - NOW.  I debated about using the EpiPen, but didn't want to overreact.  We live 4 minutes from Little Spurs Pediatric Urgent care, and luckily they had just opened and we were the first ones there...My sweet baby cried all the way there, and as much as I hated to hear it, I was glad, because it meant she was breathing.  I knew it wasn't a guarantee, though, that she was breathing well and getting enough oxygen.  

When we got there, I explained that my daughter had a Class 5 allergy to milk and that I had given her bread with milk in it, by mistake, and she was having trouble breathing.  They took her in right away and, sure enough, her pulse ox (oxygen saturation) was 87 (It should be 95 or higher).  They brought in a mask and gave her some oxygen.  As I was holding her, they told me that if they couldn't get her oxygen levels up, they would have to transport us to the ER via ambulance, because we are not allowed to drive ourselves there, for safety/liability reasons, I presume.  I was fighting back the tears, but pulled it together, for my daughter's sake.  Meanwhile, she was resting her head, peacefully, on my chest, breathing her oxygen without any fuss, which is good, but unsettling, because she was "too" cooperative, if you know what I mean.  They tested her, again, though, and her oxygen levels were on the rise! Thank goodness!  They brought in some albuterol, to do a breathing treatment and her levels got even better.  They then gave her prednisolone (oral steroid) and she was such a good girl, taking her medicine, without any fuss.  By this point, she was talking, counting the apples painted on the floor, and otherwise fine.  The doctor was skeptical, though, when I told her the milk did this to her, because she said given her history of vomiting/eczema, that it would be odd for just milk baked into something to have caused such a reaction.  She asked if my daughter had mountain cedar allergies and I told her that I think the blood tests only covered food allergies (and a few environmental allergens like mold) and she said the mountain cedar levels were very high, right now, and causing a lot of respiratory issues, around town.  Also, she had been sick and was on her last day of antibiotics, so that didn't help.  I guess it was a combination of many factors, but my mistake certainly put my poor sweet angel over the edge and I felt terrible.  (Edited to add: No, it was not "mountain cedar", it was an anaphylactic reaction!  Reactions are unpredictable and past reactions give you no indication of what a future reaction will be like...)

In retrospect, knowing what I know now, it was definitely an (Edited to add: anaphylactic) allergic reaction, because she had the tell-tale signs: itching, stomach discomfort, nasal congestion, wheezing, etc.  The reaction was complicated by other factors, but it was still an allergic reaction.  I now know that you cannot predict future reactions, based on past reactions.  Just because she had reacted with only eczema and vomiting in the past, did not mean that she would react the same for each future reaction.

After the commotion, I was talking with the nurse and asking if I should have used the EpiPen.  She said I could have and it would have been an acceptable thing to do.  In this case, her airways weren't closing very rapidly and she was OK without it, but she said, the thing is, you never know how much time you have, with an allergic reaction situation and it's best to err on the side of caution.  The silly thing is that I had just read an article, two days ago, from Kids with Food Allergies, about the EpiPen and how it's not as scary as it seems, and the needle is REALLY small, even though it comes in this huge dispenser.  The needle is way smaller than those used for vaccinations and delivers a very small dose of medication.  Even so, I was still hesitant to "pull the trigger" when the time came.

She said, in the future, if there is a known ingestion of an allergenic food, with any breathing difficulty, the process is to administer the EpiPen, and then head straight to the ER.  We now know that we should, instead, call 911 and they can take us to the ER.  We should also request that they bring epinephrine, since they don't always have it on hand.

We explained that my daughter has been on oral steroids and breathing treatments, before, but all stemming from viruses, and she said in those cases, we should go to the ER, but the EpiPen is not necessary.  That's just for acute allergic reactions.

They gave us a home nebulizer, to administer treatments every 4 hours, for the next day or so.  They were surprised that we didn't already have one, but I guess since we had the puffer-spacer for the Flovent, we didn't think we needed one, which obviously wasn't right, since Flovent is not for rescue purposes.  Well, now we have one, so that's good.

Meanwhile, my husband's parents had arrived at our house and when we got back home, my daughter was perfectly fine and you couldn't tell what a harrowing morning she had.  Since she was on the oral steroid (and due to all the excitement) she skipped her nap, and got to spend some quality time with Grandma and Grandpa.  We all opened our presents and had a really great time.  The Benadryl and oral steroid cleared up her runny/stuffy nose and cleared up her skin like magic, and she's was in better condition that she was the day before, so there is a silver lining, but I'm wasn't too happy about the route we took to get to that point.  I keep trying to tell myself that it's just good that I reacted quickly and was able to get her treated early and with little residual effects, but I can't help kicking myself for making the mistake in the first place.  I know it's all a learning experience, but it breaks my heart that these lessons are learned at my daughter's expense.  It's unsettling to know that my mistakes can affect her health so severely.  I'm so thankful, though, that she is such a strong little girl and bounces back so well and still has smiles for me every day.

Part of my reason for sharing this whole ordeal is to let people know that if you have a child with severe food allergies, who has a bad reaction to a food, don't hesitate to administer the EpiPen!  I didn't do it, in this case, but I was very lucky that we were seen quickly, and that she only ingested a small amount of baked milk protein, etc.  The EpiPen is just a medicine, and the needle is very thin and you can administer it through a pant leg, in an emergency.  If they don't "need" it, it will most likely not hurt them and if they DO need it, it can save them.  I think my problem is that I envisioned the scene from "Pulp Fiction" where they inject Uma Thurman's character in the heart with an adrenaline needle as long as my arm.  The Epi Pen is nothing like that and my daughter, in her distress, would probably not even notice it.  I won't be jabbing her for every cough, but if the time comes again (and I hope it doesn't), I'm going to use it.  I have to keep telling myself that it's OK, and that's what it's there for, and it helps more than it hurts.

For more information on epinephrine and anaphylaxis, please see my "Important Information" post. 


  1. We have an EpiPen and I'm also hesitant to use it. Thankfully, we haven't needed to, although we've been close. I enjoyed reading this recap to find that other moms are also fearful of the EpiPen. I know when I do need to use it, I will as it may mean saving my child's life.

  2. Been there! I have two girls with severe food allergies, we have had our share of trips to the emergency rooms. On two occasions, one with each child, I have asked the same question to the medical staff at the hospital, both times I was told that using the Epi-pen would have been appropriate in that particular situation. I can not tell you how guilty I have felt for not using it. Both times I was hovering with the pen, looking for the "sign" to use the pen. Not sure what I was waiting for, but I have promised myself that I will not hesitate next time. I want and must teach my girls not to be afraid of their Epi-pens, one day I will not be there with them and they will have to make the call for themselves. Fear cannot come in to play!

  3. Thank you so much for your comment! I am so glad you've found my blog and I hope it can be of some help. I wish the best for you and your daughters!