In season two, episode one, of Showtime's series, Billions, Lara Axelrod is at her children's school when she spots a small crowd of kids gathered around a girl lying on the floor outside the nurse's office.
The girl struggles for breath, her face is covered in red blotchy spots, and her forehead dotted with perspiration. The nurse is on the phone calling emergency personnel, saying the girl came into her office complaining of nausea, then she vomited. The nurse tells Lara the girl is having a seizure.
“She's in anaphylaxis," Lara says with certainty as she kneels next to the girl and searches her backpack for the girl's EpiPen. Lara finds it while the camera focuses on her face and the squirming girl on the floor trying to breathe. She presses the Epipen into her thigh.
“Listen, you're having a reaction," Lara tells the girl, “but I gotchyou."
In the midst of this commotion, there's a moment when the viewer sees the nurse's eyes widen in horror as she realizes she failed to recognize anaphylaxis. The scene is particularly compelling because it touches on a universal fear most of us have—that we wouldn't know what to do if we were with someone else's child having a life-threatening allergic reaction.
The fear is understandable. When I first learned our first child was allergic to peanuts and tree-nuts and the concept of an EpiPen was new to me. I imagined scenarios of having to save his young life, raising my arm, EpiPen in hand, ready to jab his thigh to administer an injection of adrenaline as he clutched his throat with both hands.
I was relieved to learn you don't ever jab an EpiPen, but rather, hold it to the person's thigh and press.
I see a similar fear in the eyes of the parents of my son's friends when I drop him off to play at their house for the first time. I dread this moment. It's awkward. I try to defuse the moment by saying you probably won't use it, but he needs to have it with him just in case.
My wife and I have three children with food allergies and are fortunate they are not as severe as other children's reactions. We're fortunate that we've never had an episode.
At some point, active parents who volunteer in the community will be with children who have been prescribed an EpiPen because of allergies to bee stings, food, latex or another trigger. The idea of being with someone else's child experiencing a serious allergic reaction can be an overwhelming concept. Knowing the signs of anaphylaxis and how to administer an EpiPen can reduce some of the associative fear of using one.
“Some people hesitate to give the EpiPen because they are unsure if a serious reaction is happening," says Dr. Jalkut, M.D., of Pediatric Healthcare Associates. “Many parents ask if they can give Benadryl and wait and see before giving epinephrine."
Especially if the child has had a reaction before, and an adult suspects a serious allergic reaction, “it is imperative that epinephrine be given as soon as possible." Dr. Jalkut stresses that “epinephrine helps to give time to get to the hospital. Benadryl is not a substitute for epinephrine."
Know the signs of anaphylaxis
Some indications can vary and reactions can take many forms, but you should take the following symptoms seriously:
- Trouble breathing
- Hoarse voice or wheezing
- Hives, a raised rash that itches
- Severe itching or flushed (red) skin
- Swelling of face, lips, mouth, or tongue
- Fast heart beat
- Weak pulse
- Feeling very anxious
- Vomiting and abdominal pain
“Another clear sign of anaphylaxis is if symptoms involve two systems," says Jalkut, “like hives and vomiting, or wheezing and abdominal pain."
The nurse in the scene from Billions made an especially egregious error when you consider the girl having the allergic reaction exhibited multiple signs from two systems. If you suspect a child is going into anaphylaxis, first call 911 then administer the injection.
How to administer an epinephrine auto-injector
- Flip open the cap and slide the EpiPen out of the tube.
- Pop off the blue cap, keeping your hand away from the orange tip where the needle comes out.
- Form a fist around the EpiPen. Hold the child's leg in place with your free hand. Place the orange tip to the side of the child's thigh and press until you feel and hear a click. Hold in place for three seconds.
- Release the EpiPen and massage the place where the injection occurred for 10 seconds.
Remember: Anytime a child has received an EpiPen, they need to go to the hospital afterwards to make sure everything is okay. Despite the valid anxiety that lives in the mind of most guardians, you will be equipped to react to a child in anaphylaxis like Lara Axelrod if you remember the signs and the simple steps of how to use an EpiPen.