Anaphylaxis at an expo – lessons to be learnt

One of our subscribers shares their story of when their 3-year-old had anaphylaxis while the family was at the Free From and Allergy Show in 2019. Something can be learnt from every allergic reaction and this family kindly shares the valuable lessons they took away from their experience, including when it comes to food or drink, you can never presume anything. Always ask about ingredients in food AND drink.

---

Our son Thomas, who is now 8 years old, was diagnosed with eczema when he was 1 year old and then allergic (at risk of anaphylaxis) to peanuts, tree nuts and kiwi fruit from a very early age. We understood that we would need to educate him early as this was likely to be a permanent aspect of his adult life. Upon receiving news that an allergy awareness expo (Free From and Allergy Show in 2019) was being hosted at the Melbourne Exhibition and Convention Centre, we thought it’d be a great opportunity to take Thomas along (3 years old at the time) and learn more about the management of food allergy.

It was nearing lunchtime when the unthinkable happened. I look back now and want to share our story and our learnings to educate others who may be in a similar situation.

It was a typical family outing day where we’d pack our bags and pram with the usual kid needs, snacks, drinks and most importantly, Thomas’s adrenaline injector and ASCIA Action Plan for Anaphylaxis. We had arrived at the expo and all was going well, chatting to people at various stands and learning a thing or two we hadn’t yet encountered. We visited the food stands in the venue for some lunch but did not find anything of interest. Dad went to find other food options outside the venue whilst Thomas ate his food from home and Mum and Dad could eat something purchased. It was inconvenient for me to push the pram and walk with Thomas, so Dad took the pram with him as he ventured out looking for food options. Thomas and I continued to look at various stands and we stopped at a stand that had coconut milk. I knew Thomas was fine with coconut as he had eaten it before. A few minutes after Thomas had a sip of the coconut milk, he looked a bit upset and I went back to the stand to check the ingredients. Unfortunately, the label had cashew listed as an ingredient, which Thomas is allergic to. 

As Dad waited for his food order, I called him saying I suspected that Thomas was having an allergic reaction because his lips had slightly puffed up and he was a bit upset. It was at this point that we realised the emergency medical kit was in the pram and Dad was still some 20 minutes walk away from the expo. Dad ran back to the expo with the pram as quickly as he could and arrived back at the venue with the adrenaline injector, completely puffed out and barely able to stand or even talk. I sought medical assistance inside the expo from a lady who had educated us at the start of the expo on allergy management. To our luck, she escorted us, with me cradling Thomas in my arms, to the Allergy & Anaphylaxis Australia (A&AA) stand. A&AA had apparently discussed with organisers the risk of anaphylaxis happening at the show, so there was a plan in place.

Two of the A&AA team were registered nurses and they sprang into action. The CEO and the Allergy Educator tried to calm Thomas on the floor as Dad handed them the adrenaline injector. I sat on a chair watching what was happening and answered questions I was asked. Triple zero was called and paramedics were on their way while the EpiPen® was given to Thomas, who was upset and coughing. The nurse got Dad to lie on the ground with Thomas to help keep him calm, while I sat close by in shock at what was happening. The nurses asked a few questions and with some further investigation I told them the coconut drink contained cashew. Who would have ever thought a drink would contain cashew?

Our son started to settle a bit as the adrenaline kicked in, and I recall many helpful staff assisting, with one grabbing a kid’s story book, a little stress-toy dinosaur and a helium balloon to try to entertain and distract Thomas whilst the ambulance made its way to the Melbourne Exhibition and Convention Centre.

When queried about what triggered this anaphylaxis, I explained Thomas had tasted a sample from the plant milk stand. I didn’t recall seeing any allergen warning at the stand and because I did not expect allergens to be given as samples at the allergy expo, I gave our son a sip of it thinking it was just coconut milk. We later learned that the product had cashew nuts as an ingredient, which likely caused the allergic reaction. I now understand that my presumption about no allergens being at the allergy show was not realistic. What is an allergen for my child is a health food for another child with a different food allergy.
 
The ambulance arrived and the paramedics administered more adrenaline before loading us into the ambulance and going to the Royal Children’s Hospital.

After being assessed, we were admitted and stayed in the hospital for approximately 5 hours to ensure there wouldn’t be a relapse of the anaphylaxis, before being discharged.
 
We were very fortunate in this case to have received help when we needed it most. Being part of this incident first-hand really gave us a clear understanding of what a reaction looks like and how to respond should the situation arise again. 

My husband and I learned a few things that day:

• When it comes to food or drink, you can never presume anything. We always need to ask about ingredients in food AND drink whether at an expo, café or restaurant.
• We always need to check that the person who has Thomas also has the emergency medicine at all times.
• Being calm in an emergency helps, even in an exhibition hall with hundreds of people walking around.
• The EpiPen® is not something to be feared. The nurse gave it quickly and then continued to watch Thomas closely.
• It’s important to follow instructions on the ASCIA Action Plan even AFTER you have given the EpiPen®.
• Although Thomas looked like he was improving, the paramedics listened to his chest and gave him another dose of adrenaline.
• Even though the nurses were anxious when managing the anaphylaxis, they remained calm, spoke to us and Thomas and reassured us that Thomas was going to be OK.