After a severe allergic reaction to dairy products left two-year-old Marko Vucinic hospitalised, his mother, Ms Elizabeth Socolow, never leaves home with him now without an epinephrine auto-injector.
This easy-to-use device is self-administered or handled by an adult in the case of, say, a child.
When a person gets an acute allergic reaction, or anaphylaxis, the drug epinephrine helps prevent his blood pressure from dropping and stabilises severe respiratory distress, said Dr Bernard Thong, the head and consultant at the department of rheumatology, allergy and immunology at Tan Tock Seng Hospital.
'I now carry it as a precaution. I have yet to use it and I hope I never have to,' said Ms Socolow, 40, a banker.
'People who have a history of anaphylaxis to food, insect venom stings or no specific causes should carry the epinephrine auto-injector and at the same time, avoid the triggers as best as possible,' said Dr Thong.
Dr Dawn Lim, consultant paediatrician at Kinder Clinic, said that the epinephrine auto-injector is also suitable for those who, having taken an allergy test, have a high chance of an anaphylactic reaction to particular food items they have yet to consume.
Dr Thong emphasised that even after the injection is used, an ambulance should be called immediately to get the victim to a hospital.
Ms Jenny Huang, founder of support group Food Allergy Singapore, noted that one in five victims will suffer a second anaphylaxis reaction - possibly more severe than the first - hence the urgency of getting to a hospital for observation.
Dr Lim said the epinephrine auto-injector is the only medication that is effective for the symptoms of anaphylaxis, provided the device has not passed its expiry date.
'Anaphylaxis can happen rapidly and it can lead quickly to death if not treated promptly,' said Dr Lim.
An author of one study, Dr Moshe Ben-Shoshan of McGill University Health Centre in Montreal, has been quoted as saying that research found that the main factor in whether an anaphylactic reaction was fatal depended on whether the person was carrying an epinephrine auto-injector.
He said that ideally, a shot of epinephrine should be given within 10 minutes of the start of an anaphylactic reaction.
Epipen, one company that produces the injectors, said the side effects include irregular heartbeat and nausea.
'If the correct dosage is given, the side effects are fairly minimal,' said Dr Lim.
Mum never leaves home without two injectors
Ms Julia Chou carries not one, but two epinephrine auto-injectors even though her son, Ryan Hayashi, three, has never had a severe allergic reaction that required their use.
The housewife, who is in her 30s, said she carries them for ease of mind.
'My son is allergic to peanuts, tree nuts, eggs and seafood and will break out in hives when these are eaten,' she said.
So, should anything happen to Ryan, Ms Chou is well equipped to handle the situation.
She recalled the first time she witnessed Ryan's allergic reaction to peanuts.
'When he was one, we went to a Thai restaurant and Ryan dipped his fingers into a bowl of peanut sauce. I thought I had wiped it all off, but a few minutes later, he broke out in hives,' she said.
The epinephrrine auto-injector was then prescribed by their doctor in the United States, where they were living then.
Another reason Ms Chou carries two is her fear that the first epinephrine auto-injector may wear off before he reaches the hospital.
'I've heard that sometimes, after 15 to 20 minutes, it can wear of,' she said
Ms Chou has yet another fear: 'I know of someone who injected herself accidentally while trying to hold her daughter down.'
She said the injector is relatively easy to use.
'The brand I carry comes with an instruction manual and has a training injector that does not have a needle so we can practise with it,' she said.
Each injector costs $180, Ms Chou added.
'Luckily, insurance covers most of the cost or else I would think they are a bit expensive, especially when they expire within a year or so. We have four at all times, two for his school bag and two that we carry with us,' she said.
Ms Chou may be well prepared should Ryan have an anaphylactic reaction, but she noted that not all pre-schools are.
She had difficulty finding a pre-school prepared to administer the injector should Ryan require it.
'Most of the pre-schools I called have never heard of an epinephrine auto-injector and some even said they could not administer any medication to children,' she said.
After calling 15 schools, she managed to find one willing to teach its entire staff the use of the epinephrine auto-injector.
'I wouldn't feel comfortable if they were not familiar with how severe and life-threatening food allergies are,' she said.
This article was first published in Mind Your Body, The Straits Times on July 30, 2008.
