Q:

6/25/2013
I recently was asked to consult on whether epipen is indicated. Pt is a 3 yo who has never been stung by bee. She has mild allergic rhinitis and only had wheezing once with pneumonia in 2011 and not since. Her father recently decided to be an amateur bee keeper; he had been stung once with local reaction and was given an epipen by his internist. He requested an epipen Jr for his daughter and his pediatrician informed him that it is not indicated unless his daughter has had a systemic allergic reaction to bee. Thus he wanted a second opinion by an allergist.

He stated that his other bee keeper friends had been given epipen for every family member. Please give me your advice. I know the parameter guidelines with the general population, however since this family keeps bee hives, I struggle with the decision. I understand that children tend to have milder reaction than adult. Thank you.

A:

Thank you for your inquiry.

There is no “right or wrong” answer to your question, and there is no consensus guidelines to assist you in making a decision. Therefore one is simply left to one’s own personal judgment. Thus, my answer to you should not be considered a dogmatic response, but only how I personally might respond to the request.

I see no problem in giving this father an automatic epinephrine injector for his child. It is highly unlikely that he will need the injector, but its use would not put the child in danger, and the father’s reassurance regarding his child’s potential safety is sufficient reason to prescribe the injector in my opinion. And should the unlikely occur, and the child did need the injector, the consequences due to its absence could grave.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology