Tag: allergies

What is Triggering Your Child’s Hives?

Learn how to treat your child’s hives, which could have been triggered by a food, drug, or recent viral infection.

Has your child ever had hives?

What was the first thing you thought of?

If you’re like most parents, it is likely what your child had recently eaten, thinking that is most likely to be what is causing their allergic reaction.

Hives can be scary, because they can appear suddenly all over your child's body. They are one of those things that typically looks worse than it is though.
Hives can be scary, because they can appear suddenly all over your child’s body. They are one of those things that typically looks worse than it is though. Photo by Sussman et al (CC BY 4.0)

It is important to remember that there are many more things in addition to food allergies that can cause hives in kids though. These include medications, infections, exposure to the sun, and for some kids, even physically stroking their skin, which is called dermographism.

What are Hives?

A hive on your child's lip is much different from swelling inside their mouth and throat.
A hive on your child’s lip is much different from swelling inside their mouth and throat. Photo by Sussman et al (CC BY 4.0)

Hives are a type of allergic or immune system reaction that occurs when something triggers the release of chemicals, including histamine, from cells in a child’s body.

Hives are usually harmless if they are the only symptom your child is having.

Unfortunately, children with hives and more severe symptoms, such as wheezing, difficulty breathing or swallowing, or swelling in their mouth or throat, may have anaphylaxis – a life-threatening allergic reaction. These children need immediate medical attention.

Symptoms of Hives

In addition to their typical appearance as red or pink raised areas on your child’s skin, hives are usually:

  • itchy
  • seen alone or are in groups
  • varied in size, with some being smaller than your child’s finger tip and other’s larger than a half-dollar size. Also, hives can often merge or join to form even larger hives that, for example, can cover half of your child’s abdomen.
  • temporary and come and go over several hours. They often don’t go away completely though. Instead, old hives go away in one part of your child’s body, while new ones continue to appear somewhere else. Any individual hive shouldn’t last more than 24 hours. If it does, then your child may have a similar skin rash, such as erythema multiforme, and not simple hives.

Less commonly, hives can sting, be painful, and can leave bruises on your child’s skin.

Kids with hives may have additional symptoms depending on what is triggering the hives. For example, if a viral infection is causing the hives, then they may have a sore throat, runny nose, and/or cough.

What is Triggering Your Child’s Hives?

Although some things, such as certain foods, commonly cause hives, keep in mind that almost anything can trigger hives.

Common causes of hives can include:

  • foods, especially peanuts, eggs, tree nuts, milk, shellfish, wheat, and soy
  • medications, especially antibiotics like penicillin and sulfa drugs
  • additives in foods or medications, such as the food dye tartrazine (Yellow No. 5)
  • infections, especially viral infections
  • insect bites and stings
  • latex
  • exercise
  • stress
  • exposure to heat, cold, or water, no matter what the temperature is
  • dermatographism, a physical urticaria, in which hives are triggered by stroking the skin, such as by scratching

How do you figure out what is causing your child’s hives?

It can be hard.

To help figure it out, keep a diary of all of your child’s medications and everything he recently eat or drank, shortly before breaking out.

Allergy testing is sometimes necessary to figure out what is causing hives, especially if your child’s hives are not going away or they keep getting hives over and over. Fortunately, most kids don’t need testing for their hives, and unless the trigger is obvious, like when it follows eating a peanut butter and jelly sandwich or they are on Amoxil for an ear infection, there is a good chance that they won’t get hives again.

Treatments for Hives

Since hives are caused by the chemical histamine, it makes sense that you would treat them with an antihistamine medication, such as diphenhydramine (Benadryl). Other sedating antihistamines that are sometimes used to treat hives include hydroxyzine (Atarax) and cyproheptadine (Periactin).

Non-sedating antihistamines, including Allegra, Claritin, Clarinex, and Zyrtec, are also used to treat hives, expecially hives that last longer than 6 weeks.

Less commonly, a child may need a steroid to treat his episode of hives.

Other treatments, especially for chronic hives, can sometimes include doxepin (Sinequan), an antidepressant that can work as a potent antihistamine, montelukast (Singulair), and medications such as ranitidine (Zantac) or cimetidine (Tagamet), which are more commonly used to treat reflux.

In some cases of persistent hives, your pediatrician might recommend that you give your child multiple medications, for example, both Zyrtec and Allegra, with Zantac!

Of course, the best treatment for hives, whenever possible, is to remove and then avoid whatever has triggering them.

What You Need To Know About Hives

Hives are not considered chronic or long-term until they last for six weeks or longer. Chronic hives are rarely caused by food allergies. In fact, triggers for chronic allergies are only found about 20 percent of the time.

What if no cause is found for your child’s chronic hives? Then your child has idiopathic hives, which should eventually go away.

What else should you know about your child’s hives?

Individual hives are also called welts (not whelps, a common misspelling for welts) or wheals.

It is a common myth that it has to be something ‘new’ that is causing your child’s hives, as it is much more common that your child has had something two, three or more times before it finally triggers hives.

And although an allergic reaction to a food is usually fairly quick, occurring within minutes to hours, it may take days or weeks for an antibiotic to trigger hives in your child. Your child might not even break out until a few weeks after finishing their last dose!

Also keep in mind that a pediatric allergist and/or pediatric dermatologist can often help your pediatrician figure out what is causing your child’s hives.

More on Your Child’s Hives

Options During the Epinephrine Shortage

Although there are still shortages of epinephrine, you have more options than you might think.

Of the medicines that you would hope that we would never run out of, epinephrine is probably on the top of the list for many people.

Unfortunately, many parents are still stuck dealing with shortages and delays of epinephrine injectors.

Why?

“The purpose of this letter is to inform you that in a very small number of cases, some EpiPen® 0.3 mg and EpiPen Jr® 0.15 mg Auto-Injectors, and their authorized generic versions, may not easily slide out of their carrier tube, which could delay or potentially prevent use of the device during an emergency.”

Dear Healthcare Provider Letter for Potential Label Defect of EpiPen Auto-Injectors and its Authorized Generic

For EpiPens, there was a problem with the labels on the injectors so that “in a very small number of cases, labels were not fully adhered to the surface of the auto-injector such that the device label may become stuck to the inside of the carrier tube.”

And for the Adrenaclick generic injectors, “Some lots of Epinephrine Injection auto-injector have passed all levels of inspection and met product specifications at the manufacturing facility, but have been found to contain particles upon further inspection.”

So both are now suffering from manufacturing delays after fixing these issues.

Luckily, most still have options for their kids with severe allergies.

Options During the Epinephrine Shortage

Can’t get your child’s prescription for epinephrine filled?

“Currently, EpiPen, EpiPen Jr and Adrenaclick remain in either a spot shortage or constrained supply.”

Alert – Epinephrine Shortage Update September 17, 2019

One of the first things to keep in mind is that the FDA has allowed for temporary extensions of expiration dates:

So check the NDC number and the original expiration date and see if you even need a refill yet.

The FDA has allowed for temporary extensions of expiration dates for some epinephrine injectors.

Next, know that many more versions of epinephrine are available than ever before!

If you can’t refill your child’s prescription because your pharmacy doesn’t have it, you might ask them which form of epinephrine they do have in stock, and then ask your pediatrician if you can use that version.

There are now six forms of epinephrine injectors available (with three that may be hard to find), including:

  • EpiPen, EpiPen Jr – coupon – the auto-injector with the notorious reputation for the $670 retail price tag
  • Epinephrine injection (EpiPen, EpiPen Jr authorized generics) – coupon
  • Epineprhine injection (EpiPen, EpiPen Jr Teva manufactured generics) – coupon
  • Adrenaclick Adult, Child authorized generic – coupon – this is the epinephrine auto-injector that is available for $109.99 at CVS
  • SYMJEPI 0.3mg, 0.15mg – coupon – a new epinephrine pre-filled, ready-to-use device – not an auto-injector!
  • Auvi-Q – financial support – the epinephrine auto-injector that talks to you and has the notorious reputation for the $5,000 retail price tag

Whichever version you get, if you have commercial insurance without a high deductible, the coupon will likely cover your copay.

There are now six versions of epinephrine injectors available for children and adults with severe allergic reactions.
Can your pharmacy get you the Teva manufactured generic EpiPen or EpiPen, Jr?

And in a worst case scenario, if necessary, use an expired epinephrine injector, even if it is out of range of an extension, and seek immediate medical attention.

“If an in-date auto-injector is not available, it is better to use an expired auto-injector than to not give epinephrine.“

Expired Epinephrine Can Still Save Lives

Still confused?

Hopefully you won’t be when you need to use your child’s epinephrine injector!

One very big issue with so many different types of epinephrine injectors is that their instructions for use are a little different.

“There are several different epinephrine auto-injectors available – Mylan EpiPen and Mylan Generic, Auvi-Q, and Adrenaclick; these auto-injectors have different steps for use.”

How to Use an Epinephrine Auto-Injector

We can also hope that once the shortages are resolved, a little competition will bring down the prices of all of these drugs, as even the generic EpiPens are at least $300!

More on Options During the Epinephrine Shortage

Get Control of Your Child’s Allergy Triggers

Identifying your child’s allergy trigger or allergy season won’t make them away. It can help you learn to avoid or control them though, or at least help get prepared by starting your child’s allergy medicines before he is exposed.

What’s triggering your child’s allergies and asthma?

Is it the cat?

The roses she loves to smell?

The dust on all of the stuffed animals in her room?

The Cottonwood tree blooming in the yard next door?

How do you know?

Identifying Allergy Triggers

Roses are not a common allergy trigger.
Roses are not a common allergy trigger.

If your other kids are dog lovers, they are probably voting for the cat, but depending on the time of year, her pattern of symptoms, and where you live, there could be plenty of candidates.

One thing you can check off your list – the roses.

Allergies are typically caused by pollen from trees, grasses, and weeds – not other types of flowering plants, like roses, geraniums, or begonias, etc. These “allergy-friendly” plants don’t produce much pollen. Other plants with flowers that are said to be fairly non-allergenic include orchids, pansies, petunias, snapdragons, and zinnias, etc.

“Brightly colored flowers that attract bees and other insects or humming birds are generally not allergenic.”

Michael J. Schumacher, MB, FRACP, The University of Arizona

In general, plants with wind-borne pollen can trigger allergies.

Are your child’s allergies better after it rains? Since heavy rains can lower pollen counts in the air, that could be a hint to a seasonal allergy trigger.

What about when it is dry and windy? Does that make your child’s allergies worse? Since pollen is carried by the wind, a dry, windy day will likely mean that there is more pollen in the air, which is another hint to a seasonal allergy trigger.

Do your child’s year round allergies quickly get better when he is away from home for a few days or weeks? That could be a hint to something inside your house being a trigger, although if he traveled far away, to another area of the country, it could simply mean that he wasn’t exposed to the same pollen in the air.

Understanding Allergy Triggers

Year round, or perennial allergy symptoms, are likely caused by things inside your home.

If your child’s allergies only seem to be bad at very specific times of the year, then pollen from grasses, trees, or weeds could be the trigger. Which pollen is high in your area when your child’s allergy symptoms are acting up?

Allergy testing is always an option if your child’s allergies are hard to control, either skin testing or a blood test.

Indoor Allergens That Trigger Allergy Symptoms

Year round allergy symptoms can often be caused by things in your home:

  • Cat and dog dander
  • Dermatophagoides farinae and pteronyssinus (dust mites)
  • Mice (mouse allergens/mouse urine proteins)
  • Cockroach saliva, feces, and body parts (cockroach allergens)

While allergy testing can help you figure out which to blame, if you don’t have any indoor pets and can eliminate mold in the house, then maybe you can blame dust mites.

Weeds That Trigger Allergy Symptoms

Most people think of ragweed as the classic weed that can trigger seasonal allergies. Often described as being “packed with pollen,” each ragweed plant produces up to one billion pollen grains each season! These ragweed pollen grains are carried by the wind and can trigger allergy symptoms from early to mid-August through September and October – fall allergy season.

Others weeds that commonly trigger allergies include:

  • nettle
  • mugwort
  • Russian thistle (tumbleweed)
  • plantain
  • Rough marsh elder
  • Rough pigweed
  • Sheep sorrel

Again, if necessary, allergy testing can help you figure out to which weed your child is allergic, but if their allergies peak in the fall, it is likely triggered by weeds.

Trees That Trigger Allergy Symptoms

Which trees are most likely to trigger allergy symptoms?

It depends on where you live, but in the spring, mountain cedar, pecan, elm, maple, birch, ash, oak, and cottonwood, are common offenders.

If you are allergic to tree pollen, you can expect symptoms in late winter to early spring.

Grasses That Trigger Allergy Symptoms

While many people don’t think of summer as a typical allergy season, that is actually when grass pollen is in the air.

Do you know which grasses are commonly grown in your area?

Bermuda grass, Timothy, Kentucky Blue, Johnson, Rye, or Fescue? Are your kids allergic to any of them? If so, their allergy symptoms will probably act up in the late spring and early summer.

Molds That Trigger Allergy Symptoms

Depending on where you live, molds can either cause seasonal symptoms (colder climates) or they can be a cause of year round symptoms.

And you can expect outdoor mold spore counts to be extra high when it is warm and humid.

Inside, mold grows best in parts of the house that are cool and damp, with common suspects including:

  • Cladosporium herbarum
  • Penicillium notatum
  • Alternaria alternata
  • Aspergillus fumigatus

Have you seen any of these names on your child’s allergy test results? Although it is considered part of our natural environment, you can keep mold from growing inside your home.

What To Know About Allergy Triggers

Identifying your child’s allergy trigger or allergy season won’t make them  away. It can help you learn to avoid or control them though, or at least help get prepared by starting your child’s allergy medicines before he is exposed.

More Information about Allergy Triggers

Avoiding Confusion During an Allergy Attack – Adrenaclick vs EpiPen Directions

Learn how to avoid confusion by learning when and how to use different epinephrine injections, including the EpiPen and Adrenaclick injectors.

Whether you have an EpiPen or Adrenacick injector, make sure everyone around your child with allergies knows how to use it.
The FARE Food Allergy & Anaphylaxis Emergency Care Plan provides detailed instructions for all available epinephrine injectors.

The price of EpiPens has been in the news a lot recently.

Most people know that they went Mylan’s EpiPen 2-Pak went from costing about $100 in 2006 to over $600 today and that there has been little or no competition.

One competing device, Auvi-Q was recalled in 2015, but it was fairly expensive too.

Good News and Bad News About EpiPens

Things have gotten better recently.

First, a generic EpiPen 2-Pak is now available. It costs $339.99. While still expensive, it does lower co-pays for many people with good insurance.

The latest news? A generic Adrenaclick injector for $109.99 at CVS pharmacies.

Even better, coupons are available that can make the injectors free for many people.

So what’s the bad news?

The directions for using the EpiPen 2-Pak and the Adrenaclick are not the same. That can cause some confusion. Do you want someone to grab one and not be sure how to use it when your child is having a life-threatening allergic reaction?

That makes it important for everyone to be familiar with both types of epinephrine injectors.

Adrenaclick vs EpiPen 2-Pak Directions

The fact that the Adrenaclick has two caps that you need to remove before use, while the EpiPen only has one, can lead to confusion. Also, the Adrenaclick injector, despite its name, doesn’t actually ‘click’ after you use it, like the EpiPen does.

EpiPen 2-Pak auto-injector directions:

  1. Remove the EpiPen Auto-Injector from the clear carrier tube to find an EpiPen Jr (green label) or EpiPen (yellow label).
  2. Remove the blue safety release by pulling straight up without bending or twisting it.
  3. Swing and firmly push orange tip against mid-outer thigh until it ‘clicks’.
  4. Hold firmly in place for 3 seconds (count slowly 1, 2, 3).
  5. Remove auto-injector from the thigh and massage the injection area for 10 seconds.

Remember that the orange end is the needle end! And you know that your child got your dose if you heard the click sound.

Adrenaclick epinephrine auto-injector directions:

  1. Remove the outer case.
  2. Remove grey caps labeled “1” and “2”.
  3. Place red rounded tip against mid-outer thigh.
  4. Press down hard until needle enters thigh.
  5. Hold in place for 10 seconds. Remove from thigh.

With the Adrenaclick injector, the red tip end is the needle end! Do not touch this end or you could unintentionally inject your self. After use, the needle should be visible.

Avoiding Confusion About Your Epinephrine Injector

All of the epinephrine injectors are easy to use. At least on paper.

In the heat of the moment though, when a child is having a life-threatening allergic reaction, it may not seem so easy though.

It will likely be even more difficult if the epinephrine injector you grab is not what you are expecting. Make sure you know how to use your epinephrine injector, both when your pediatrician prescribes it and when your pharmacist dispenses it to you (in case you get a different one, which is allowed in some states).

  1. Read the instructions.
  2. Watch a video.
  3. Use a trainer device.
  4. Be prepared!

It is also important that anyone that watches your child, whether it is a family member or the school nurse, knows how to use your child’s epinephrine injector.

“Individuals and caregivers are often reluctant to use self-injectable epinephrine in anaphylaxis despite instruction to do so.”

Pediatrics March 2007

Other things that can lead to confusion about epinephrine injectors include that you:

  • use an EpiPen or Adrenaclick training pen instead of the real injector with active medication when your child is having an anaphalytic reaction
  • use the real injector when you meant to use the training pen
  • don’t carry your child’s epinephrine injector with you at all times, which is why it is important to get more than one injector each time, allowing you to keep one at school, one at home, and one and travels with your child, etc., eventually allowing your child to carry his or own epinephrine injector at an age-appropriate time
  • forget to move to a higher dose of epinephrine as you child grows, keeping in mind that the Jr (0.15mg) dosing is only for kids under 66 pounds
  • aren’t sure when to use your EpiPen or Adrenaclick injector or are afraid to use it, which can lead to an unnecessary delay in your child getting a lifesaving treatment
  • don’t get a refill if your epinephrine injectors have expired or you actually needed to use one
  • understand that you still need to call 911 after you have used your epinephrine injector, even if your child begins to immediately feel better. Symptoms can return, which is why you are given two doses (2-Pack) of epinephrine.

A good Food Allergy & Anaphylaxis Emergency Care Plan can help avoid much of this confusion. In addition to easy to read instructions on when to give epinephrine, this type of plan should include directions for your child’s epinephrine injector.

When in doubt – you should usually give epinephrine if you have any concerns that your child is having an anaphylactic reaction. It is a safe medicine.

More Information About Epinephrine Injectors

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Treating Hard to Control Nosebleeds

Don’t panic when your child has a bloody nose. Instead, encourage them to sit, lean, pinch, and wait and learn to prevent chronic nosebleeds.

Parents usually get scared when their kids get a nosebleed.

Fortunately, most nosebleeds aren’t serious. That doesn’t make them less scary when they are happening though, especially when it is your first or it doesn’t stop right away.

Nosebleeds

There are two things to understand about nosebleeds in kids. They are common and most of the things that you probably know about stopping them aren’t very helpful.

We no longer recommend tilting a child’s head back during a nosebleed, pinching the bridge of their nose, stuffing tissue into their nostrils, or holding a tissue lightly against their nostrils. Although your child’s nose will likely eventually stop bleeding with these methods, it will take a long time and it won’t be from any of those interventions.

Treating Nosebleeds

When your child has a nosebleed, the best treatment advice is to:

  • have your child sit down
  • encourage them to lean forward
  • pinch the tip of their nostrils firmly for five or ten minutes with their fingers or a tissue if it is available (don’t check every few minutes to see if it has stopped)
  • continue to pinch for another ten minutes if it is still bleeding (again, wait and don’t check every few minutes to see if it has stopped)
  • for persistent bleeding, some experts recommend blowing out the clot, spraying a nasal decongestant into your child’s nostril, and then applying firm pressure for ten minutes

If blood is still coming out while you are pinching the soft, lower part of your child’s nose, then you likely aren’t pinching firmly enough or may not be pinching in the right spot. Pinching the bony part doesn’t help.

Keep in mind that it takes at least a few days for blood vessels to heal, so your child  might easily get another bloody nose in the hours or days after a nosebleed. That’s why some kids might get a nose bleed without really doing anything to provoke it.

After a bloody nose, you might encourage your child to avoid blowing out the clot in their nostrils and leave their nose alone.

Treating Hard to Control Nosebleeds

What about if your child has hard to control nosebleeds?

If the nosebleed is hard to control because it just won’t stop after about 20 minutes, then you likely need to seek quick medical attention.

On the other hand, if you can stop your child’s nosebleeds, but they are hard to control because they keep coming back, then ask yourself these questions and share the answers with your pediatrician:

  • Are your child’s nosebleeds seasonal, which could mean that allergies are a trigger?
  • Have you been using a nasal steroid to treat your child’s allergies? Nosebleeds can sometimes be a side effect of using a steroid nose spray, especially if you don’t spray towards the outside of the nostril when you use them.
  • Does your child frequently pick his nose?
  • Have you noticed any other signs of heavy bleeding or easy, large bruising? If not, a bleeding disorder is almost certainly not causing your child’s nose to bleed.
  • Do your child’s nosebleeds increase in the winter, when it is dry in the house?
  • Does anyone in the house smoke? Second hand smoke is an irritant.
  • Has your child been using a nasal decongestant for more than a few days? That can dry out your child’s nasal passages and lead to nose bleeds.
  • Could your child’s head or nose have been hit recently?
  • Did your child stick anything in his nose?

In addition to treating uncontrolled allergies, things that might help chronic nosebleeds include keeping your child’s nails cut short, encouraging your child to not pick his nose, using nasal gel (or Vaseline) or saline spray to keep your child’s nostrils moist (can discourage picking too), using a cool mist humidifier (this can increase mold and dust mites and make allergies worse though), and avoiding second hand smoke.

A pediatric ENT can help your child with chronic nosebleeds when routine treatments don’t work. Although a little painful, cautery with a silver nitrate stick is an option to seal blood vessels in the nose for some kids who keep getting nosebleeds.

What To Know About Treating Hard to Control Nosebleeds

Don’t panic when your child has a bloody nose. Instead, encourage them to sit, lean, pinch, and wait and learn to prevent chronic nosebleeds.

More Information About Treating Hard to Control Nosebleeds

Treating Hard To Control Headaches

It can be frustrating when your kids have regular headaches, including migraines, but fortunately, there are many things you can do to both prevent and treat your child’s chronic headaches.

Does your child get headaches?

Are they easy to control?

Headaches

Headaches, including migraines, are much more common in kids than most parents imagine.  In fact, one study showed that up to 8% of kids have migraines, with many starting to have headaches by age 7 or 8 years.

Treating Headaches in Kids

In addition to treating headaches when they happen, it is important to teach your kids to get SMART and prevent their headaches:

  • Get plenty of Sleep each night.
  • Never skip Meals.
  • Be physically Active and exercise each day.
  • Learn ways to Relax and reduce any extra stress in their life.
  • Avoid things that you know Trigger their headaches.

If this doesn’t work and your child’s headaches are bothersome, you can consider treating them with a standard, age-appropriate pain reliever, such as acetaminophen or ibuprofen.

Treating Hard To Control Headaches

If your child has chronic headaches, ask yourself these questions and share the answers with your pediatrician:

  • Does your child have any signs of symptoms that might indicate that he needs immediate medical attention, including severe headaches that are getting worse, high blood pressure, a recent head injury, seizures, fever, or headaches that routinely wake your child up in the middle of the night?
  • Are your child’s headaches interfering with daily activities, including school, sports, or social activities?
  • Do headaches, especially migraine headaches, run in the family?
  • Does your child routinely have symptoms of allergies, in addition to headaches, with a runny nose and congestion, which could be a sign of allergy headaches?
  • How does your child describe her headache pain?
  • Does your child have any other symptoms with the headache, such as anorexia, nausea, vomiting, photophobia (light hurts their eyes), phonophobia (loud sounds bother them), or osmophobia (smells bother them)?
  • Can your child sense when a headache is about to begin, with with an aura, including symptoms like slow or slurred speech (dysarthria), vertigo (sense of spinning), or changes in their vision?
  • What does your child do during a headache?
  • Do you think that your child is having migraine headaches, tension type headaches, or allergy headaches, etc.?
  • Have you been giving your child pain medicines for her headaches on most days (more than 15 times a month), which can cause rebound or worsening headaches?
  • Have you been giving your child a triptan medicine for her headaches on most days (more than 10 times a month), which can cause rebound or worsening headaches?
  • If stress is a major trigger for your child’s headaches, have you considered seeing a counselor or child psychologist for extra help?
  • Have you tried keeping a symptom diary to try and identify headache triggers, such as caffeine, chocolate, weather changes, or stress, etc.?

What’s next if your child is still having bothersome headaches?

The FDA has approved a few medications (triptans) that can stop migraine headaches in kids, including:

  • Axert (almotriptan) – FDA approved for children between the ages of 12 and 17 years
  • Maxalt (rizatriptan) – FDA approved for children between the ages of 6 and 17 years

Zofran (ondansetron) can also be helpful if your child has nausea and vomiting with her headaches.

Lastly, a daily medication might help prevent your child from getting headaches in the first place. These preventative migraine medications can include Periactin (cyproheptadine), Elavil (amitripyline), Topamax (topiramate), Depakote (valproic acid), propanolol, or clonidine.

A pediatric neurologist can help manage your child with hard to control headaches. Other treatments for chronic headaches can include biofeedback, guided-imagery, cognitive behavioral therapy, and select nutritional supplements.

What To Know About Treating Hard To Control Headaches

It can be frustrating when your kids have regular headaches, including migraines, but fortunately, there are many things you can do to both prevent and treat your child’s chronic headaches.

More Information On Treating Hard To Control Headaches

Are Drug Coupons Behind the Jump in the Cost of an EpiPen?

The high price of Mylan’s EpiPens is getting a lot of attention lately.

In a way that’s good. Not just so that something will finally be done about high drug prices, but because more people need to know about food allergies and about the importance of having and using EpiPens. That is one thing Mylan got right. Their education and awareness campaigns not only encouraged parents to get EpiPens for their kids, but they strongly encouraged them to use them.

Just a ploy to sell more EpiPens? Not when you realize that many people are afraid to use their EpiPens, even when they are having a severe allergic reaction.

Still, they certainly got greedy with the continued price hikes.

Although we are getting used to hearing about high drug prices, they typically aren’t for drugs that your pediatrician prescribes everyday.

You were likely outraged when Martin Shkreli raised the price of Darapim to $750 a pill, but you probably still have no idea what it is used for. On the other hand, you may have or almost certainly know someone with an EpiPen.

An epinephrine autoinjector is traditionally the only treatment for people having anaphylactic reactions to peanuts, insect bites and stings, or other serious allergic reactions.

Why fuss about the cost of a life-saving drug or device? A product that can save your child’s life in a manner of seconds would be priceless to most people.

Much of the issue is that they went from costing about $100 in 2006 to over $600 today. Even last year, a set of two EpiPens (one dose) cost up to $450. So it would be nice to have that option to save lives and save money. Afterall, the very same EpiPens are much cheaper in most other countries.

Surprisingly, it has been the media and not parents or patients who are doing most of the complaining about the high cost of EpiPens. Most of us have insurance and can use a coupon to waive their copay and effectively get their EpiPens free. Those without insurance may not be able to see a doctor to get a prescription, but if they can, may be eligible for Mylan’s patient assistance program.

So who is paying full price?

Mostly people with high deductible insurance plans, at least until they realize that they might save money going with a more costly insurance plan without a deductible, especially if family members have other medical problems, like asthma.

Why asthma?

Have you priced an asthma inhaler lately? Those that you use to prevent asthma can easily cost $300 to $400 each month. A rescue inhaler can cost another $100.

Competition hasn’t helped us get less expensive asthma inhalers. You will need a coupon for that.

Drug coupon use by patients could “come at the cost of higher long-term expenses for themselves and society.” That was a warning in the New England Journal of Medicine editorial “Prescription-Drug Coupons — No Such Thing as a Free Lunch.”

Unfortunately, instead of heeding the warning back in 2013, some companies adopted it as a business model.

Martin Shkreli didn’t do anything original when he bought the rights to the antiparasitic drug pyrimethamine and rebranded it as Darapim, raising the price 5,000%.

For example, although Lupin Pharmaceuticals makes many generic medications, they chose to license Suprax, an expensive antibiotic with a coupon, as a branded generic. So while a similar generic antibiotic, such as cefdinir, might cost about $50, Suprax costs about $250 to $400 for a 10 day course. It will also likely be on the highest and most expensive tier of your insurance, which is why they offer a coupon.

Impax Laboratories, another big maker of generic drugs, takes the cake though. They are selling Emverm for $596 a pill. A chewable pill that is used to treat pinworms, with two doses over two weeks, that means one treatment to stop your child’s butt from itching can cost almost $1200 – unless you use their coupon. An inexpensive generic version of the very same medicine, Vermox, was discontinued in 2011.

It was discontinued by Teva Pharmaceuticals, who then sold the rights to the drug to Amedra Pharmaceuticals, which was then acquired by Impax.

An off-patent, generic drug, Vermox should have been getting cheaper, not having its price soar. The fact that they offer consumers free coupons, meaning they won’t actually pay for the drug, likely explains how they get away with it.

Of course, we all end up paying. There is no free lunch, except maybe when the drug reps for these companies drop off those coupons at your doctor’s office.

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