How do you know WHEN do you give your 4 year old an Epipen?

I know that anaphylaxis is a very serious thing.
I know that epinephrine saves lives.
I know that epinephrine won't harm my child if administrated unnecessarily.
I know that if you even consider administering an Epipen, you should.

But last night, when I suspected my boy was having an anaphylactic reaction, I didn't give him his Epipen.

I didn't want it to be true, I hadn't actually seen it happen myself and his breathing wasn't laboured; I told myself he didn't need his Epipen, not yet.

He complained ferociously of a sore throat and made a wet grunting kind of noise, I thought he might be having an oral allergy of some sort so I gave him some Benadryl. I worried it could be an anaphylactic allergy, but in truth I worry about Bolt a lot so I tried to dismiss my fears.

Then the grunting became gurgling and Bolt threw up everywhere, with intensity. At that point I  really began to worry. I almost ran for the Epipen, but Bolt seemed calmer, like the reaction might have passed.

Despite my hopes, I noticed a body rash coming up on Bolt's torso and legs. I snuggled with Bolt, gave him a large dose of Benadryl and the rash began to subside fairly quickly.  For a moment, we were both able to relax, just a little bit. 

About an hour, a half a piece of bread and a glass of water later, Bolt vomited again. He began to complain of stomach pain and his body was starting to hunch over.

Immediately, I was scared. Scared that I had fed him something that wasn't peanut free, scared that he had found one of the few treats we have in the home that MAY contain peanuts or potentially worse, I was scared that Bolt had developed an anaphylactic allergy to something new.

With my Mom in tow, I packed Bolt up and drove him to Children's Hospital. But I still didn't give him his Epipen.

I can only conclude that I was in some sort of denial, that I didn't want my boy to have a reaction that required an Epipen and that I didn't want to HAVE to give my boy a shot in the leg to save his life. I just didn't want any of it to be true, event though I knew it was.

I know, for a fact, that if his breathing was laboured, I would have administered the Epipen without question. I also know, that in my heart I must have known that he was having a reaction. Perhaps worst of all, I know that my 4 year old boy suffered more than he should have because I didn't want to believe he needed his Epipen. It makes me sad, but I refuse to wallow in guilt, instead I will learn the lesson and I will remember:

I am the mother of my children and no one knows them like I do. 

If I am worried, I have just cause.

My instincts will keep my children safe,

I need only follow them.

The ER doctor also said something very simple that really resonated with me: 'TWO symptoms, you JAB him in the leg'.