Fatal Food Anaphylaxis: Distinguishing Fact From Fiction

Authors

Aikaterini Anagnostou, Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, Texas; Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Houston, Texas. Electronic address: Aikaterini.Anagnostou@bcm.edu.
Vibha Sharma, Paediatric Allergy and Immunology Department, Royal Manchester Children's Hospital, Manchester NHS Foundation Trust, Manchester, United Kingdom; The Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom.
Linda Herbert, Division of Psychology and Behavioral Health, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
Paul J. Turner, National Heart & Lung Institute, Imperial College London, London, United Kingdom.

Document Type

Journal Article

Publication Date

1-1-2022

Journal

The journal of allergy and clinical immunology. In practice

Volume

10

Issue

1

DOI

10.1016/j.jaip.2021.10.008

Keywords

Anaphylaxis; Fatalities; Risk factors; Serum tryptase

Abstract

Although there is a general perception that the prevalence of food allergy is increasing, data supporting this are limited. Food is the least common cause of fatal anaphylaxis, and fortunately, it is a very rare event; however, it is also unpredictable. There is widespread consensus that severe reactions cannot be predicted in a clinically meaningful way. Certain food triggers are more frequently associated with fatal anaphylaxis than others. In observational studies, peanut and tree nuts account for at least 30% to 50% of fatalities, with seafood and cow's milk also associated with fatal reactions. Fatal food-induced anaphylaxis is most likely to occur during adolescence and young adulthood, although the reasons for this are unclear. International guidelines agree that intramuscular (IM) epinephrine is the treatment of choice for managing food-triggered anaphylaxis and has a good safety profile when given by the IM route. However, fatalities still occur despite the timely administration of epinephrine. Food-allergic individuals must navigate a world that requires daily vigilance for allergens and preparedness for allergic reactions. Although the actual risk of fatal reactions is minimal, it is not zero, and severe reactions are unpredictable. Clinicians need to help patients better understand the very low but real risk of fatal reaction and enable them to lead as normal a life as possible through appropriate education, safety netting, and risk reduction.

APA Citation

Anagnostou, Aikaterini; Sharma, Vibha; Herbert, Linda; and Turner, Paul J., "Fatal Food Anaphylaxis: Distinguishing Fact From Fiction" (2022). GW Authored Works. Paper 455.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/455

Department

Psychiatry and Behavioral Sciences