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Food Allergy

Lessons From a Teen Food Allergy Tragedy

Robert Wood and captionThirteen-year-old Natalie Giorgi was camping with a group of families in Sacramento, California when she ate a single bite of a Rice Krispies square. The peanut-allergic teen thought it tasted “funny”, and spat it out. The taste turned out to be peanut butter.

At first Natalie didn’t show any symptoms and her mother gave her a dose of antihistamine; but in 20 minutes the systemic reaction began. Her father, a physician, gave her three doses of epinephrine, but it wasn’t enough to stop the rapid-fire chain of events. She began vomiting, her throat swelled to the point where she could no longer breathe and she went into cardiac arrest. She died in her parents’ arms.

“It’s beyond words what they’re feeling,” Rev. Michael Kiernan of Our Lady of Assumption, the family’s church, said in early August 2013.

Natalie’s story has spiked fears among Allergic Living’s readers, in particular parents of children and teens with food allergies. It has also raised questions about just what to do in case of an accidental allergen ingestion, so we turned to two experts for answers. First to be interviewed is Dr. Robert Wood, the director of Pediatric Allergy and Immunology at the Johns Hopkins Children’s Center in Baltimore. Next is Dr. Susan Waserman, an allergist and professor of medicine at McMaster University in Canada.

Allergic Living‘s Jennifer Van Evra: There seems to be a lot of confusion about whether to administer epinephrine in the case of allergen exposure and how soon. What do you tell patients?

Dr. Robert Wood: There is no single set of recommendations, because it depends on many factors. But the general rules are that you need to have epinephrine readily available; that it needs to be given promptly in the event of a reaction; that the longer it’s delayed before being given, the greater chances that it won’t work; and that every patient needs to have an individualized action plan that they’ve worked out with their caretaker.

AL: What determines that type of action plan?

RW:  There are certainly people who are at higher risk than others. The four main risk factors are the individual’s prior reaction history — although you can have no history of severe reaction and still react very severely in the future. But if someone has a history of severe reaction, you never wait and see what happens. The second is that any food has the potential for dangerous reactions, but most fatal reactions are related to peanut and tree nut allergy, so they automatically indicate a higher possibility of a severe reaction. The third risk factor is having asthma because it’s very rare to find a fatality in someone who doesn’t have asthma. Then the last risk factor is that the vast majority of fatalities have occurred in teenagers and young adults.

AL: Is that a function of physiology or lifestyle?

RW:  Likely some of both. There is some increase in allergy severity to peanuts and tree nuts through childhood, so by the time you’re a teenager or young adult, most people are at their peak level of sensitivity. But the far more important factors have to do with lifestyle: a greater availability of food items, less supervision, more risk-taking behavior, and less chance that your epinephrine will be on hand.

Next: Length of time for systemic reactions

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