On April 7, 2013, Adrian Gutierrez, an 8-year-old boy from Monmouth County, New Jersey, experienced a severe reaction and died in hospital. The reaction came over the boy on his family’s drive home from church, following a visit to a coffee shop. The boy’s mother suspects that Adrian, who was allergic to dairy and peanuts, may have accidentally sipped from his brother’s hot chocolate with milk. (Adrian had ordered a hot chocolate with  soy milk.)

One news report stated that an epinephrine auto-injector was administered to the boy. However, it is not clear whether the shot was given immediately after the reaction began, or  whether there was a significant delay. In the case of a severe allergic reaction, epinephrine should always be administered right away, as the drug can be less effective if a reaction has progressed.

On March 13, 2013, Maia Santarelli-Gallo, a 12-year-old girl from Burlington, Ontario (in Canada), appears to have experienced anaphylaxis during an outing to a shopping mall with her father and older sister. Local news reports suggest Maia had reacted to dairy and egg in the past, but her parents had been told she was intolerant rather than allergic, and she had never been prescribed an auto-injector. At this point, it is not definitively known what caused the reaction, but milk is suspected – since the last thing Maia ate was an ice cream cone.

Asked to comment on the girl’s fatal reaction, allergist Dr. Susan Waserman expressed profound concern to the local press. “It speaks to the need for proper diagnoses, proper education, how the family was told to handle this supposed food intolerance,” she said, adding that better support for the family would have led the girl to have an auto-injector. “The whole community feels terrible when we feel something like this,” she said.

On March 8, 2013, Cameron Groezinger-Fitzpatrick, a 19-year-old from Plymouth, Massachusetts, died from his peanut allergy while home from university for spring break. His family has said that a friend had offered him a cookie, which was supposed to be peanut-free but turned out to contain peanut butter.

According to ABC News, Cameron’s mother was told over the phone by a 911 operator not to administer an expired EpiPen which was in a nearby cupboard. Cameron’s current auto-injector couldn’t be found in time, as he had not finished unpacking for his visit.

“I didn’t know you can die from nut allergies. I feel foolish,” Robin Fitzpatrick, Cameron’s mother, told ABC News.

These tragic events reinforce the need for allergy education and having epinephrine always ready to access for those with food (and sting) allergies.

In more positive news, several states are beginning to see the importance of readily available epinephrine and are passing bills that allow doctors to prescribe “stock” auto-injectors to schools. These devices can used in emergencies for students who don’t have an auto-injector on school premises (in some cases, it may be a first allergic reaction).

Kentucky, Nevada, Oregon, Georgia and Tennessee have all seen recent progress in such bills in their state legislatures. In fact, Kentucky Governor Steve Beshear will be holding a formal ceremony to sign that state’ stock epinephrine bill into law on April 22, 2013.

The following article is from the Winter 2013 of Allergic Living magazine.

Michael Saffioti’s mom Rose thought her 22-year-old son was doing the right thing by turning himself into police after a missed court date last July. But for the Washington state man, who had a life-threatening allergy to dairy, one night in jail turned into a death sentence.

The young man had landed in the court system on a misdemeanor marijuana possession charge – he spoke of using pot to curb crippling anxiety about his food allergy and asthma – and then a legal technicality led to him spending a night in the county prison.

Under normal circumstances, he would have gone before a judge then been released, but Saffioti never made it past breakfast. According to witness testimony from fellow inmates, the young man was given a meal that included a pancake and oatmeal, and when he reminded staff of his dairy allergy, they removed the pancake and told him the oatmeal was safe.

After a few spoonfuls, Saffioti began having difficulty breathing and asked for his asthma medication. Soon after, the prisoners were locked into their cells and the guards changed shifts. Saffioti’s reaction continued to worsen. According to Anne Bremner, the Seattle lawyer representing the family, Saffioti pressed his emergency button and called for medical help, but his emergency light got turned off; as his breathing grew more labored, Saffioti pleaded for someone to call 911.

Other inmates say they began pressing their emergency buttons and yelling for help, making clear that this guy was not faking. Their calls were ignored.

Saffioti was supposed to be housed in the prison’s medical ward, and his mother had made sure that corrections staff had his asthma medication, EpiPen auto-injector and medical records, and yet no help came for at least 20 minutes. A prison trustee (an inmate who has work privileges) said he watched in horror as Saffioti finally collapsed in his cell. By the time paramedics arrived, it was too late.

“The trustee is a tough guy, but he said it’s the worst thing he’s ever seen,” says Bremner. “They let this guy die, and he was begging for help.”

Next: Mother’s Actions

WHEN news surfaced that 15-year-old Christina Desforges of Saguenay, Quebec, had died of what appeared to be an anaphylactic reaction to a kiss from a boyfriend who had eaten a peanut butter sandwich, the story travelled from Canada to Mexico to South Africa and on to Europe.

The reason for the media interest was simple: it seemed incredible that death could come from the tiny amount of peanut encountered in a kiss. Not only that, but the young man had eaten his sandwich about nine hours before the kissing started.

The investigation into Christina’s death in November, 2005 is raising questions about whether anaphylaxis and the kiss were to blame – or, at least, solely to blame. In early March, Coroner Michel Miron told the Quebec media that Christina did not die from peanut exposure through a kiss, but added that he had further tests to complete.

At press time, Miron was still finalizing his report and was considering asthma as the likely main cause of death. [*SEE “Update” at end of this article.] However, a leading Canadian allergy expert has toldAllergic Living that it may be difficult to entirely rule out anaphylaxis, the severe food allergic reaction, because the condition is inter-related with asthma.

But whatever the final pathology report concludes, what is certain is that Christina was having great trouble breathing at her boyfriend’s home in the early hours of November 21. She was asthmatic and allergic to peanut.

If anaphylaxis or asthma or both were the cause of her respiratory distress, Allergic Living has learned this as well: contrary to the news reports, Christina did not get epinephrine promptly. “It really was not ‘immediately’,” confirmed Dr. Nina Verreault, the Saguenay allergist working with the coroner. “It was more like ‘late’.”

This is not the only recent allergy-related teenage tragedy. A month after Christina died, Chantelle Yambao of Edmonton, who was severely allergic to nuts and peanuts, ate a store-bought Nanaimo square and began to feel shortness of breath. Thinking she was having an asthma attack, the 13-year-old used her bronchodilator (or puffer).

Hours passed on December 23, 2005, before she let her mother know of her breathing trouble. Then Chantelle collapsed. Her parents phoned 911, but the teen was well into a serious reaction. She lost consciousness and was put on life support in hospital. She died a few days later.

Both of these tragedies have left families shattered, and in both there are important lessons and disturbing parallels. For instance, each of the girls was asthmatic, food allergic and a teenager, automatically putting her into the highest risk category for fatal reactions.

While Chantelle’s death is considered the more evident case of anaphylaxis (to peanut or nut in the square she ate), each girl assumed she was having an asthma attack. In the panic of breathing distress, both Chantelle and Christina reached for a puffer, but neither administered an epinephrine auto-injector, which would have been effective in an anaphylactic episode and also in severe asthma.

In an acute asthma attack, “we tell people to use their bronchodilator, four puffs every 15 minutes,” says Dr. Susan Waserman, president of the Canadian Society of Allergy and Clinical Immunology and an allergist practising in Hamilton, Ontario. But asthma is also often a key manifestation of anaphylaxis, and a puffer is not sufficient to halt this type of reaction, which can have symptoms ranging from breathing trouble to vomiting or cramps, hives and itchiness, or even a potentially fatal drop in blood pressure.

Waserman is waiting to see the results of the coroner’s report in Christina’s death, but as an allergy expert she can say that “finding something that looks like a death from acute asthma can in fact be part of anaphylaxis. “It would be difficult to rule out anaphylaxis; it might not be an ‘either-or’ scenario.”