The shocking deaths of two teens provide clues to what goes wrong in fatal food allergy reactions. [From the Summer 2006 edition of Allergic Living.]
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 told Allergic 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 Quebec 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 reliever 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 practicing 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.”