Fatal and Near-Fatal Anaphylactic Reactions to Food in Children and Adolescents

Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients). Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minutes of the ingestion of the allergen, but only two received epinephrine in the first hour. All the patients who survived had symptoms within 5 minutes of allergen ingestion, and all but one received epinephrine within 30 minutes. The course of anaphylaxis was rapidly progressive and uniphasic in seven patients; biphasic, with a relatively symptom-free interval in three; and protracted in three, requiring intubation for 3 to 21 days. Dangerous anaphylactic reactions to food occur in children and adolescents. The failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome. (N Engl J Med 1992;327:380–4.), THERE are few reports in the medical literature of fatal or near-fatal anaphylactic reactions caused by food. There is no code for the diagnosis of food-induced anaphylaxis in the International Classification of Diseases, so it has been difficult to ascertain the incidence of fatal food-induced anaphylactic reactions. Before the recent survey of Yunginger et al.,¹ the medical literature consisted mainly of isolated case reports. Yunginger and coworkers described seven cases of fatal anaphylaxis due to food allergy that occurred over a period of 16 months. These reactions occurred primarily in adults who unknowingly ingested the allergen while eating away…