Lessons from cases of mortality due to food allergy in Israel: cow's milk protein should be considered a potentially fatal allergen.

BACKGROUND Most reports in the medical literature on food allergy mortality are related to peanut and tree nut. There is limited knowledge regarding these reactions and often only a partial medical history is described. OBJECTIVE To record and characterize all known cases of mortality due to food allergy in Israel occurring during the period 2004-2011. METHODS All cases of food allergy-related mortality that were known to medical personnel or were published in the Israeli national communications media were investigated. We interviewed the parents and, when feasible, physicians who treated the final event. RESULTS Four cases of food-related mortality were identified: three cases were due to cow's milk and one to hazelnut. All were exposed to a hidden/non-obvious allergen. All four had a history of asthma but were not on controller medications, and none had experienced previous non-life threatening accidental reactions. Three of the four patients had not been evaluated by an allergist, nor were they prescribed injectable epinephrine. The one patient who had been prescribed injectable epinephrine did not use it during her fatal anaphylactic attack. CONCLUSIONS Fatal reactions to cow's milk and hazelnut but not to peanut are the only reported food mortality cases in Israel. Although these patients had previous reactions following accidental exposures, none had experienced a life-threatening reaction. Patients at risk are not adequately evaluated by allergists, nor are they prescribed and instructed on the proper use of injectable epinephrine. Cow's milk should be considered a potentially fatal allergen.