Lethal Food-Induced Anaphylaxis in Children
نویسنده
چکیده
Despite careful contributions, food allergic children have a significant risk of anaphylactic episodes. Especially at risk are children not accompanied by parents or caregivers in public places, or restaurants, or not provided with injectable epinephrine. We shortly report two children and conclude that parents should be provided with medication for emergency treatment. peanut in three cases, cashew in two, and egg in one, and of the six patients who died only two received epinephrine in the first hour [4] as in the two reported cases: no child soon recognized the impending danger. However, in one fatality in France not even a quick injection of epinephrine saved the child’s life [6], as 2 children who died despite receiving epinephrine before admission to hospital. [7]. Unfortunately, no reliable data exist on the epidemiology of lethal food-induced anaphylaxis in children (Table 1) [4]. In a meta-analysis we have summarized 70 cases [8], 23 (32.4%) to peanuts, 17 (23.9%) to nuts, 13 (18.3%) to CM, and 5 to eggs (7.0%), but in the 17 children, peanut and nuts accounted for 15 (88.2%) deaths [4,5]. Bock reported several cases also in 3to 4-yearold children due to peanut, walnut, shrimp, spices, and to sulfite containing foods, such as catsup and vinegar [9]. Cow’s milk-induced anaphylaxis in children In addition to peanut and tree-nuts, another allergen as much potent is CM, responsible for cases of anaphylaxis in up to 11% [9] and 12.6% of cases [2] and severe reactions triggered by 1-2 drops put upon the inner bor der of the lower lip [10], up to anaphylactic death as 5 victims aged 2-16 who died at home or at a friend’s home because they received no epinephrine, or received it late [11]. In England, there were 8 deaths over a 11-year period in 3-monthto 15-year-old children, and 4 were caused by CM (50%) [7]. Four babies aged 6 weeks to 6 months experienced severe life-threatening reactions, all related to un supervised self-challenge with either a CM-based formula or a dairy product [12]. We have reported 3 cases of shock and 15 of anaphylaxis to CM-based formulas in children aged 1 month-7 years [13] and in 41 children aged 7 days-15 months worsening of atopic dermatitis, urticaria, vomiting, wheezing, shock (1 case), bronchospasm requiring epinephrine to a CM-based formula [14]. A CM-sensitive infant was hospitalized with systemic anaphylaxis that developed immediately after the application of a diaper rash ointment that contained 5% Ca casein ate [15]. A child aged 12 developed systemic anaphylaxis after eating a cheese-free pizza. It was shown that a small amount of CM was added to the pizza dough. The boy was treated with emergency medication [17]. Contact with minute doses of CM may trigger severe symptoms. Two Fatal Cases Two fatal cases of food induced anaphylaxis were triggered by inadvertent food ingestion. Both cases were reported by the Italian press during last summer. Nobody had epinephrine ready, so both were rushed to a local emergency department [ED], but there apparently was a delay before they received epinephrine, and both died. In a city of Northern Italy, during a dance exhibition as part of a flower celebration, a severely nut-allergic 12-year-old girl as soon as she ate a home-made cake perceived a nut-taste and soon systemic symptoms were triggered. Nobody had epinephrine at hand, and the girl, despite the hospital cures died of anaphylactic shock. In Rome, an exquisitely CM allergic 9-year-old boy went to a pizza-parlor with his mates. Some adults were also present. He may have touched some mozzarella cheese on the pizza-maker counter, or when mozzarella is sliced, fresh cow’s milk [CM] gushes out and the child may have touched some drops of CM spilling from a pizza. Also in this case nobody had epinephrine ready, and the anaphylactic shock was so severe that no hospital cure saved him. In these cases, in addition to the lacking epinephrine, the allergic history of both children was rich of similar, less severe manifestations. Obviously, both were subjected to skin-prick tests, clearly highly positive to the incriminated foods. Of such children the allergy world is very rich, but strangely enough, some parents do not perceive that their allergic children should always be accompanied by a parent or a caregiver expert on the use of Epi-Pen. Epidemiology Anaphylaxis is frequent in children: 27 out of 544 (4.9%] investigated children with food allergy (FA) had anaphylaxis as part of their clinical presentation [1]. In 76 children occurred 95 cases of anaphylaxis, 62 of them [82%] had a personal history of atopic symptoms; foods were identified as causative agents in 57% of the episodes of anaphylaxis [2]. Instead, the parents of 4,173 children aged 3-17 reported a food-induced anaphylaxis rate of 0.59% [3]. Anaphylactic shock was triggered in 17 children and adolescents [4,5]. In 13 cases of anaphylaxis, all were due to masked allergens, Case Report Lethal Food-Induced Anaphylaxis in Children Arnaldo Cantani* Department of Pediatrics, Division of Pediatric Allergy and Immunology, University of Roma “La Sapienza”, Roma, Italy Dates: Received: 10 June 2015; Accepted: 17 August, 2015; Published: 19 August, 2015 *Corresponding author: Arnaldo Cantani, Department of Pediatrics, Division of Pediatric Allergy and Immunology, University of Roma “La Sapienza”, Roma, Italy, E-mail:
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