Kirsi M. Järvinen

Disclosures

Curr Opin Allergy Clin Immunol. 2011;11(3):255-261. 

In This Article

Where and Why do Food-induced Anaphylactic Reactions Occur?

Most reactions in children occur at home, whereas most reactions in adults occur in restaurants followed by home and work or school.[39•,41] Among peanut-allergic and tree nut-allergic reactions in the USA, most (76%) first reactions occurred at home, whereas most subsequent reactions occurred outside home.[29] In the UK, nearly one-fifth of the reactions in children occurred at school.[18] Commercial catering accounted for 68% of nut reactions.[52]

Most peanut and tree nut reactions at school occurred in the classroom and were due to craft projects using nuts or celebrations such as birthdays. A number of reactions also occurred in the playground or on school trips, among others.[53] Multiple studies have identified inadequacies in management plans and in symptom recognition in schools.[54••]

Among reactions in food establishments, most occurred in Asian food restaurants, ice cream parlors and bakeries/doughnut shops, and desserts were a common meal course.[55] Half of the patients with known allergy did not give prior notification of their allergy to the staff; in the majority of reactions someone in the establishment would have known that nut was an ingredient. Twenty percent of the reactions resulted from food in a buffet, or a food bar, or due to skin contact or inhalation. Survey of staff individuals (managers, waiters, chefs) indicated that there was a false sense of security among them: one in four believed that consuming a small amount of allergen or removing an allergen from a finished meal is well tolerated, 35% thought that fryer heat would destroy allergens, and half of them considered that a buffet is well tolerated if kept 'clean'.[56]

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