Kirsi M. Järvinen

Disclosures

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

In This Article

What Happens in Fatal Food-induced Anaphylaxis?

The rate of fatal anaphylaxis due to foods is rare but probably underreported.[57••] The risk of a fatal outcome has been estimated less than 1 per million population per year[57••] or less than 1 per 20 million population per year in children.[58] In the UK, food allergens were responsible for up to 30% of fatal cases of anaphylaxis.[52]

Unfortunately, most life-threatening, near fatal, and fatal anaphylaxis is unpredictable. The most common risk factors are (poorly controlled) asthma, failure to identify a known food allergen in the meal, and previous allergic reactions to the food in question.[26,42,52,59,60] The most cases of fatal food-induced anaphylactic reactions are associated with peanut and tree nuts, with milk, egg and seafood responsible for the rest.[26,52] Adolescents and young adults are the peak age group at risk.[26,52]

Most fatal and near-fatal reactions due to foods occurred within 30 min of ingesting the triggering food allergen.[35,60] The time from the ingestion of the food allergen to the fatal collapse was approximately 25–35 min (range 10 min to 6 h) in one study.[52] Both biphasic and protracted courses have been reported in fatal and near-fatal anaphylaxis.[60] Fatal food reactions are more commonly associated with asphyxia, which is in contrast to insect sting or medication reactions that present with cardiovascular shock. Missing cutaneous symptoms may be a risk factor for fatal anaphylaxis.[60] An upright position is associated with fatalities due to reduced venous return, and it is recommended to stay in a supine position during treatment of anaphylactic reaction[35] unless prevented by profuse vomiting.

Lack of timely treatment with epinephrine is a significant risk factor for a fatal food-induced anaphylaxis,[26,52,59,60] although fatalities have also been reported after timely administration of epinephrine.[52] One out of six with fatal outcome received epinephrine in 30 min vs. six out of seven with a near-fatal outcome.[60] No or late administration of epinephrine was seen in 22/32 with fatalities.[26]

Vadas et al.[61] reported that the mean serum platelet-activating factor acetylhydrolase (PAF-AH) activity was significantly lower in patients with fatal peanut anaphylaxis as compared with those with peanut allergy or nonfatal anaphylaxis, suggesting PAF-AH as a potential marker for more severe food-induced anaphylaxis.

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