Allergists Respond to Death of Boy, 3, in Food Challenge

Marcia Frellick

August 04, 2017

In the wake of the news that a 3-year-old boy has died during a routine oral food challenge, the American College of Allergy, Asthma & Immunology, the American Academy of Allergy, Asthma & Immunology, and the Canadian Society of Allergy and Clinical Immunology released a joint statement.

According to the societies, the death of Alastair Watson on July 30 after a severe anaphylactic reaction in Trussville, Alabama, is the first reported fatality associated with an oral food allergy challenge. The test was given at Children's Hospital of Alabama at Birmingham, according to a report in Allergic Living.

"His death is a tragedy, and we cannot even imagine the horror of this loss," the societies write.

"While critical details surrounding this tragedy are not available, nor should they be out of respect for the family and all involved, this is an important time to address oral food challenges in general."

The statement goes on to say, "This event should serve as a valuable reminder for everyone involved in oral food challenges to review internal procedures and ensure the proper set-up, staffing, supervision, and protocols are in place to continue offering one of the safest procedures in allergy/immunology.

"Oral food challenges have been conducted for decades to test whether someone is allergic to a certain food. …. While even one death is too many, oral food challenges are considered the 'gold standard' test to determine if someone is allergic to a food. As allergists, we use this test when a person's medical history and/or allergy test results are inconclusive. We also use this test to determine if someone with previously diagnosed food allergy has developed tolerance, and may no longer be allergic."

Alastair's mother, Pamela, was quoted as saying to Allergic Living: "It is my understanding that this has never happened before. I was not warned of this possibility."

Gary Stadtmauer, MD, associate professor of medicine at Mount Sinai in New York, told Medscape Medical News, "This could mushroom. Patients are going to have questions and physicians need to be prepared to answer. They also need to have resuscitative equipment available."

Sometimes people can tolerate the raw form but not the cooked form of a food; sometimes they can tolerate baked eggs, but not runny eggs — food challenges sort that out.

"What we know according to reports is that [Alastair] was tested with baked milk," Dr Stadtmauer said.

"We don't know the details of this case and without knowing that, we can't say that this changes the paradigm for how we handle food challenges in any way," he said.

Dr Stadtmauer is a member of Medscape's allergy board.

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