In a case series, six young patients with fatal anaphylaxis after food ingestion and seven others with near-fatal anaphylaxis not only had a history of reactions to food but also had asthma and were highly allergic to many substances. Their parents or caregivers had failed to appreciate the potential seriousness of the food allergies. Four of the six fatal reactions occurred at school. Although self-injectable epinephrine had been prescribed for half of the children with fatal reactions, they did not have it available when they died. Many of the children had deceptively mild symptoms for 1 or more hours before breathing problems developed, yet none of them received epinephrine before severe respiratory symptoms developed.
Some foods pose a much greater threat than others.
Even trace amounts of these foods can provoke anaphylaxis in susceptible patients. When specific IgE forms against a food antigen in a susceptible person, subsequent exposure to the antigen may result in IgE-mediated activation of mast cells and basophils, followed by release of histamine, tryptase and other biologically active substances. For any acute reaction to food a description of the symptoms and signs and of all foods eaten before the reaction, including manufacturer and lot number of processed foods, recipe ingredients and all other relevant information, should be obtained. The food implicated in the reaction should be precisely identified. If necessary, uneaten portions of the food suspected of triggering the anaphylactic episode can be tested for specific antigens by means of an inhibition immunoassay.