UK inquest into fatal anaphylaxis
6 May 2019:
It is with great sadness that we read about the recent UK inquest into a case of fatal anaphylaxis of a 13 year old school student, Karanbir Cheema, who had multiple food allergies. https://apple.news/AH7nE6Jr3RHGTrMlPZVp7qQ
The Coroner's Court heard that whilst there were other cases of children having severe allergic reactions through skin contact, none of these incidents had been fatal. The inquest was told that Karanbir had eczema and he scratched at his neck after contact with cheese, with blood visible following the incident. Further scratching and degrading of the skin barrier could have led to increased contact with the cow’s milk protein. His adrenaline (epinephrine) autoinjector was 11 months out of date and this was the only adrenaline administered before he went into cardiac arrest.
Published studies about skin contact with food allergens
Reference 1: Frequency and significance of immediate contact reactions to peanut in peanut-sensitive children
Wainstein BK, Kashef S, Ziegler M, Jelley D, Ziegler JB.
Clin Exp Allergy. 2007 Jun;37(6):839-45.
https://www.ncbi.nlm.nih.gov/pubmed/17517097
A concern for many parents of children allergic to foods is the risk of an accidental reaction occurring from environmental exposure to food allergens, such as skin contact or inhalation, even when ingestion is unlikely.
This study included children who were peanut-sensitive, but not necessarily severely allergic. The aim was to determine the:
- Frequency with which they exhibit contact sensitivity to peanut butter.
- Incidence of systemic allergic reactions to peanut following skin contact with peanut butter in these children.
Conclusion: A minority of children sensitized to peanut (positive SPT) develop localized urticaria (hives) from prolonged skin contact with peanut butter. In this study, no tested subjects, including ones with systemic reactions upon oral challenge, developed a systemic reaction to prolonged skin exposure to peanut. Therefore, systemic reactions resulting from this mode of contact with peanut butter appear highly unlikely.
Reference 2: Severe food allergies by skin contact
Tan BM, Sher MR, Good RA, Bahna SL.
Ann Allergy Asthma Immunol. 2001 May;86(5):583-6.
https://www.ncbi.nlm.nih.gov/pubmed/11379811
Ingestion is the principal route for food allergens, yet some highly sensitive patients may develop severe symptoms upon skin contact. Five cases of severe food allergic reactions through skin contact, including inhalation in one were reported in this study. These cases were found to have a strong family history of allergy, early age of onset, very high total serum IgE level, and strong reactivity to foods by skin prick testing or RAST.
Conclusion: Severe food allergic reactions can occur from exposure to minute quantities of allergen by skin contact or inhalation. Food allergy by a non-ingestant route should be considered in patients with the above characteristics.
Content created May 2019
