Tag Archives: health

Wondering About Age and Food Allergy Deaths

OK, this is a bit morbid, but bear with me.

Most news stories about deaths from food allergies feature children or teenagers, maybe young adults in their twenties. You read about grieving parents. You rarely read about the 40-year-old who leaves behind a grieving spouse and kids.

Food allergies send a lot of people to the emergency room: 200,000 annually in the US alone according to FARE. Almost all are successfully treated. But people do die from anaphylaxis, roughly 63–99 each year in the US according to AAAAI.

So why are the fatalities we hear about so young?

Is it just demographics? Allergy prevalence has been increasing, after all, so kids are more likely to have food allergies than adults are.

Newsworthiness? A three-year-old dying at day care tugs at the heartstrings in a way that a 38-year-old dying from takeout doesn’t.

Is it onset age? A reaction is more likely to kill you if you don’t know about the allergy yet, don’t know you need to carry epinephrine, and don’t know that the warning signs mean “hospital now!” and not just “lie down and try to get through the asthma attack.” By the time you’re an adult, you’ve probably already encountered everything you might be allergic to, so you’re less likely to get that surprise first reaction. It happens – I’ve known people who developed shellfish allergies as adults, and I found my own nut and peanut allergies expanding their range in my early 20s – and there’s the Lone Star tick – but it’s less likely.

Are adults more careful? Teenagers take more risks. Children often have to rely on secondary caregivers who don’t always have the training or understanding that their parents do. And of course, the longer you deal with something, the more it becomes second nature. Is it that we’ve gotten better at avoiding triggers, keeping our medication on hand, and seeking treatment faster?

Are you more likely to have died of something else in the meantime? According to one NIH study, “Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population.” So the longer you live, as long as you’re taking precautions with the allergy, chances are that something else will kill you before the allergy can.

I suspect all of these are factors, but I do wonder how they balance.

Preventable Death. From Grilled Cheese.

If you are told a child in your care has a severe food allergy, believe them. Don’t kill a three-year-old with a grilled cheese sandwich.

According to his parents, staff at the preschool knew about his severe dairy allergy, but an adult gave him the cheese sandwich anyway. He ate it, went into anaphylactic shock, and died in the emergency room. No word on whether they gave him epinephrine. (New York law allows schools to stock it, but doesn’t require them to.) Update: Apparently the school called his mother instead of 911. Want to bet paramedics could have helped?

“We will get to the bottom of what happened here…” says a spokesman for NYC’s health department, “and whether the facility could have done something differently to prevent this tragedy.” Well, yeah: Don’t give kids food that you know they’re severely allergic to!

Children with severe allergies know to avoid certain foods, but they need help to do it:

  • It takes time to learn how to avoid all forms of food you’re allergic to. I was seventeen before I learned that cross-hatches meant peanut butter cookies, because we’d never had them in the house. (Incidentally: that was the first time I actually used an Epi-Pen.)
  • Some foods have substitutes that look and taste similar enough that you could take a bite — and it only takes one bite — before discovering it’s the real thing. Sunflower seed butter for peanut butter. Daiya for cheese (and yes, you can make a grilled Daiya sandwich).
  • Ingredients can be hidden. There are an awful lot of pasta sauces that look like standard tomato sauce with herbs that also have cheese in them.
  • Kids that young have no choice but to trust the adults taking care of them. There’s a power difference. If you trust someone, you’re less likely to double-check them. And when you’re not sure? Not all kids can push back against an insistent adult, especially one they’re accustomed to depending on. (Keep that issue of power imbalance in mind when you read other stories in the news today, too.)
  • Preschoolers aren’t exactly known for their impulse control, so even the ones who have the courage to self-advocate won’t always stop to check before taking that first bite.

Maybe it was someone new who didn’t know yet. Maybe it was someone who didn’t take it seriously. Maybe there was a mix-up and he was supposed to get something else, but they handed him the cheese sandwich by mistake. All of those could have been prevented.

Yes, mistakes happen. Even fatal ones. But they happen a lot less often when you listen to people who are facing the danger, believe them, and take action to follow through on it.

1 in 13 children has a food allergy. Even if your child doesn’t, they have friends who do.

Don’t let them down.

Update on the case from Allergic Living (Nov 16):

The incident is still under investigation. It’s not even clear at this point whether the specific person who gave him the sandwich was aware of the allergy (though they certainly should have been), or whether they gave him epinephrine, though it is clear that:

  • The school was aware of his allergy
  • The school didn’t call 911, they called his mother instead.

The school has been closed pending the investigation results, and new directives have been issued that childcare staff will call 911 in the event of a medical emergency.

Another update from Allergic Living (May 2018):

  • The preschool didn’t tell Elijah’s mother that he’d eaten, so she thought he was experiencing an asthma attack. (This is also how I interpreted my first anaphylaxis experience at 17: as an asthma attack that didn’t respond to my normal medication. I didn’t know it at the time, but I could have died.) He didn’t get epinephrine right away, which might have saved him.
  • NYC has launched a major training program to help preschool staff understand and handle food allergies and anaphylaxis.
  • Elijah’s parents have been active in raising awareness of severe allergies in the community and online.

Predictive Frameshift

I’ve been thinking a lot about Robert J. Sawyer’s Quantum Night the last few months. It links human cruelty, psychopathy, and mob behavior to the nature of consciousness, mostly focusing on the main characters but playing out against a global crisis brought on by a rising tide of xenophobia.

More recently, I’ve been thinking about Frameshift. His 1997 novel deals with (among other things) eugenics, Neanderthals, Nazis, and health insurance companies doing everything they can to avoid covering people with pre-existing conditions.

I can’t imagine why that keeps coming to mind….

Why would you risk eating out with a food allergy?

On every news story about someone who experienced a severe allergic reaction outside the home, there will be someone who says, “If it’s that dangerous, why would you even risk it? Keep your kid at home and make all their food yourself from scratch all the time!”*

Let’s think about this.

A car could kill your child. Today, tomorrow, years down the line. This is not a hypothetical. This is a fact, and it’s a risk that you live with.

Why on earth would you risk letting your child cross the street? Keep them at home! Don’t let them out of the house in case someone jumps the curb!

That’s…not exactly practical, is it?

You don’t keep your child inside 24/7 to avoid cars. You take them outside, with precautions. You teach them to stay on the sidewalk, cross at corners and crosswalks, and look for cars before crossing. You walk with them until they’re old enough to walk safely on their own.

You rely on drivers to follow the rules of the road…but you still look both ways in case someone’s distracted or feels entitled and plows through a red light anyway.

And then your children can live their lives out in the world instead of being frightened recluses who hide in the basement whenever a car goes by.

You can’t eliminate risk 100%, but you can manage it.

The exact balance is going to be different for each person with an allergy.** But it’s not unreasonable to expect the food industry to follow basic safety procedures to avoid cross-contact — and to not introduce a danger that wasn’t there to begin with.

*Even if you have the time to prepare every meal at home, there’s still the risk of mislabeling or cross-contamination in the supply chain. Right now, there’s an ongoing recall of baked goods produced with peanut-contaminated flour. A year ago, supplies of cumin were tainted with peanuts. That impacted everything from prepared foods down to bulk-bin spices. Everyone’s at risk with the massive listeria recall of vegetables, allergies or no.

**Heck, it’s different for each of my allergies, and I’m one person. I’ll cheerfully walk into a coffee shop that serves almond milk and soy milk, but won’t set foot in one of those burger places that plops a bin of peanuts on the table. Even with my Epi-Pen. That’s just playing live-action Frogger.

Dosage Matters: The Car Analogy

It’s clear that many people online don’t understand the concept of dosage or concentration when it comes to substances of any sort (food, drugs, additives, environmental factors, chemicals*, radioactive isotopes): Something can be harmless or even beneficial in small amounts, but dangerous in large amounts.

Trivial examples:

  • You need salt for neural function, but if you drink sea water you’ll get sick.
  • Vinegar is dilute acetic acid. It’s useful for cooking and great on salads. Highly-concentrated acetic acid is corrosive.

Think of it like turning the steering wheel on your car (or the handlebars on your bike, if you prefer):

  • Turn it too far, and you go off the road, lose control, spin out, or otherwise crash.
  • Turn it just right, and you change lanes, avoid an obstacle, or go down a different road.

Also, most things will have multiple effects, some positive and some negative. (Consider aspirin: pain relief, fever reducer, blood thinner, but high doses can cause ulcers.) The balance of how strong each effect is will change with dosage, so you might have a strong positive and mild negative at one dosage, and a mild positive and strong negative effect at a higher one, and at an even higher dose even the positive effects would become negative as described above.

So the next time you see a warning about how hazardous something is in high concentrations…think about whether that has anything to do with the level at which people are actually exposed to it in the typical case.

*Remember: Everything is made of chemicals, including raw organically grown food.