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John W. Yunginger, MD; Kristin G. Sweeney, MD; William Q. Sturner, MD; Leigh A. Giannandrea, MD; Joel D. Teigland, MD; Michael Bray, MD; Peter A. Benson, MD; James A. York; Lynda Biedrzycki, MD; Diane L. Squillace; Ricki M. Helm, PhD

JAMA. 1988;260(10):1450-1452.

Abstract
Fatal food-induced anaphylaxis is rarely reported. In 16 months, we identified seven such cases involving five males and two females, aged 11 to 43 years. All victims were atopic with multiple prior anaphylactic episodes after ingestion of the incriminated food (peanut, four; pecan, one; crab, one; fish, one). In six cases the allergenic food was ingested away from home. Factors contributing to the severity of individual reactions included denial of symptoms, concomitant intake of alcohol, reliance on oral antihistamines alone to treat symptoms, and adrenal suppression by chronic glucocorticoid therapy for coexisting asthma. In no case was epinephrine administered immediately after onset of symptoms. Premortem or postmortem serum samples were available from six victims; in each case elevated levels of IgE antibodies to the incriminated food were demonstrated. Food-sensitive individuals must self-administer epinephrine promptly at the first sign of systemic reaction. Emergency care providers should be aware of cricothyrotomy as a life-saving procedure.

(JAMA 1988;260:1450-1452)

Author Affiliations
From the Departments of Pediatrics and Internal Medicine (Allergy) (Dr Yunginger) and Immunology (Ms Squillace and Dr Helm), Mayo Medical School, Mayo Clinic and Foundation, Rochester, Minn; Office of State Medical Examiners, Providence, RI (Drs Sweeney, Sturner, and Giannandrea); Allergy/Asthma Associates, PC, Des Moines (Dr Teigland); Office of the Chief Medical Examiner, Washington, DC (Dr Bray); San Mateo County Coroner's Office, Redwood City, Calif (Dr Benson); Office of Coroner of Napa County, Napa, Calif (Mr York); and the Oakland County Department of Institutional and Human Services, Pontiac, Mich (Dr Biedrzycki).

Footnotes
Reprint requests to the Allergen Resource Reference Laboratory, 406 Guggenheim Bldg, Mayo Clinic, Rochester, MN 55905 (Dr Yunginger).

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