Girl's Death Prompts Discussion Of Surviving Food Allergies

When a woman plucked shrimp off a plate of pasta and handed it to Dr. Samuel Grandinetti, D.D.S., she had no idea the dish could have killed him.

After Grandinetti, a dentist with offices at Touhy and Harlem in Chicago, ate the pasta, his allergy to shrimp caused him to start going into anaphylactic shock.

"I could feel my throat closing up," he said, adding he was having trouble breathing.

Fortunately, other friends administered Benadryl, an antihistamine, in time to stop the reaction.  

Other food-allergic people have not been so lucky. 

Thirteen-year-old Katelyn Carlson, who had a peanut allergy, that her seventh-grade teacher had ordered for a class party Dec. 17. The case was in the news again last week after her parents .

It has stirred interest in food allergies in local homes and schools. 

Katelyn's story prompted Dr. Joel Klein, M.D., who is on the medical staffs of Advocate Lutheran General Hospital and NorthShore University Health System and has an office in Highland Park, to talk with Patch about what the food-allergic person can eat, and how to treat bad reactions to allergens. 

While cautioning that he had never met Katelyn and couldn't comment specifically on the medical treatment she received, he offered general guidelines for surviving food allergies.

How to order in restaurants

When ordering for a food-allergic child in a restaurant, Klein suggested, tell the manager and/or server exactly which food the child is allergic to. Since even the residue of an allergen food can cause a reaction, the kitchen must use different pans, utensils and frying oil to avoid cross-contamination. 

"There's the issue of carryover," Klein said. "If someone is holding a ladle or some cooking utensil with traces of residue of peanut oil, that ladle shouldn't be carried over to the area where the allergic child's food is being prepared."

How to Recognize a Food Allergy Reaction

Four areas of the body show symptoms of allergic reactions, Klein said. Here's what to look for:

• Skin and mucous membranes. Watch for swelling and/or itching of the mouth, lips and tongue, the roof of the mouth and the uvula (the piece of skin that hangs down from the back of the mouth ceiling).
• Lungs. Watch for wheezing, shortness of breath, cough and tightness in the throat or chest.
• Gastrointestinal. Watch for vomiting, nausea, abdominal pain and/or diarrhea.
• Heart and blood vessels. Watch for pale skin color, light-headedness and loss of consciousness.

How to treat a reaction

Doctors of food-allergic children write food allergy action plans for them that set down what to do if the child has a reaction. In the past, Klein said, doctors would appear to have had more discretion (because of the format of the food allergy action plan form) on whether to recommend an antihistamine (such as Benadryl) or epinephrine.

"But, epinephrine should be  available at all times for any person at risk for life-threatening symptoms from a food allergy, especially for those with peanut and tree nut allergies," Klein said.  

Klein is one of 150 members of the Anaphylaxis Community Experts group, which are American College of Allergy, Asthma and Immunology members who have volunteered to educate the public that epinephrine is the first line of treatment for food-allergic people who have anaphylactic reactions.

If a food-allergic person has only a mild reaction, such as a localized skin rash, it's OK to treat that with antihistamine, Klein continues. 

"But for hives affecting most of the body or for severe reactions, epinephrine is more effective."

In life-threatening reactions, epinephrine "would have to be used" because its benefits substantially outweigh the risks, he said.

Three choices to deliver epinephrine

Three manufacturers make epinephrine devices that can be injected into the upper thigh, without removing clothing, during an anaphylactic reaction.  Klein said he shows all three to each patient, or parents of a patient, and lets them decide.

They are:

• EpiPen.
• Twinject, which contains two doses of epinephrine which can be administered one at a time. The second dose can be given if the reaction is not improving after around 15 minutes and the allergic person has not yet reached the hospital.
• Adrenaclick.

"Generally, two doses of epinephrine are recommended to be available--either two devices of the Epipen or of the Adrenaclick, or one Twinject device," Klein said.

Parents, or food-allergic children who are mature enough, generally age 10 and up, should carry one of these devices with them wherever they go, in case they accidentally eat something which contained an allergen, Klein said. 

For kids who are old enough to go to school, Illinois law requires school districts to have a plan for each food-allergic child in case they have a reaction. 

"Parents should know the plan well and be in contact with the appropriate school officials," Klein advised. "Be in contact with the physicians managing the food allergy at least on a yearly basis." 

For more information: 

 www.aanma.org/anaphylaxis andwww.AllergyandAsthmaRelief.org