A 16 year old female presents to your office for a well-child exam. She has a history of peanut allergy but admits that she does not carry her epinephrine autoinjector. She feels that she is always careful in avoiding food with peanuts.
What advice would you give this patient regarding her risk of fatal anaphylaxis?
Explanation to Question 8
Teenagers are at higher risk for fatal food-induced anaphylaxis than younger children. In fact, recent data suggest that the dose provoking symptoms in peanut-allergic patients decreases with age, which may in part contribute to the observed difference in risk. Studies have also shown that adolescents have poor understanding of when food allergy reactions are severe and when epinephrine is indicated. Accidental exposure to peanuts and tree nuts are very common and has been reported to be as high as 48%. In addition, 54% of adolescents admit to purposefully eating potentially unsafe food.
The correct answer is B, foods may be unknowingly contaminated with peanuts and therefore having an epinephrine autoinjector is critical at all times.
Sources:
1. Sampson M, Muñoz-Furlong A, Sicherer S. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol 2006; 117:1440-45.
2. van der Zee T, Dubois A, Kerkhof M, van der Heide S, Vlieg-Boerstra B. The eliciting dose of peanut in double blind, placebo-controlled food challenges decreases with increasing age and specific IgE level in children and young adults. J Allergy Clin Immunol 2011; 128:1031-36.
