Risk Assessment on Allergens: Cases Review

A 16-year old athlete developed hives and fainted on two separate occasions while running 2 hours after lunch. She had a tuna salad sandwich with celery. She has eaten the same type of sandwich since without symptoms, but not within 6 hours of running.

The patient suffered from urticaria induced by physical activity. Most commonly, this health condition occurs several hours after the consumption of certain foods. In the case under analysis, the patient is allergic to celery that is often associated with allergic reactions in people (EFSA Panel on Dietetic Products, Nutrition and Allergies [NDA] 2014). In quite rare instances, urticaria can be induced by physical activity such as running although the symptoms do not occur after eating this food without exercising (NDA 2014). Since the patient had hives and fainted after eating celery and exercising quite strenuously, it is possible to note that she should avoid eating celery before physical activity.

A 15-year old boy has itchy lips and throat when eating fresh bananas but not banoffee pie. Each Spring he suffers from itchy eyes, sneezing, and a runny nose typical of hay fever.

Banana is a common allergen, and it is characterized by a significant level of cross-reactivity. People who are sensitive to bananas may also be allergic to pollen (especially birch pollen) or latex (NDA 2014). The patient develops certain symptoms after eating fresh bananas or during the springtime. At the same time, the boy can eat banoffee with no allergic reactions. The patient has anaphylaxis induced by certain proteins bananas (and some other plants such as birches) contain. This assumption is based on the fact that some allergens may be sensitive to temperatures (Wongsa et al. 2017). Wongsa et al. (2017) report about a patient who did not tolerate fresh bananas, but could consume baked bananas. Likewise, the patient under discussion can eat banoffee as the proteins bananas contain are affected by low temperatures, and their impact on the patient’s immune system is minimal or absent.

A 45-year old female presents with headache, nausea, diarrhea, and a red blanching rash about 60 minutes after eating tuna at a restaurant. She also complained of severe itchy skin and a restless feeling. Her face became flushed soon after her meal. Her friend who also ate tuna had similar symptoms. The patient was healthy with no medical problems. She had a conjunctival injection and a diffusely red blanching rash on her face, neck, trunk, and extremities. Her physical examination was otherwise unremarkable. She was treated with antihistamines which resulted in improvement in her symptoms; with complete resolution of her symptoms after approximately 10 hours.

One of the primary factors to consider is the health condition of both patients. The friend of the patient allergic to tuna had no previous history of fish allergies. Therefore, it is important to look at conditions that look like allergies but are not allergies proper. Scombrotoxin poisoning that is often referred to as histamine fish poisoning is a health issue caused by the consumption of histamine-contaminated products (mainly fish) (Ridolo et al. 2016). This health condition occurs within minutes after the consumption of the contaminated food and tends to be over in 12-24 hours. In severe cases, it can take a few days to eliminate the symptoms. Since histamine induces anaphylaxis related to scombrotoxin poisoning, the condition is treated similarly to allergies. The fact that both patients felt better after the administration of antihistamine medications also indicates that the person with no history of fish allergies had scombrotoxin poisoning.

A 19-year old student had been experiencing occasional discomfort after meals. At home, he rarely consumed dairy products but at university had started eating out more frequently. The discomfort reached a new peak one evening about an hour after eating a burger and a large strawberry milkshake. The symptoms were abdominal cramps, diarrhea, and generally feeling sick.

Lactose intolerance is the most likely diagnosis in this case. The severity of this condition is low or medium as the student does not suffer serious symptoms each time he had lactose-containing foods. The provided information is rather insufficient for making a proper diagnosis. For example, the reasons for avoiding dairy products in adolescence are not highlighted. The symptoms of lactose intolerance include bloating, diarrhea, vomiting, nausea, abdominal pain (Deng et al. 2015). It is mentioned that the patient had occasional discomfort after meals, so it is possible to assume that on those occasions, he consumed lactose-containing dishes in significant quantities. The discomfort could reach a new peak as the patient consumed a considerable amount of milk. Moreover, it is noted that the students started having quite an unhealthy diet, and the fact that he had a hamburger is an illustration of this dietary pattern. Such dietary habits increase the risk of developing a tummy infection, which can damage lactase-producing cells. Such damages make the symptoms of lactose intolerance more pronounced.

A 17-year-old visited the local Thai restaurant and purchased chicken satay. The 17-year-old knew they had an allergy to peanuts that were being actively managed. Symptoms of abdominal pain, nausea, vomiting, and diarrhea with difficulty swallowing due to shortness of breath, following itching of the mouth and throat, were experienced rapidly following consumption of the food after which the person collapsed. An injection of adrenaline was administered incorrectly and did not affect.

The student suffered from peanut-induced anaphylaxis after consuming a dish that contained the allergen. Severe cases of food-induced anaphylaxis are commonly treated with epinephrine, also known as adrenaline, that is injected into the outer thigh (Eigenmann et al. 2016). It is crucial to ensure that adrenaline is injected correctly as it has an impact on patient outcomes. Lomas and Järvinen (2015) note that up to 40% of the patients who experienced severe anaphylaxis did not receive adrenaline timely, which led to adverse effects. Patients often pull the injector too soon or do not press it hard enough, which prevents epinephrine from being absorbed quickly and entirely. In many cases, it can be hard to estimate the necessary dose of adrenaline, so another injection is necessary if consciousness is not regained within 10 minutes (Lomas & Järvinen 2015). This is the case with the patient under analysis who remained unconscious even after the administration of adrenaline. The received dose was not sufficient, so the patient needed another injection.

A 21-year-old visited the local Chinese restaurant and purchased a chicken curry dish. The 21-year-old knew he had an allergy to nuts and peanuts. The allergy was being actively managed. Clear instructions for a peanut/nut-free meal were given to the catering staff though it was well known other dishes were prepared in the kitchen containing peanuts. Symptoms of an allergic response were experienced immediately on consuming the food after which the person collapsed. Medical care was provided and the person was resuscitated. The meal was subsequently tested and peanut protein was found in the ‘almond’ paste used to make the meal.’

Allergy is often referred to as the plague of the twenty-first century. Tang and Mullins (2017) note that the prevalence of this disorder is increasing exponentially in young children. For example, it has been estimated that the rate of pre-schoolers allergic to some foods is as high as 10% in such countries as the UK (Tang & Mullins 2017). Researchers have focused on different aspects related to this health condition, which affected the way allergy is defined. For example, allergy can be regarded as a type 1 hypersensitivity reaction of mammalian bodies to certain agents (Rajan 2003). These reactions are aimed at preventing hostile agents from occupying certain systems. For instance, anaphylaxis is a way to protect the respiratory and gastrointestinal systems of the human body. Recent research indicates that human mast cells play a primary role in the occurrence of reactions to different allergens (Saito, Ishizaka & Ishizaka 2013). This report addresses the case of the young adult allergic to peanuts who had anaphylaxis after eating in a Chinese restaurant although he warned the staff about his condition. The report includes three preventive measures that could have been undertaken in that case.

Prevention Strategies

It has been found that American restaurant servers tend to have limited knowledge about allergies and put the entire responsibility related to risks on customers (Wen & Kwon 2017). The situation in other countries is similar, which may be one of the factors contributing to a high rate of serious allergic reactions caused by restaurant food. The case under discussion is an illustration of restaurant employees’ negligence as they were warned about their client’s allergy, but still served the food containing hazardous components. One of the preventive measures is allergen avoidance, which has proved to be effective and widely used (Wen & Kwon 2017). In the case in question, the young adult had to avoid eating food in a restaurant where peanut is one of the most common ingredients. The person allergic to peanuts had to be more cautious and choose places with a certain reputation, the ones where allergic people were served safe food.

Another preventive strategy aimed at serving safe food and avoid the development of anaphylaxis in the customer could be restaurant employees’ proper response to the young man’s information concerning his health. Wen and Kwon (2017) emphasize that employees’ training and previous experiences involving witnessing allergic reactions correlated with their responsiveness to such health issues. This restaurant’s employees should have received certain training that had to involve videos and pictures of severe cases of anaphylaxis. Restaurant servers would have become more knowledgeable and cautious as to serving people with allergies. The employees would have ensured that the food was prepared without any trace of peanut. If this was impossible, the employees would notify the potential customer about their inability to ensure the provision of peanut-free foods.

Finally, to avoid such severe reactions as collapse, the adult had to make sure that he was ready for any situation. He had to take an epinephrine injection kit (but it is better to take two kits) every time he went to eat out (Lomas & Järvinen 2015). The young man’s physician or allergist must have provided all the necessary data concerning different types of reactions and ways to address them. Once the customer had felt the first serious symptoms of the allergic reaction, he should have injected one (if necessary two doses) dose of epinephrine. The next step was to seek medical treatment as even after such injections (especially if they were administered incorrectly), new and usually more severe symptoms may occur (Lomas & Järvinen 2015). Although this method would not have prevented a medical episode per se, the customer would not have experienced severe symptoms of anaphylaxis.

Conclusion

To sum up, it is possible to note that allergy is becoming a heavy burden as the prevalence among children and adolescents is increasing at a high pace. People may experience severe allergic reactions that can even result in death. Food allergies are common, so people with this health condition have to be specifically cautious when eating out. Avoidance is the most effective way to avoid such reactions as anaphylaxis. To ensure their safety, customers have to be quite straight-forward and even assertive when informing restaurant servers about potential health issues. One of the ways to avoid severe symptoms such as collapse for customers with food allergies is to keep an epinephrine injection kit close at hand. Finally, restaurant employees should receive extensive training related to treating customers with allergies.

Reference List

Deng, Y, Misselwitz, B, Dai, N & Fox, M 2015, ‘Lactose intolerance in adults: biological mechanism and dietary management’, Nutrients, vol. 7, no. 9, pp. 8020-8035.

EFSA Panel on Dietetic Products, Nutrition and Allergies [NDA] 2014, ‘Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes’, EFSA Journal, vol. 12, no. 11, pp. 1-286.

Eigenmann, PA, Lack, G, Mazon, A, Nieto, A, Haddad, D, Brough, HA & Caubet, JC 2016, ‘Managing nut allergy: a remaining clinical challenge’, The Journal of Allergy and Clinical Immunology: In Practice, vol. 5, no. 2, pp. 296-300.

Lomas, JM & Järvinen, KM 2015, ‘Managing nut-induced anaphylaxis: challenges and solutions’, Journal of Asthma and Allergy, vol. 8, pp. 115-123.

Rajan, TV 2003, ‘The Gell–Coombs classification of hypersensitivity reactions: a re-interpretation’, Trends in Immunology, vol. 24, no. 7, pp. 376-379.

Ridolo, E, Martignago, I, Senna, G & Ricci, G 2016, ‘Scombroid syndrome: it seems to be fish allergy but… it isn’t’, Current Opinion in Allergy and Clinical Immunology, vol. 16, no. 5, pp. 516-521.

Saito, H, Ishizaka, T & Ishizaka, K 2013, ‘Mast Cells and IgE: from history to today’, Allergology International, vol. 62, no. 1, pp. 3-12.

Tang, MLK & Mullins, RJ 2017, ‘Food allergy: is prevalence increasing?’ Internal Medicine Journal, vol. 47, no. 3, pp. 256-261.

Wen, H & Kwon, J 2017, ‘Restaurant servers’ risk perceptions and risk communication-related behaviors when serving customers with food allergies in the U.S’, International Journal of Hospitality Management, 64, pp. 11-20.

Wongsa, C, Intapiboon, P, Dechapaphapitak, N, Tongdee, M, Oncham, S, Kafaksom, T & Laisuan, W 2017, ‘Tolerance to baked banana in adult with banana anaphylaxis: a case report’, The Bangkok Medical Journal, vol. 13, no. 1, pp. 53-56.