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Why epinephrine may not work in a food allergy reaction.

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For Natalie Giorgi, epinephrine was not enough to stop a severe reaction to peanut butter from taking her life. Natalie, 13 years old, died this week after taking a bite of a Rice Krispie treat that contained peanut butter. Reports state that she immediately spit out the bite and told her parents that she ate something with peanuts. Natalie did not have a reaction right away. It took 20 minutes for her to show visible signs of an allergic reaction. Once she did, not even three injections of epinephrine were enough to save her.

Within 20 minutes, the teenager was vomiting and falling into anaphylactic shock, even as her father injected her with three EpiPens. "Her dad was a doctor and he couldn't save her from one bite of a dessert. This is a lesson to all of us how serious these allergies are," said Brothers. (KCRA.com)

This tragedy plays on every parent of a food allergic child's nightmare - that epinephrine will not work. Food allergic individuals carry epinephrine injectors to ward off the life threatening affects of a severe allergic reaction until they can get to an emergency care facility. Many tragic food allergy reactions could have been avoided by simply giving epinephrine. This story is particulary disturbing since epinephrine was given. In fact, three shots of epinephrine were given by a doctor at the scene. So, what went wrong?

Natalie was monitored by her parents for 20 minutes, her father a physician, and it is reported that she showed no symptoms. Then she vomited one time and had a shortness of breath.
Her father then administered the first of three EpiPens to deliver epinephrine, the correct lifesaving medicine for an allergic emergency, and he gave her oxygen. Natalie was in anaphylactic shock, had a cardiac arrest and died. (EpiCenter Medical Inc.)

Allergist Dr. Mark Greenwald explains in a recent blog post that the problem was in the 20 minute wait for symptoms to occur. He explains that current guidelines are incorrect on the use of epinephrine in an allergic reaction. We should not wait for symptoms to occur, but we should use the injector as soon as we know that the allergen was ingested. It is likely that Natalie's body was reacting to the allergen as soon as she took a bite of the treat. The best chance for epinephrine to work is when it is given immediately after a known allergen is ingested.

Think about it in these terms: A person who has ingested their allergen is like someone sitting on top of a barrel of nitroglycerine which can explode at any time. Get the person out of there! Don’t wait for even the first explosion...Symptoms can be rapid or delayed, symptoms in the same patient may be different from one episode to the next... (Dr. Mark Greenwald - Read full blog post here)

What we can learn from this tragedy is two fold. One, give epinephrine at the first instance that a life threatening allergen has been consumed. Two, never assume that a food item is o.k. to try without knowing the ingredients. If you are unsure, don't eat it! This becomes a much more difficult rule to follow as children get older and are given more autonomy. It is better to go hungry than to take a gamble with a treat.

Our prayers go out to Natalie's family and friends. A precious life has been taken from us due to a peanut allergy. Our hearts break for this family and we offer our support and condolences.

Cards of care and concern can be sent to: The Family of Natalie Giorgi, c/o Our Lady of the Assumption Catholic Church, 5057 Cottage Way, Carmichael, CA 95608

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