Case of Bubonic Plague in Oregon

Here is a general interest story that we found….interesting. A man in Oregon contracted bubonic plague after trying to take a rat out of a stray cat’s mouth. Near death, he spent a month on life support. Now, he will need to have his hands and toes removed. (picture below gives meaning to the Black Death).

As you know, the bubonic plague or Black Death has had a large impact on the history of mankind. Through a series of major pandemics (6th to 7th century in the Mediterranean, 1300 to 1650 in Europe, and 19th and early 20th century in Asia and ports around the world), the plague wiped out some 200 million people (close to a third of Europe in the dark ages). The responsible organism, Yersinia pestis, is spread by fleas carried on rats. The disease was mostly eradicated by improved sanitary practices. While considered an ancient disease, there are still cases that pop up from time to time. There have been a reported 11 cases in the US since 1976, most all cases were in western US. (People living and working in areas with natural environment where there is a higher prevalence of woodrats).

Yersinia pestis, a gram negative organism, is one of the most pathogenic organisms known. It can infect through lesions in the skin (such as a flea bite) where it infects the lymphnodes and then invades other organs where it causes massive tissue destruction. Gangrene often sets in on the dead tissue. It can also spread through inhalation of infective respiratory particles (pneumonia). Disease is initially characterized by development of one or more inflamed, swollen lymph nodes (buboes), and then chills and fever, lethargy and confusion. Historically, the fatality rate was greater than 50%, but now with antibiotics, it is now about 5%. But still, who wants to be this guy.

Plague infects Oregon man who tried to get rodent from stray cat
An Oregon man who was bitten by a stray cat has contracted the plague — the fifth case of the disease in Oregon since 1995.
http://seattletimes.nwsource.com/html/localnews/2018446561_plague16.html
By Nigel Duara and Steven Duboist
The Associated Press

PORTLAND — Health officials have confirmed an Oregon man has the plague after he was bitten while trying to take a dead rodent from the mouth of a stray cat.
The unidentified Prineville, Ore., man was in critical condition on Friday. He is suffering from a blood-borne version of the disease, not the bubonic plague, which wiped out at least one-third of Europe in the 14th century. The bubonic plague affects the lymph nodes.

There is an average of seven human plague cases in the U.S. each year. A map maintained by the Centers for Disease Control and Prevention shows most cases since the 1970s have been in the West, primarily the southwest.

The last reported case of plague in Washington state occurred in 1984 when an animal trapper in Yakima became infected while skinning a bobcat. In 2010, a Washington laboratory technician was treated to prevent plague infection after working with a specimen from one of the two reported cases in Oregon at the time.

The plague bacteria cycles through rodent populations without killing them off; in urban areas, it's transmitted back and forth from rats to fleas. There's even a name for it, the "enzootic cycle."

The bacteria thrive in forests, semiarid areas and grasslands, which plague-carrying rodents from wood rats to rock squirrels call home.

Once a coin flip with death, the plague is now easier to handle for humans in the U.S. The national mortality rate stood at 66 percent before World War II, but advances in antibiotics dropped that rate to its present 16 percent.

Central Oregon health officials don't blame the cat.

"The reality is that, in rural areas, part of the role of cats is to keep the rodent population controlled around our homes and barns" said Karen Yeargain of the Crook County Health Department.
 The Prineville man, who is in his 50s, remained in critical condition Friday at a Bend hospital. His illness marks the fifth case of plague in Oregon since 1995.

State public health veterinarian Dr. Emilio DeBess said the man was infected when he was bitten by the stray his family befriended. The cat died and its body is being sent to the CDC for testing.

DeBess has collected blood samples from two dogs and another cat that lives with the man's family. DeBess also collected blood samples from neighbors' pets and from animals in the local shelter to determine whether the area has a plague problem.

More than a dozen people who were in contact with the sick man have been notified and are receiving preventive antibiotics.

 

Reward outweighs risk when it comes to summer's fresh produce

Thursday, July 12, 2012
http://live.psu.edu/story/60347

UNIVERSITY PARK, Pa. -- With what seems to be an ongoing wave of news reports linking foodborne illness to fresh produce, many consumers are questioning whether it is worth the risk.
But Martin Bucknavage, extension food-safety specialist in Penn State's College of Agricultural Sciences, emphasizes that the benefits far outweigh the risks when it comes to consuming fresh fruits and vegetables.

According to Bucknavage, consumers should appreciate that they can take advantage of the wide selection of fresh produce available during the summer, instead of worrying about the remote possibility of foodborne illness.

"While there have been cases of illnesses reported from time to time that come as a result of contaminated produce," he said, "the risks are quite low when you consider the amount of produce consumed in the United States."

But it is important that consumers take specific steps to help ensure the safety of the produce they purchase, Bucknavage advised.

"Fruits and vegetables must always be washed before being sliced or eaten and must be refrigerated once they have been cut," he said.

Bucknavage also cautioned that certain items, such as cantaloupes, have surfaces that are more difficult to clean, so consumers must be particularly vigilant about washing them.

He explained that it is important to follow these precautions regardless of whether the produce is purchased from a large supermarket or a small farmer's market, but he emphasized that there are many advantages to buying food locally.

"Locally grown produce normally reaches the consumer within a day or so of when it is harvested, so it is fresher," he said. "And it also is harvested closer to the time it ripens, which often results in a better tasting, more nutritious product."

When shopping at farmer's markets, he encourages buyers to follow a few simple guidelines to ensure the safety of their purchases.

"Make sure that produce is fresh looking -- it should have proper color and firmness," Bucknavage said. "Also, avoid fruits and vegetables with decay or excessive bruising, regardless of the price. Damaged produce is more likely to harbor harmful bacteria."

Consumers need to learn about what is grown in their local area and the optimal time for harvest. "People should take advantage of all the different types of fruits and vegetables grown around them," he said. "It is fun to find new recipes that maximize the taste and healthfulness of those items."

Bucknavage noted that freezing and canning can preserve the local bounty for later use. "However, we should never purchase more than we can handle in a day or so," he said. "And it is important to use only approved procedures for canning and freezing, such as those listed on the USDA website."

Don't get discouraged with fresh produce, he urged.

"We get jaded by all the stories we hear on the news, but really, there is minimal risk," Bucknavage said. "Rather, I encourage folks to try all types of local fresh fruits and vegetables and not worry about the possibility of contracting foodborne illness."

Raw Shellfish and the Risk Associated with Vibrio vulnificus

This news report, submitted by our colleague Larry Grunden, shows the potential danger of infection associated with eating raw clams and oysters. In this report, a 61 year old woman suffered a life threatening Vibrio vulnificus infection after eating raw clams two year ago. She survived, but did need to have her leg amputated, and nearly lost one of her arms. (The attached news report is incorrect in calling this a virus).

Vibrio vulnificus is a gram negative bacterium found in warm seawater. In healthy people, it can cause gastroenteritis (vomiting, diarrhea, and abdominal pain), but in people with an underlying health issue, particularly chronic liver disease, it cause infection of the bloodstream (septicemia). In these cases, it has a high mortality rate (~50%). The organism is highly invasive and produces toxins (a cytolysin, a hemolysin, and a thermolysin).

A few other notes:
- Hot sauce will not kill the organism.
- Consumption of liquor will not help either, in fact, those who drink too much of this type of sauce will be more susceptible.
- Other pathogens associated with raw clams and oysters that are also naturally found in seawater – other members of the Vibrio family (Vibrio parahaemolyticus, Vibrio cholerae - causative agent for cholera, and other vibrio species), Aeromonas, and Plesiomonas.
- Enteric pathogens associated with shellfish contamination - the viruses norovirus and Hepatitis A as well as bacterial pathogens Shigella, Salmonella, Campylobacter, and E. coli.
- Water testing done for the safety of harvesting water normally uses indicators associated with fecal contamination. This is good for the enteric pathogens, but not good for the pathogens such as Vibrio that are naturally found in seawater.
- The risk of Vibrio vulnificus contamination increases in the warmer months (due to warmer ocean waters).

Key message – there is a risk when consuming raw oysters and clams, and this risk is greatly magnified for those with underlying health issues such as immunosuppression or advanced age, and especially chronic liver disease.

Flesh-eating virus nearly cost woman her life

http://www.wgal.com/news/susquehanna-valley/york-adams/Flesh-eating-virus-nearly-cost-woman-her-life/-/9704248/15568968/-/item/1/-/gqpdltz/-/index.html

Lewisberry woman got bacteria from clams
LEWISBERRY, Pa. - 

A York County woman nearly died from a flesh-eating bacteria she came in contact with about two years ago.

Maureen Horan, 61, known to her friends as "Mo," said she almost didn't survive her ordeal.
Her near-death ordeal began on the last day of a 2010 during a vacation to the Jersey Shore. Horan and her husband, Dennis, had a late lunch. Horan's meal included raw clams.

"I knew there was something wrong when I swallowed the one clam, but it was too late," Horan said.

By the next day Horan said she was in severe pain. She went to the emergency came home, but her condition only got worse.

"I get up and the pain is worse. My toes are black, my arm is red, my leg is red and my sister-in-law said, "I don't know what it is, but you make them admit her," Horan said.

E. coli in Ground Beef - FSIS Data and Risk

USDA-FSIS recently updated their data on E. coli O157:H7 in ground beef and trim through July 8, 2012 (http://www.fsis.usda.gov/Science/RGBC_STEC_Results/index.asp).  In order to get a visual representation of the risk associated with ground beef, the year-end results were plotted.  Only routine samples were evaluated for ground beef (both federal plant and retail).  Based upon this sampling, E. coli O157:H7 is found in approximately 0.1% to 0.2% of ground beef samples.

This rate is a lower than the percent positive found in trim (beef trim that goes into ground beef).  For 2011, trim verification yielded a 0.64% positive and thru 7/2012, 0.53%.

The results indicate that interventions put in place by the meat industry have had an impact in reducing the level of E. coli in ground beef, however, from a consumer's perspective, careful handling and preparation is required.  Specifically, cleaning hands and food contact surfaces when handling and preparing, and cooking to the proper internal temperature of 160ºF.

French cheese linked to a case of listeriosis

An elderly Pennsylvania man was stricken with listerosis after eating a high-priced soft cheese imported from France.  Whole Foods is recalling the cheese baring thier own label.

Interesting is the fact that Whole Foods looks to have cut and repackaged the cheese which begs the question...where did the contamination occur - was it present in the original package, or did the cheese become contaminated during repackaging?  Additionally, the article stated that the cheese product was slow moving in regard to retail sales, which means that it would have given more time for Listeria to grow.  Listeria, as we know, grows at refrigeration temperatures, although slowly.


Whole Foods recalls contaminated cheese
Man seriously ill after consuming tainted product from East Liberty grocer
July 13, 2012 12:08 am

By David Templeton / Pittsburgh Post-Gazette

A pricey French cheese sold at Whole Foods Market in East Liberty is being recalled more than a month after a 69-year-old Westmoreland County man grew seriously ill from listeriosis, a food-borne bacterial infection.

The man fell ill June 7 and was hospitalized after eating Jean Perrin Edel de Cleron cheese -- a soft, pasteurized cow's milk French cheese that sells for about $25 a pound. The man continues to recover in a rehabilitation center, said Guillermo Cole, Allegheny County Health Department spokesman.

On Thursday, the health department and Whole Foods Market announced the recall of the cheese, which was cut and packaged in clear plastic wrap bearing a Whole Foods Market scale label and code beginning with 293351. The cheese was sold between May 20 and July 3.

The recall didn't occur until more than a month after the man fell ill, Mr. Cole said, because it took time for him to be diagnosed and then to get positive test results on foods he had consumed with follow-up efforts to test samples from the market where he purchased the cheese.

"It required some medical detective work," Mr. Cole said.

The store is offering full refunds for the cheese. The health department said customers who purchased it from the market during that time period should either dispose of it in the garbage or return it to the store. Those who touch the cheese should wash their hands immediately afterward to avoid cross-contamination. The store also has posted signs in the store to notify customers of the recall.

The store and health department are working to ensure that no cross-contamination occurred and that equipment and utensils used in cutting, weighing or packaging the cheese isn't contaminated with listeria monocytogenes, the bacterium that causes listeriosis.

The illness primarily affects older adults, people with weakened immune systems, pregnant women and newborns. Such infections, caused by consumption of food contaminated with the bacterium, can be serious and possibly fatal.

Anyone who consumed the cheese should seek medical help if the individual has diarrhea and gastrointestinal illness followed by fever and muscular aches.

Customers who have the recalled product may contact the health department at 412-687-2243 (ACHD) and arrange to have the cheese tested.

The health department declined to identify the ill man. Mr. Cole said the man represents the only one affected by the contamination to date. The cheese that the man purchased tested positive for the bacterium, as did samples of the cheese taken at the store.

On the upside, Mr. Cole said, the price of the cheese meant that not a large quantity had been sold.

Read more: http://www.post-gazette.com/stories/news/health/whole-foods-recalls-contaminated-cheese-644522/#ixzz20W0tMurV

Three cases of botulism from home preserved foods

There are three confirmed cases of botulism from home preserved foods.  Unfortunately, there is no additional information regarding the circumstances.

With an increasing number of people preserving their own foods, we unfortunately expect that there will be these types of incidents.  It is important that consumers practice 'approved procedures' when canning foods.  Penn State has a dedicated website for support - http://extension.psu.edu/food-safety/food-preservation. 

In our interactions with consumers, we still find that people are using improper techniques (canning in the oven, not using a pressure cooker for low acid foods, etc).   Where do they get this dangerous information -
- word-of-mouth from a friend - "I know this guy who cans in the oven all the time"
- the memory of what they think their grandmother used to do - "I recall my grandmother never using a pressure cooker to can green beans"
- some misguided blogger on the web

Do not put yourself, your family, or your friends in danger, use proper, approved procedures for preserving food.

County News Release
http://www.deschutes.org/Media-Releases/Botulism-in-3-People-Caused-by-Home-Canned-Food.aspx
Deschutes County Oregon -- 7/2/2012 --

The Oregon State Public Health Lab has confirmed that three Central Oregon residents,who were hospitalized, contracted botulism at a private barbeque. Deschutes County Health Services has conducted an investigation and implicated home-canned food as the source of the Botulism. Final testing results are pending. This was an isolated incident and Deschutes County Health Services has notified all involved individuals. Botulism in NOT spread person to person so there is no risk to the general public as a result of these cases.

This is a good reminder of the importance of following strict hygienic procedures to reduce contamination of foods while canning as well as obtaining the necessary pressure when canning to effectively destroy bacteria and prevent botulism. Detailed instructions on safe home canning can be obtained from Oregon State extension services at the following website: http://extension.oregonstate.edu/fch/food-preservation. Oregon Residents can also call the Food Preservation and Food Safety Hotline at (800) 354-7319 to talk to trained OSU Extension staff.

There are three primary types of botulism:

1. Foodborne botulism is caused by eating foods that contain the botulism toxin and is often associated with home-canned foods that have been improperly processed. Ingesting botulism toxin can lead to illness within a few hours- to days. Foodborne botulism is often caused from home-canned foods with low acid content such as asparagus, green beans, beets and corn.

2. Wound botulism is caused by toxin produced from a wound infected with the bacterium. Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using contaminated injectable drugs.

3. Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. Honey can contain spores of the botulinum bacteria and has been a source of infection for infants. Children less than 12 months old should not be fed honey. Generally, honey is safe for people one year of age and older.

The classic symptoms of botulism include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and breathing muscles. In foodborne botulism, symptoms generally begin 12 to 36 hours after eating a contaminated food, but they can occur as early as six hours or as late as 10 days later.

In the United States an average of 145 cases of botulism are reported each year. Of these, approximately 15 percent are foodborne, 65 percent are infant botulism, and the rest are wound botulism.

Nationally, outbreaks of foodborne botulism involving two or more people occur most years and are usually caused by eating contaminated home-canned foods.

NJ Firm recalling frozen meat product due to possible Listeria contamination

A New Jersey company is recalling 324770 pounds of frozen, ready-to-eat meat and poultry products due to possible Listeria contamination. The recall is being ordered based on positive testing results by FSIS and Ohio Department of Ag. There were no reported illnesses to this point in time.

Here again is a recall coming after government testing has found positive results. The recall covers 5 days of production, which probably goes beyond the typical lot (clean-up to clean-up).

What is the risk? While Listeria will not grow on the frozen product and while these products will likely be cooked before consumption, there can still be issues. Since the product is considered RTE, then there is the risk that someone will not cook the product sufficiently to kill the Listeria present. Also, if product is thawed and held at refrigeration temperatures for an extended period of time, then the Listeria can grow to higher levels.


Meatball company recalls 300,000 pounds of meat over listeria risk
Published July 09, 2012
Reutershttp://www.reuters.com/article/2012/07/08/us-usa-beef-recall-idUSBRE86700M20120708
By Lily Kuo
Sat Jul 7, 2012 9:32pm EDT

(Reuters) - A New Jersey meatball manufacturer is recalling more than 300,000 pounds (136,000 kg) of meat products due to possible listeria contamination, the U.S. Department of Agriculture's Food Safety and Inspection Service said on Saturday.

Bridgeton, New Jersey-based Buona Vita Inc was recalling about 324,770 pounds of frozen, ready-to-eat meat and poultry products produced in May, including meatballs, chicken and beef patties, and loafs of chicken and beef, the agency said in a written statement.

The FSIS described the health risk related to the recall as "high," according to the statement.

Representatives for Buona Vita, which says on its website that it produces 200,000 pounds (90,000 kg) of meatballs a day, could not immediately be reached for comment.

The possible contamination was discovered through testing by FSIS and the Ohio Department of Agriculture, the FSIS statement said. There have been no reports of illness related to the company's products, it added.
In 2011, more than 30 people died from listeria-contaminated cantaloupe linked to Jensen Farms in Colorado.

Listeria bacteria thrive in low temperatures. Outbreaks are usually associated with deli meats, unpasteurized cheeses and smoked refrigerated seafood products.

Listeriosis has a long incubation period, with symptoms sometimes not showing up until two months after people consume tainted foods.

Symptoms include fever and muscle aches, sometimes preceded by diarrhea and other gastric problems.

USDA News Releasehttp://www.fsis.usda.gov/News_&_Events/Recall_042_2012_Release/index.asp

New Jersey Firm Recalls Various Frozen, Ready-To-Eat Meat and Poultry Products Due To Potential Listeria Monocytogenes Contamination

Recall Release
CLASS I RECALL
FSIS-RC-042-2012
HEALTH RISK: HIGH  Congressional and Public Affairs
Catherine Cochran
(202) 720-9113

WASHINGTON, July 7, 2012 - Buona Vita, Inc., a Bridgeton, N.J. establishment, is recalling approximately 324,770 pounds of various frozen, ready-to-eat meat and poultry products due to possible contamination with Listeria monocytogenes, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today.

The products subject to recall include:

Dole Recalls Bagged Romaine Due to Listeria Postive Test Result

Dole is recalling approximately 2500 cases of bagged romaine lettuce due to the a positive test result for Listeria. The product was shipped to 9 states (Alabama, Florida, Georgia, Maryland, North Carolina, Pennsylvania, South Carolina, Tennessee and Virginia). The product is already past its stated shelf-life date. There have been no recalls.

This is the third recall by Dole for bagged salads in the last few months. Last week, Dole recalled bagged Romaine lettuce (http://www.fda.gov/Safety/Recalls/ucm309601.htm). This recall was due to a positive test result for Listeria and resulted in a recall of 1077 cases distributed in six states.  

Dole also had a recall of bagged lettuce back in April. (http://www.fda.gov/Safety/Recalls/ucm300414.htm). This came as a result of a positive test for Salmonella.

All three were the result of random sampling conducted by the governmental agencies. Dole is not alone in having to recall bagged salad. Rather, this is the new reality for manufacturers of processed fresh produce.


FDA Recall Notice 6/29/12
Dole Fresh Vegetables Announces Precautionary Recall of Limited Number of Salads
http://www.fda.gov/Safety/Recalls/ucm310329.htm?source=govdelivery

Contact
Consumer:
Dole Food Company Consumer Response Center
(800) 356-3111

Media:
Marty Ordman
Phone: (818) 874-4834
marty.ordman@dole.com

FOR IMMEDIATE RELEASE – June 29, 2012 – Dole Fresh Vegetables is voluntarily recalling 2,598 cases of bagged salad. The product being recalled is Dole Hearts of Romaine coded 0540N165112A or B, with Use-by date of June 26 and UPC 7143000956 due to a possible health risk from Listeria monocytogenes. Dole Fresh Vegetables is coordinating closely with regulatory officials. No illnesses have been reported in association with the recall.

The product code and Use-by date are in the upper right-hand corner of the package; the UPC code is on the back of the package, below the barcode. The salads were distributed in nine U.S. states (Alabama, Florida, Georgia, Maryland, North Carolina, Pennsylvania, South Carolina, Tennessee and Virginia).

No illnesses have been reported in association with the recall. This precautionary recall notification is being issued due to an isolated instance in which a sample of Dole Hearts of Romaine salad yielded a positive result for Listeria monocytogenes in a random sample test conducted by the FDA.

No other salads are included in the recall. Only the specific Product Codes, UPC codes and June 26, 2012 Use-by date identified above are included in the recall. Consumers who have any remaining product with these Product Codes should not consume it, but rather discard it. Retailers and consumers with questions may call the Dole Food Company Consumer Response Center at (800) 356-3111, which is open 8:00 am to 3:00 pm (PT) Monday - Friday.

Although the product is 3 days past its Use-by date and it is highly unlikely that any product is still available at retail, retailers should check their inventories and store shelves to confirm that none of the product is mistakenly present or available for purchase by consumers or in warehouse inventories. Dole Fresh Vegetables customer service representatives are already contacting retailers and are in the process of confirming that the recalled product is not in the stream of commerce.

Listeria monocytogenes is an organism that can cause foodborne illness in a person who eats a food item contaminated with it. Symptoms of infection may include fever, muscle aches, gastrointestinal symptoms such as nausea or diarrhea. The illness primarily impacts pregnant women and adults with weakened immune systems. Most healthy adults and children rarely become seriously ill.

NIH Study - Children with Food Allergies Often Suffer Allergic Reactions

This study, conducted by NIH, shows that a large percentage (72%) of children who have food allergies suffer from an allergic reaction each year, with 11% of those being serious reactions. Often times, the child’s caregiver did not administer epinephrine (didn’t have it, didn’t know how or when to do it). Exposure to allergens was because the child accidently ate a food containing the allergen, but in a limited number of cases, the caregiver intentionally provided the food to the child.

This study demonstrates that parents / caregivers must be more diligent with regard to their child’s food allergies, including knowing the foods children are eating and how to react when an allergic reaction occurs.

Rate of Severe Reactions Higher Than Thought in Young Children with Food Allergies
NIH-Funded Study Finds Some Caregivers Unsure About When to Give Epinephrine
National Institute of Allergy and
Infectious Diseases (NIAID)
http://www.niaid.nih.gov

FOR IMMEDIATE RELEASE
Monday, June 25, 2012
http://www.niaid.nih.gov/news/newsreleases/2012/Pages/CoFAR2.aspx

Young children with allergies to milk and egg experience reactions to these and other foods more often than researchers had expected, a study reports. The study also found that severe and potentially life-threatening reactions in a significant number of these children occur and that some caregivers are hesitant to give such children epinephrine, a medication that reverses the symptoms of such reactions and can save lives. 

“This study reinforces the importance of doctors, parents and other caregivers working together to be even more vigilant in managing food allergy in children,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. 

The study results appear online in the June 25 issue of Pediatrics and are the latest findings from the Consortium of Food Allergy Research (CoFAR), a network established by NIAID to conduct clinical trials, observational studies and basic research to better understand and treat food allergy. 

The research is part of an ongoing CoFAR observational study that enrolled 512 infants aged 3 to 15 months who at study entry were allergic to milk or egg, or who were likely to be allergic, based on a positive skin test and the presence of moderate-to-severe eczema, a chronic skin condition. The investigators are carefully following these children to see whether their allergies resolve or if new allergies, particularly peanut allergy, develop. The study is ongoing at research hospitals in Baltimore; Denver; Durham, N.C.; Little Rock, Ark.; and New York City.

CoFAR investigators advised parents and caregivers to avoid giving their children foods that could cause an allergic reaction. Study participants also received an emergency action plan, describing the symptoms of a severe allergic reaction to food and what to do if a child has one, along with a prescription and instructions on how to give epinephrine if a severe reaction occurred.

Data compiled from patient questionnaires and clinic visits over three years showed that 72 percent of the children had a food-allergic reaction, and that 53 percent of the children had more than one reaction, with the majority of reactions being to milk, egg or peanut. This translated into a rate of nearly 1 food-allergic reaction per child per year. Approximately 11 percent of the reactions were classified as severe and included symptoms such as swelling in the throat, difficulty breathing, a sudden drop in blood pressure, dizziness or fainting. Almost all of the severe reactions were caused by ingestion of the allergen rather than inhalation or skin contact.
In only 30 percent of the severe reactions did caregivers administer epinephrine, a drug that alleviates the symptoms of severe reactions by increasing heart rate, constricting blood vessels and opening the airways. Investigators found that caregivers did not give children epinephrine for a number of reasons: the drug was not available, they were too afraid to administer it, they did not recognize the symptoms as those of an allergic reaction, or they did not recognize the reaction as severe.