I think so, too. (Which is why I'm going to all this trouble, basically... if I didn't think that she were likely to score in the top 1-5%, a few points wouldn't matter so much one way or the other, YK?)
Right now, I am pulling everything into the format that the doc liked, but I need to add some references in there. I know that they are out there, I just need to FIND them again...
(my apologies, this is a lengthy list; I'll eventually split these out into component posts associated with each reference point)
References:
1. Future anaphylaxis likely in spite of avoidance.
This, but it also plays to several OTHER points. Terrific article, really:
Nguyen-Luu NU, Ben-Shoshan M, et al. Inadvertent exposures in children with peanut allergy. Pediatr Allergy Immunol. 2012 Mar;23(2):134-140.
Abstract
To cite this article: Nguyen-Luu NU, Ben-Shoshan M, Alizadehfar R, Joseph L, Harada L, Allen M, St-Pierre Y, Clarke A. Inadvertent exposures in children with peanut allergy. Pediatr Allergy Immunol 2011: Doi: 10.1111/j.1399-3038.2011.01235.x ABSTRACT: Objectives: To determine the annual incidence, characterize the severity and management, and identify predictors of accidental exposure among a cohort of children with peanut allergy. Methods: From 2004 to November 2009, parents of Canadian children with a physician-confirmed peanut allergy completed entry and follow-up questionnaires about accidental exposures over the preceding year. Logistic regression analyses were used to examine potential predictors. Results: A total of 1411 children [61.3% boys, mean age 7.1 yr (SD, 3.9)] participated. When all children were included, regardless of length of observation, 266 accidental exposures occurred over 2227 patient-years, yielding an annual incidence rate of 11.9% (95% CI, 10.6-13.5). When all accidental exposures occurring after study entry and patients providing <1 yr of observation were excluded, 147 exposures occurred over a period of 1175 patient-years, yielding a rate of 12.5% (95% CI, 10.7-14.5). Only 21% of moderate and severe reactions were treated with epinephrine. Age ≥13 yr at study entry (OR, 2.33; 95% CI, 1.20-4.53) and a severe previous reaction to peanut (OR, 2.04; 95% CI, 1.44-2.91) were associated with an increased risk of accidental exposure, and increasing disease duration (OR, 0.88; 95% CI, 0.83-0.92) with a decreased risk. Conclusion: The annual incidence rate of accidental exposure for children with peanut allergy is 12.5%. Children with a recent diagnosis and adolescents are at higher risk. Hence, education of allergic children and their families is crucial immediately after diagnosis and during adolescence. As many reactions were treated inappropriately, healthcare professionals require better education on anaphylaxis management.
(emphasis mine) Ding-ding-ding. This one is a MAJOR winner.
2. Anaphylaxis outcomes are unpredictable.
I think that is this one, but I'll check it later:
Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327(6):380-384.
Could be this one instead:
Yunginger JW, Sweeney KG, Sturner WQ, et al. Fatal food-induced anaphylaxis. JAMA. 1988;260(10):1450-1452.
This is the one that pretty much says,
Look, you can do everything right, but still have a fatality sometimes. (This is the scariest freaking article EVER, IMO.)
Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy.2000;30 :1144– 1150
3. Highest risks for fatality—adolescent, female, previous severe Hx, nut allergy, asthma):
The first of these is the best of them:
Shah E, Pongracic J. Food-induced anaphylaxis: who, what, why, and where? Pediatr Ann. 2008 Aug;37(8):536-41.
Abstract
Food-induced anaphylaxis is a leading cause of anaphylaxis treated in emergency departments and hospitals around the world. Peanuts, tree nuts, fish, and shellfish are the most commonly implicated foods. Food-induced anaphylaxis may occur in any age group and with any food. However, food-induced anaphylaxis fatalities disproportionately affect adolescents and young adults with peanut and tree nut allergy. Individuals who have both IgE-mediated food allergy and asthma are at a higher risk for food-induced anaphylaxis fatality. Delayed administration of epinephrine is also associated with fatal outcome. Often, in fatal reactions, the food allergen is unknowingly ingested away from home, in settings such as restaurants and schools. Although avoidance of food allergens is critical, timely administration of epinephrine is also of great importance in the treatment of food-induced anaphylaxis. Patients, families, and caregivers must be well educated regarding the signs, symptoms and risk factors for anaphylaxis. They must also be counseled on the importance of strict food avoidance of the implicated food allergens, compliance with having self-injectable epinephrine available at all times, and the importance of timely administration of epinephrine, even when cutaneous symptoms are lacking
Muñoz-Furlong A, Weiss CC. Characteristics of food-allergic patients placing them at risk for a fatal anaphylactic episode. Curr Allergy Asthma Rep. 2009;9(1):57-63.
Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol.2001;107 :191– 193
4. Sampson Pediatrics—Food anaphylaxis, grading chart.(This, by the way, is the source of our community's "plain English" grading chart!)
Sampson HA. Anaphylaxis and emergency treatment. Pediatrics.2003;111 :1601– 16085. Position paper/treatment guidance for diagnosis of food allergy?:
Either of:
Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol. 2010;126(3):477-480 e1-42.
or
Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-Sponsored Expert Panel report. J Allergy Clin Immunol. 2010;126(6):1105-1118.
6. DBPC challenge poses unnecessary risk in patients with severe and clear rxn hx.
(well, I think that Pumphrey article from above pretty nicely sums up why THIS is a really crappy way to diagnose a PA in someone who has already anaphylaxed, don't you?
)
Coupled with that one:
van der Zee T, Dubois A, et al. 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 Nov;128(5):1031-6. Epub 2011 Aug 31.
Mankad VS, Williams LW, et al. Safety of open food challenges in the office setting. Ann Allergy Asthma Immunol. 2008 May;100(5):469-74.
7. Identifying shock vs. anxiety, docs mistake anaphylaxis in emergency rooms
THIS.
Pathophysiology
Anaphylactic mediators cause vasodilation, fluid extravasation, smooth muscle contraction and increased mucosal secretions. Death may occur from hypoxaemia (due to upper airway angioedema, bronchospasm and mucus plugging) and/or shock (due to massive vasodilation, fluid shift into the extravascular space and depressed myocardial function).17 While compensatory tachycardia in response to hypotension is considered a characteristic feature, sudden bradycardia with cardiovascular collapse and cardiac arrest may occur before any skin features become apparent.18 The cause of this phenomenon is unclear, but it is an important clinical feature to recognise in order to avoid making an initial misdiagnosis of a “panic attack” or “vasovagal reaction” in cases where dyspnoea, nausea, anxiety, and bradycardia may occur just before cardiovascular collapse.
Brown SGA, Mullins RJ, Gold MS. Anaphylaxis: diagnosis and management. Med J Aust 2006; 185 (5): 283-289.
Not exactly, but related to this notion of rapid cardiovascular incompetence leading to death outside of hospital settings, esp. when laypersons are required to 'evaluate' and decide whether or not such a reaction is or is not anaphylaxis:
Simons FE. Anaphylaxis, killer allergy: long-term management in the community. J Allergy Clin Immunol.2006;117 :367– 377
8. Anxiety impairs performance?
Staal, M. Stress, Cognition, and Human Performance: A Literature Review and Conceptual Framework, NASA Ames Research Center, 2004. retrieved from
www.human-factors.arc.nasa.gov April 2, 2012.
Duncko, R., Johnson, L., Merikangas, K., & Grillon, C. (2009). Working memory performance after acute exposure to the cold pressor stress in healthy volunteers. Neurobiology of Learning and Memory, 91, 377–381.
Lee, J. H. (1999). Test anxiety and working memory. Journal of Experimental Education, 67, 218-225.
Park, C. R., Zoladz, P. R., Conrad, C. D., Fleshner, M., & Diamond, D.M. (2008). Acute predator stress impairs the consolidation and retrieval of hippocampus-dependent memory in male and female rats. Learning and Memory, 15, 271-280.
Baddeley, A., Eysenck, M. W. & Anderson, M. C. (2010). Memory. Psychology Press: New York.
Jelicic, M., Geraerts, E., Merckelbach, H., Guerrieri, R. (2004). Acute Stress Enhances Memory For Emotional Words, But Impairs Memory For Neutral Words. International Journal of Neuroscience, 114, 1343- 1351.
9. Ignoring symptoms in adolescents? “Toughing it out” syndrome & anxiety-- psychological factors, basically--
Not specifically about this particular thing, but more about "risk taking" and "peer pressure" which of course is related--
Anaphylaxis in Schools & Other Settings, 2nd Edition Revised, Canadian Society of Allergy and Clinical Immunology. 2005.
Similarly (and I'm following the citations trail from this one here):
Marklund B, Wilde-Larsson B, et al. Adolescents' experiences of being food-hypersensitive: a qualitative study. BMC Nursing 2007, 6:8(That one is a real treasure trove, by the way.)
Steinberg L. Risk Taking in Adolescence. What Changes, and
Why? Ann N Y Acad Sci 2004, 1021:51-58.
Steinberg L: Cognitive and affective development in adolescence.
TRENDS in Cognitive Sciences 2005, 9(2):69-74.
10. Early treatment = better outcomes. Delays = deaths.
Simons KJ, Simons FE. Epinephrine and its use in anaphylaxis: current issues. Curr Opin Allergy Clin Immunol. 2010;10(4):354-361.
11. Dey—how to use an autoinjector
12. Standing up during shock = cardiac arrest.
Pumphrey RS. Fatal posture in anaphylactic shock. J Allergy Clin Immunol.2003;112 :451– 452
Brown SG. Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis. Curr Opin Allergy Clin Immunol. 2005; 5(4):359-64.
I'll have to come back to this later and fill in the references in the list. The only ones that I know I'm going to be digging for are 6 and 9, but I've seen them published before, so I'm pretty sure that the info is out there.
And on a related note... this is the reference that I wanted to pull out of my purse for DD's surgeon the other day...
Dewachter P, Jouan-Hureaux V, Franck P, et al. Anaphylactic shock: a form of distributive shock without inhibition of oxygen consumption. Anesthesiology 2005; 103:40.
and this one--
Pumphrey RS, Roberts IS. Postmortem findings after fatal anaphylactic reactions. J Clin Pathol 2000; 53:273.
Most notably--
CONCLUSIONS: In many cases of fatal anaphylaxis no specific macroscopic findings are present at postmortem examination. This reflects the rapidity and mode of death, which is often the result of shock rather than asphyxia.
Yes, that's right. Fully competent airways and cardiovascular collapse. NOT mutually exclusive things. Who knew??
Finally, even MILD symptoms (treated or untreated) negatively impact performance:
Walker S, Khan-Wasti S, et al. Seasonal Allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: Case control study. J Allergy Clin Immunol. 2007 Aug;120(2):381-7. Epub 2007 Jun 8.
The reason why that one is ultimately important is that most "inhalation" reactive patients aren't considered (at least officially) to be at "real risk" of anaphylaxis from such exposure, which is generaly regarded as "annoying" and not particularly 'dangerous' in nature. This may be true, but in an exam setting, "annoying" is enough to impair performance significantly.
I'm still hunting references re: fear and impairment at cognitively demanding tasks. It's there, but it's also indirect. The military and NASA have both studied it, for obvious reasons. Anxiety isn't the same phenomenon as "fear" in physiological terms. Smelling a potent allergen during a high-stakes, stressful situation is regarded by the amygdala as "important! Drop everything NOW-NOW-NOW" and is pretty much physiologicaly impossible to "tune out" in order to focus attention on the cognitive tasks requiring working memory. Having a lot of trouble finding applicable resources for that one, though. Mostly because it's a highly challenging thing to
study, which is the same problem that NASA and the Air Force have had with it. It's unethical to make someone fear for their life while you are demanding their "best" otherwise.