[lisper]

> If my child ingests sesame, they go into anaphylactic shock and without an epipen administered in minutes they will die.

Please excuse my skepticism, I am asking this out of a genuine desire to become better informed: how can you possibly know this? Unless you happened to have an epi-pen handy the first time your kid ever ate a sesame seed, which seems unlikely, then if this were true would not your kid have died then and there?

[doctor_eval]

I can’t answer for sesame, but my kid has an allergy to a specific nut, that we discovered after mum picked baby up after handling said nut, leaving bright red welts on their little body. No ingestion required.

Subsequently, immunology department, skin prick tests to identify the specific culprit, “risk of anaphylaxis” posters, and an Epipen - with risk factor based on the size of the reaction, in millimeters, to the skin prick test.

[lisper]

Thanks.

[shiroiushi]

Yep: instead of a bunch of downvotes, that was exactly the right kind of response to your question. Those of us who don't have these kinds of allergies (or kids with them) would have no clue about this kind of thing, and that response summed it all up very well.

[pvaldes]

Was the nut cashew?

[doctor_eval]

No, it was walnut and pecan (they are related, it turns out). Some other minor reactions but those were the big two.

[tiltowait]

With some allergies, they become more acute on subsequent exposures. Think first time you break out in welts, second time you have a hard time breathing, third time you die.

[itsoktocry]

Good question.

The idea that coming into contact with a seed could kill you seems insane and terrible. Yet where are all the people dying of this? Is the implication that our prevention is so good we are somehow avoiding it? I'm also skeptical.

I'm not denying that it exists, but common knowledge (you literally can't eat peanut butter at school) indicates it's so common. How could this be?

The solution is to stock epipens everywhere.

[throwup238]

> Yet where are all the people dying of this?

Based on this metastudy titled Epidemiology of anaphylaxis in Europe, they found the prognosis was:

> Case fatality rates were noted in three studies at 0.000002%, 0.00009%, and 0.0001%.

That's among all cases of anaphylaxis, so the answer is "they are almost nonexistent". It's not even a rounding error. Something on the order of a few dozen people per year for a country the size of the UK and from what I can tell, most of those are due to administration of IV medication where the allergy was previously unknown and much more severe.

[1] https://onlinelibrary.wiley.com/doi/epdf/10.1111/all.12272

[kortex]

I think part of the confusion is that food anaphylaxis isn't automatic death sentence in all cases, but the risk is that it could be. I have a peanut allergy and carry an epipen. I've been exposed ~5 times in my life but it never was severe enough to deploy it, and instead took benadryl and closely monitored it with epipen in hand and 911 on speed dial. I also know people who eat their allergen occasionally because they just get hives and it's worth it as a treat, and I know people who had severe asthma in minutes after a cross-contamination and needed the epi.

It's just game theory. It's like asking how many metaphorical empty barrels do you want to add to your Russian roulette revolver before you are willing to risk it, the reward being basically "ordinary food". Oh and the risk can suddenly one day go from just causing hives to severe anaphylaxis at a much smaller dose.

Most people who learn of a sensitivity (I learned in elementary school after breaking out in hives from doing art involving peanut shells, the horror to think this is something schools just did!) just don't want to know that badly how dire their allergy is and assume it's life threatening, because it's not worth it to be cavalier.

[jimbob45]

There are kits now with allergens that you can feed your kid to test for this kind of thing[0]. The idea is that you have them eat it in the parking lot of a hospital and see what happens.

[0]https://readysetfood.com/products/stage-1-2-bottle-mix-in

[lisper]

OK, but surely not everyone does this?

Here's the thing: if there really are kids out there who will drop dead within minutes of eating a sesame seed, surely some of them will discover this the hard way, i.e. by accidentally consuming a sesame seed and dying. But not once have I ever heard a news report about a kid dying this way, and I can't find any data on how many people die this way. I also can't imagine any reliable way that one could possibly learn that your allergy is so severe that a sesame seed will kill you without having at least some people actually die.

All this leads me to suspect that the belief that sesame seeds are potentially deadly in small doses might not be solidly grounded in facts.

[LorenPechtel]

Actually, we can estimate odds even with zero deaths.

The thing is regardless of the trigger anaphylaxis is anaphylaxis. The severity differs, the mechanism is the same. We can see the distribution of reactions and estimate the number that will be lethal even if we have no examples.

(And I rather suspect that a fair number of the lethal cases don't get diagnosed. I don't believe autopsy will reveal what set it off unless the contaminant is obvious.)

[moregrist]

It’s usually the second exposure that causes the reaction.

There are plenty of anecdotes of close calls. EMTs carry epipens for this reason. And occasionally it’s tragic when one is not administered in time.

But ingestion is not the only way to learn that you have a severe allergy. Skin contact with the allergen with usually result in bad hives. When this happens with a child, it’s scary and tends to result in an appointment with an allergist, who can assess the severity with skin tests and blood draws.

I had an epipen on-hand when my child ate hummus the second time, and started going into anaphylactic shock. They had had a bad hive reaction to spilled milk, so we had already seen the allergist for milk allergies, which were severe enough to warrant an epipen.

It was a terrifying event, and I am very thankful that we had the epipen and that my child did not have a second wave reaction.

[lisper]

Thanks. I'm glad your kid is OK, and sorry that you need to deal with the added stress.

Still it leaves me wondering where is the data on the kids who have this happen to them whose parents don't happen to have an epi-pen on hand. You'd think there would be some deaths, and you'd think someone would be keeping track of them, but I can't find the numbers on this anywhere. Seems weird.