PRE-TEEN FATAL COW'S MILK ANAPHYLAXIS: PROTEIN BEVERAGE INGESTION IRREVERSIBLY MISTAKEN WITHOUT ALLERGEN ON FRONT LABEL

Abstract

<h3>Introduction</h3> IgE-mediated cow's milk allergy (CMA) is the most common pediatric food allergen (FA). Persistent CMA is uncommon (50% CMA tolerance, by 5 years-of-age/75% by adolescence/0.2% remain into adulthood). FA Labeling and Consumer Protection Act (FALCPA) requires product listing of 8 major FAs, including cow's milk (CM). This mandate does not require front-product labeling (FPL) on FA-containing products. We describe a CMA fatality in a parent-supervised pre-teen female who ingested CM-protein drink, misinterpreted as non-CM-containing with FPL of fruit imagery, without CM-FA notation. <h3>Case Description</h3> Early childhood, atopic asthma and CMA confirmed (history; IgE-CM); allergist prescribed epinephrine/gave CMA education. Late childhood, failed baked-CM challenge and intermittent CMA exposures resulted in extended CM avoidance. Mother and patient identified new protein beverage that appeared juice-like with its transparency and FPL-CM absence. Back label was not seen/read before ingestion: "whey" "contains milk". Immediate anaphylaxis ensued; despite immediate epinephrine administered by mother, 911 resuscitation and intensive care-tertiary pediatric attention, anaphylaxis persisted; patient succumbed to irreversible anaphylaxis with death within 24 hours. <h3>Discussion</h3> CMA morbidity-mortality alerts are illuminated: 1. CMA may persist beyond early childhood and can be fatal; 2. Thorough FA education for practical application was missing; education alone was incomplete. FA-registered dietitians are trained to teach FA patients-families-communities to implement FA health literacy techniques, critical to preventing life-threatening exposures; 3. Current FALCPA is insufficient given that FA identifiers may be absent on FPL, leaving consumer products to masquerade as non-FA products, posing irreversible risks. FA labeling renewal combined with effective FA health literacy is necessary and life-saving.