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home : columns : ask the doctors June 26, 2019

3/11/2019 8:15:00 AM
Extreme allergic reaction not common, but still a concern

Dear Doctor: I saw on TV that someone who's allergic to fish actually died just from smelling it. Is that really possible?

Dear Reader: You're referring to a news story about an 11-year-old boy who died on New Year's Day after visiting relatives in whose home fish was cooking. The boy, who was allergic to both seafood and peanuts, did not eat or touch the fish. When he told his parents he felt ill and was having trouble breathing, they treated him with the nebulizer he carried because he also suffered from asthma. At first the treatment appeared to be successful. Soon, however, the boy's condition worsened and paramedics were called. The boy, who became unconscious and unresponsive, was transported to a local hospital where he was pronounced dead.

The circumstances were so unusual that a definitive cause of death was not immediately announced, and the case was referred to the medical examiner's office. However, authorities believe that vapors from the cooking process contained fish proteins, which activated the child's immune system when he inhaled them. This triggered an allergic response, which, in combination with his asthma, proved to be fatal.

A food allergy is a chronic overreaction by the immune system to even a minute amount of a specific food. The most common allergies are to the proteins found in peanuts, tree nuts, cow's milk, fish and shellfish, eggs, wheat and soy. Although these proteins are not actually dangerous, the immune system of an allergic person will flag them as a threat. It will then mount an attack that produces physical symptoms that range from mild to dangerous. These include digestive problems, tingling, itching, rash, flushing, hives and swelling of the lips, tongue, face, throat or other parts of the body.

The most severe allergic reaction is anaphylaxis, which is life-threatening. When this occurs, the airways can become so swollen it becomes difficult or impossible to breathe. Other symptoms of anaphylaxis include rapid pulse, loss of consciousness and a severe drop in blood pressure. Immediate medical treatment for anaphylaxis is crucial. Reaction to a food allergen begins anywhere from several minutes to several hours after eating the trigger food.

It's estimated that of the 15 million Americans with food allergies, about 6 million are children younger than 18. Close to one-third of those are allergic to more than one food. Although it is not known why, food allergies are on the rise. Between 1997 and 2008, peanut and tree nut allergies in children tripled. All-cause food allergies in children increased by 50 percent between 1997 and 2011. Not only does this result in tens of thousands of health emergencies in children each year, there's a financial cost as well. It's estimated that families spend upwards of $25 billion annually caring for children with food allergies. Recent spikes in the cost of epinephrine auto-injectors have angered families and health professionals alike and made headline news.

Although the hypersensitivity in this case is rare, it is becoming an increasingly recognized problem. The American College of Allergy, Asthma and Immunology warns anyone with a fish or seafood allergy to avoid any area where these foods are being cooked.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.

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