[CURRENT STATUS OF FOOD ALLERGY MANAGEMENT IN FOOD SERVICE PROVIDERS]

OBJECTIVE

Assess the current state of food allergy management strategies and the perceptions of them among food service providers.

METHODS

The study surveyed establishments that participated in a food allergy management workshop or- ganized by the Tokyo Metropolitan Government in February 2018. The survey inquired about the implemen- tation status of food allergy management strategies, the frequency of accidental ingestions and near misses, and the necessary actions for advancing food allergy management.

RESULTS

The survey yielded a response rate of 78% (257/331); 81% of the operators reported having implemented some form of food allergy management strategies. However, only 51% had created a manual for food allergy management and 55% had labeled 7 specified ingredients. 29% of the operators reported experiencing accidental ingestions or near misses, with 34% of those incidents requiring medical attention. 49% of the operators identified the "establishment of industry standards" as a crucial step in advancing food allergy management.

CONCLUSION

The survey results indicate that establishments have not fully implemented adequate and effective food allergy management strategies. There is a need to enhance the awareness and understanding of food allergies among businesses and to establish appropriate and sufficient food allergy management measures in the future.

Small Bowel Perforation Secondary to Blister Pill Pack Ingestion: A Case Report

We present a case of accidental ingestion of a foreign body-blister pill pack (FB-BPP) causing small bowel perforation in a patient taking aspirin and clopidogrel due to past history of coronary artery disease. A 71-year-old male presented in the emergency department (ED) with a two-day history of abdominal discomfort and loss of consciousness. His relevant home medication included aspirin and clopidogrel secondary to a history of coronary artery stents. Initial workup with emergent CT scan of abdomen/pelvis with intravenous contrast showed a loop of the terminal ileum with thickened wall and perforation. Incidentally, he was also found to have type II myocardial infarction. Emergent laparoscopic ileocecectomy with primary anastomosis was done. The postoperative course was unremarkable. The pathology report of the small bowel was consistent with a FB-BPP associated perforation. FB-BPP ingestion with perforation is a rare occurrence. It occurs more often in the elderly with significant mortality. Our case of accidental ingestion of FB-BPP was confirmed retrospectively after histopathological evaluation, and complicated by type II myocardial infarction. Emergent laparoscopic bowel resection was done despite significant preoperative risks.

Methylene Blue Infusion to Treat Severe Dapsone-Induced Methemoglobinemia in a Pediatric Patient

Dapsone overdose is a well-known potent cause of methemoglobinemia and hemolytic anemia. We discuss a case of a two-year-old male who developed severe persistent methemoglobinemia treated with multiple doses of methylene blue (MB), multidose activated charcoal, and vitamin C. Methylene blue infusion (rather than bolus dosing) aided in controlling this patient's methemoglobin (MetHb) levels and symptoms and may reduce the total needed dose.

Accidental ingestions to known allergens by food allergic children and adolescents

BACKGROUND

Accidental ingestions (AI) of food allergens in children compared with adolescents with food allergies are poorly characterized. It is suggested that AIs are higher in adolescents than children and that their reactions may be more severe, presumptively due, at least in part, to increased risk-taking behavior. We compared reported AIs in children versus adolescents.

METHODS

An online cross-sectional survey was distributed to parents of children with food allergies via Twitter, food allergy advocacy groups in the UK, South Africa, and Australia, and locally at Children's Hospital Colorado.

RESULTS

Of 558 respondents, 105 were parents of adolescents, and 453 had children <12 years. 73% (341) reported an AI since diagnosis, with 85% of adolescents having had an AI versus 70% of children (p = 0.0058). The annualized rate of AI was significantly lower in the adolescent population at 0.21 versus 0.53 in children (p = <0.0001). Although adolescents reported fewer severe reactions (2% vs. 16%, p = 0.0283), more adolescents required epinephrine administered by a medical professional for their most severe AI, (48% vs. 24%, p = 0.0378). Comparison of the two age groups is limited by the fact that many AIs in the adolescent group occurred prior to age 12. There was no significant difference between the groups as to where the food was consumed or the type of food. There was a significant difference in accidental ingestions in patients in all age groups with more than one reported food allergy; 78% of those with more than one food allergy reported a prior history of at least one accidental ingestion, compared with 59% in those with a single food allergy (p < 0.0001). Regional differences were also noted with respondents in the United States reporting 0.3 accidental ingestions a year, 0.4 in the UK, and 0.5 in other countries (p = 0.0455). The number of reactions was, on average, 27% lower (95% CI: 40, 11%) in the United States compared with the UK (p = 0.0019).

CONCLUSION

The number of severe reactions, and epinephrine need, differs in children compared with adolescents, although many of the reported reactions in both groups occurred before the age of 12. There were also regional differences with the United States reporting a lower number of AIs and less AIs per year than the other participating regions, as well as increased rates of AI in participants with more than one food allergy. Further characterization of the differences in AIs between children and adolescents, as well as between regions, is needed to assist with more patient-centered anticipatory guidance.

Undiagnosed Accidental Blister Pack Pill Ingestion in Elderly

Ingestion of foreign body is a common occurrence in children. Most of these foreign bodies pass through gastrointestinal tract without causing any symptom or complication. Sharp edgy objects have propensity to cause tear or damage to the mucosal linings of gastrointestinal tract. Here is an interesting case of unintentional ingestion of blister pack pill in an elderly, whose initial presentation was intestinal obstruction and later on developed intestinal perforation.

Accidental ingestion of a long dental crown

It is recommended that a sharp-pointed object, such as a dental crown, in the proximal duodenum be retrieved endoscopically if this can be accomplished safely.

A case of lip edema caused by the accidental ingestion of a bar of soap

The most common symptom following the accidental ingestion of a soap is lip edema. Although most cases are asymptomatic or exhibit mild symptoms, in some cases, aspiration pneumonia, oropharyngeal edema, and bronchial obstruction may be fatal.

Acute abdominal pain caused by accidental ingestion of Latoia species larva: a case report

We report the clinical and endoscopic manifestations in a patient with acute abdominal pain caused by the accidental ingestion of a Latoia consocia (Walker) larva. Clinical data including the patient’s medical history, and the results of physical examination, laboratory tests, and gastroscopy were collected. Based on this rare case, we discuss the clinical characteristics and manifestations, diagnostic methods, and principles of this disease.

[A SURVEY ON ACCIDENTAL INGESTION OF PACKAGED PROCESSED FOODS, EATING OUT AND OVER-THE-COUNTER SALES BY INDIVIDUALS WITH FOOD ALLERGIES]

OBJECTIVE

To determine the frequency and effects of accidental ingestion of packaged processed foods, eating out, and over-the-counter sales in individuals with food allergies.

METHODS

The participants were guardians of children hospitalized for an oral food challenge test during January and February 2016 at the Department of Pediatrics, Sagamihara National Hospital. We conducted a questionnaire survey on food allergies, accidental ingestion via packaged processed foods, eating out, and over-the-counter sales in the past 1 year, and the degree of understanding of the display of allergen-related information.

RESULTS

A total of 442 participants were given questionnaires, and 226 provided valid responses. Among these respondents, 31% had experienced accidental ingestion (packaged processed food: 24%, food service: 12%), and approximately one quarter of the subjects with allergic symptoms had repeated accidental ingestion. About 70% of the causes were due to overlooking or misunderstanding of allergen information. Of the participants, 85% were aware that processed foods must display allergen information, and 39% were aware that there was no requirement to label food sold in food service and over-the-counter sales.

CONCLUSIONS

Patients with food allergies are familiar with and repeatedly experience accidental ingestion of packaged processed foods, eating out, and over-the-counter sales. In order to prevent accidental ingestion, it is important to thoroughly check allergy labeling and to instruct patients on precautions to take when eating out or over-the-counter sales.

Valproate-Induced Hyperammonemic Encephalopathy Following Accidental Ingestion in a Toddler

Clinical manifestations of valproic acid (VPA) toxicity can range from just mild confusion and drowsiness to serious encephalopathy, leading to depressed sensorium and even coma and death. The exact cause(s) of how VPA influences the integrity of brain function remains unknown. Nevertheless, several mechanisms have been postulated including a surge in the blood ammonia concentration. Valproic acid-induced hyperammonemic encephalopathy is a rare yet serious sequalae and that can lead to grave outcomes. We report a case of hyperammonemic encephalopathy with preserved liver function following a moderate VPA intoxication in a toddler, who was successfully managed conservatively. Additionally, we briefly discuss mechanistic basis of VPA toxicity and highlight some of the available potential therapies.

Toxicological Risk Assessment of the Accidental Ingestion of a Honeybee (Apis mellifera L.) Present in Food

The aim of the present work was to evaluate the possible risk of toxic effects due to the ingestion of a honeybee (Apis mellifera L.) accidentally present in food. The methodology used in this study was a bibliographic survey of studies on the toxic effects related to honeybees, with a critical analysis of the possible risks of accidental ingestion of these insects. The amount of venom present in a bee is considered insufficient to induce detectable toxic effects in a person who ingests it by accident, and various components of the venom are destroyed by gastric secretions. However, despite the rare frequency, there is a risk of the ingestion of a bee, causing an allergic reaction to some components of the venom in sensitized individuals. In addition, pollen carried by a bee may cause an allergic reaction in a sensitive individual. Thus, the accidental ingestion of a bee present in a food does not pose the risk of toxic effects for the majority of the population but may promote allergic reactions in susceptible individuals.

Oral chemical burn due to accidental ingestion of calcium oxide food desiccant in a patient with dementia

Oral chemical burns occur when a chemical accidentally enters the mouth, causing burns and ulcers in the oral mucosa, esophagus, stomach, and upper digestive tract if swallowed. Oral chemical burns primarily occur in children because of accidental ingestion. However, a few reports have described advanced-age patients with dementia who developed oral chemical burns. Patients with dementia often exhibit impaired judgment and irregular eating behaviors, at times leading them to ingest nonfood substances. We herein describe a case of an advanced-age patient with dementia who ingested a calcium oxide food desiccant at home and developed chemical burns that were exacerbated by an improperly placed implant-supported complete fixed prosthesis. This case report emphasizes the need for families and nurses who care for patients with dementia to renew their understanding of the danger of accidental ingestion of nonfood substances. Knowledge of the appropriate response to calcium oxide food desiccant ingestion is also important to prevent the occurrence of severe chemical burns.

A Pediatric Case of Accidental Eucalyptus Oil Poisoning from New Delhi, India: Emergency Measures, Historical Context, and Implications for Practice

Eucalyptus oil (EO) and EO containing products are readily available worldwide over the counter as topical nasal decongestants, rubefacients, anti-pyretics, and anti-inflammatory agents. However, EO is poisonous when orally ingested, or otherwise internally administered, resulting in serious outcomes such as seizures, vomiting, drowsiness, and even death. In this case report, we describe emergency measures adopted in a suspected case of EO ingestion by a 17-month-old female infant. It was found that stomach washes with normal saline followed by the oral administration of ranitidine to prevent vomiting restored and maintained normalcy over a 24-hour period. We situate our experience within the Indian context and recommend that pediatricians and healthcare workers routinely and explicitly warn parents about the serious consequences of the incorrect usage of substances containing essential oils in general and EO in particular.

Safety and efficacy of intravenous administration for tranexamic acid-induced emesis in dogs with accidental ingestion of foreign substances

A prospective observational study was performed in canine clinical medicine to evaluate the emetic action and adverse effects of tranexamic acid. Veterinarians treated 137 dogs with a single dose of tranexamic acid (50 mg/kg, IV) after accidental ingestion of foreign substances. If needed, a second (median, 50 mg/kg; range, 20–50 mg/kg, IV) or third dose (median, 50 mg/kg; range, 25–50 mg/kg, IV) was administered. Tranexamic acid induced emesis in 116 of 137 (84.7%) dogs. Median time to onset of emesis was 116.5 sec (range, 26–370 sec), median duration of emesis was 151.5 sec (range, 30–780 sec), and median number of emesis episodes was 2 (range, 1–8). Second and third administrations of tranexamic acid induced emesis in 64.7 and 66.7% of dogs, respectively. In total, IV administration of tranexamic acid successfully induced emesis in 129 of 137 (94.2%) dogs. Adverse effects included a tonic-clonic convulsion and hemostatic disorder in two different dogs, both of which recovered after receiving medical care. Tranexamic acid induced emesis in most dogs following a single-dose. When a single dose was not sufficient, an additional dosage effectively induced emesis. Overall, adverse effects were considered low and self-limiting.

Sulphuric acid marketed in water bottle in India: A cause for fatal accidental poisoning in an adult

Corrosive acid ingestion is a rare but serious health hazard with fatal complications. Cases of suicidal and accidental acid ingestion have been documented in the scientific literature. Accidental acid poisoning due to a mistaken identity of the bottle containing sulphuric acid is a matter of grave concern especially in a household set-up. We hereby report a fatal case of accidental sulphuric acid ingestion in an adult, who unsuspectingly swallowed about 50 ml of 'toilet-cleaner' at his residence. The bottle containing the acid was recently purchased from a local vendor and placed with water bottles in the kitchen. The autopsy and toxicological findings of this case are discussed in this paper with discussion of medico-legal issues on the sale and use of such corrosive acids in illegal bottles and its subsequent health hazards in India.

Corrosive oesophageal injuries: a preventable menace

Introduction

Potentially catastrophic presentations and lifelong complications resulting from corrosive ingestions in humans is one of the most challenging situations encountered in clinical medical practice. This study reviewed pattern, mechanisms and associated socio-medical challenges with ingestion of corrosive agents as seen in a tertiary health institution in South-western Nigeria.

Methods

A retrospective review of all patients that were managed for corrosive ingestion at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a seven year period.

Results

A total of 28 patients M:F: 1.6:1. There were 7 children and 21 adults. Majority (78.6%) of the patients ingested alkaline substances. Accidental ingestion occurred in 28.6% while 71.4% resulted from deliberate self harm especially among adults (66.7%). Almost two thirds (64.3%) of the patients presented after 48hrs of ingestion. Patients who presented early were managed conservatively. Most patients (64.3%) who presented late had nutritional and fluid rehabilitation. Two patients died from oesophageal perforation and resulting septicaemia. Psychiatric evaluation revealed that seven adults (25%) had psychotic illness while (42.9%) of the patients developed oesophageal strictures. Short segment strictures were managed with oesophageal dilatation with good outcome while long and multiple segment strictures were referred to cardiothoracic surgeons for management.

Conclusion

Corrosive oesophageal injuries remain a prevalent and preventable condition in the developing countries. Preventive strategies should include regulation and packaging of corrosive substances, organization of psychiatric services, and education of the population on corrosive ingestion.

Accidental ingestion of BiTine ring and a note on inefficient ring separation forceps

Background:

Accidental ingestion of medium-to-large instruments is relatively uncommon during dental treatment but can be potentially dangerous. A case of BiTine ring ingestion is presented with a note on inefficient ring separation forceps.

Case description:

A 28-year-old male patient accidentally ingested the BiTine ring (2 cm diameter, 0.5 cm outward projections) while it was being applied to a distoproximal cavity in tooth # 19. The ring placement forceps were excessively flexible; bending of the beaks towards the ring combined with a poor no-slippage mechanism led to sudden disengagement of the ring and accelerated movement towards the pharynx. We followed the patient with bulk forming agents and radiographs. Fortunately the ring passed out without any complications.

Clinical implications:

Checking equipment and methods is as important as taking precautions against any preventable medical emergency. It is the responsibility of the clinician to check, verify and then use any instrument/equipment.