This is an update to our previous story regarding the tragic death of 13-year-old Natalie Giorgi, who accidentally ingested a treat containing peanut butter and suffered a fatal bout of anaphylaxis. We publish this to provide details of the epinephrine administration as requested by many of our readers.
The Sacramento Bee reports that upon learning that Natalie had bit into a snack containing peanut butter, she was given a dose of Benadryl®, presumably by one of her parents. She seemed fine after the incident, smiling and enjoying herself.
Twenty minutes after ingesting the treat, Natalie began vomiting and experienced labored breathing. Her father, urologist Dr. Louis Giorgi, immediately administered the first dose of epinephrine via EpiPen®, and then two more doses within several minutes after her symptoms failed to subside. She stopped breathing shortly afterward and could not be revived despite CPR.
We at SnackSafely.com are devastated by the news of another child succumbing to fatal anaphylaxis and are deeply concerned by the confusion within the food allergy community regarding when to administer epinephrine and antihistamines like Benadryl.
If you care for a child with food allergy, we urge you to contact the child’s allergist to develop an emergency action plan. The plan should include strategies for (1) when you suspect your child has ingested an allergen but is not showing symptoms (as was the case with Natalie) and (2) for when your child is showing signs of anaphylaxis.
Don’t forget to share these plans with your child, family, and friends and be sure to review these plans with your child’s school administration including the school nurse, teachers, and principal.
Epinephrine was never guaranteed to work 100%, but I think many of us believed it would, especially if given “quickly.” (What is quickly? 2 min.? 20?) This is devastating.
Devastating indeed. Now I’m feeling like my backup plan is no backup at all—I’ve always been told to give Benadryl first if a reaction seems minor. The first time my daughter had anaphylaxis, the EMTs didn’t even have an Epi-Pen and even though she was vomiting and coughing and swelled up beyond belief, the ER did a “wait and see” before administering the Epi.
After administering the epinephrine, you need to get the person to the emergency room ASAP. The dose in the pen only delays the critical moment for about 20 minutes, and the victim still needs emergency attention immediately.
Seven years ago, our son went into anaphylaxis after putting a 1/4 of a cashew nut into his mouth and immediately spitting it out. We decided after what happened that we would ALWAYS administer epinephrine first. This decision may not be for everyone BUT with OUR child’s reaction, this is our action plan.
The situation is exacerbated by the fact that this girl was at a camp environment, presumably not near an ER.
This is all so sad….. And so confusing. I gave my daughter the Epi once after vomiting/ sneezing/ red skin etc. from ingesting egg….. It worked thank goodness but the EMT told me I probably didn’t need to give it!!! I obviously knew he didn’t know what he was talking about but it just proves how different each person and reaction is and I guess the rule of thumb should be to just give it……you never know how the reaction could escalate…… Thinking of Natalie and her family. XO
We had a similar experience at AT&T Park when our son was exposed to peanuts on his skin at the children’s play area. The ER personnel at First Aid did not want to give him Epinephrine until waiting to see if Benadryl worked, which of course it did not. When they finally did administer Epinephrine, they gave a dose which I later learned was half of the recommended dose by our pediatrician. Thankfully, she responded to my texts immediately and assured me to administer Epinephrine and head to the ER. We were lucky . . he did not experience any breathing complications. . . but we did EXACTLY what Natalie’s father did. This is a great reminder for us to follow the recommendations of our pediatrician whenever we have any doubt about his health and safety.
My world of all things allergy has been rocked. I have always felt strongly about my six year old living life as normally as he can with severe food allergies to 5 foods. My entire premise has been rooted in the fact that the epi would always save his life.
Even two weeks ago he had a reaction EXACTLY like Natalie’s to milk. I gave Benadryl and watched closely as symptoms did not progress, epi ready if so.
I am so disturbed that this could have killed him and that the epi is not the life saving miracle I thought it was.
I have some concern that the message is being disseminated that the Epipen does not work. In our experience, the Epipen DOES work, if it is administered in time. I was very surprised to read that the parents waited to see how Natalie did, given how serious a peanut allergy is and that they had the Epipens. (And it is devastating even to think that she may have been saved if they had just given the Epi in time). Once anaphylaxis starts, it is very hard to get ahead of it. Of course, confirm all plans with your MD. We have found the Epipens to be lifesaving in more than one event. In the ER we were followed-up with a steroid breathing treatment (they breathe into a tube that releases an aerosol steroid to keep the airway open) and additional IVs. The crucial point to be made about Epis’ being effective is that they must be used in time. The ACAI recommends that if you are unsure whether to give the Epi, to give it.
How did you end up having ER visits for the allergy attacks, i.e. how were the substances accidentally ingested? I am asking in order to learn from those situations.
Christy,in each case we administered the Epipen right away, called for EMTs, and were taken to the ER in an emergency vehicle. Even though we had given the Epipen, the EMTs would open an IV line en route to the hospital, just in case. I know this wasn’t your question, but I wanted to add that each reaction was different, especially in that symptoms occurred in different sequence, but there were some factors in common, such as itching in the mouth and throat, hives, and minor or major wheezing; almost every time there has been vomiting and severe abdominal cramping. Looking back, there were 2 times things did seem fine for a while, and then things happened pretty intensely. The foods that caused anaphylactic reactions for us included: 1) peanut butter jellybean (jellybeans distributed at a party; I hadn’t known peanut butter jellybeans were made, and I had mistakenly deemed the jellybeans safe); 2) a chicken curry in a restaurant that had been spiced/thickened with peanut sauce – the peanut flavor was masked by the spiciness of the curry; 3) another restaurant in which, even though the food was said to be free of peanuts, there was cross contamination and a reaction ensued; 4) a child’s table where another child had handled peanut butter and left some of it on the surface, which got onto the skin and into the eyes; 5) peanut butter ice cream served with other safe flavors in the bowl in someone’s home (again my mistake as the watching adult); 6) in another child’s home: eating a piece of Ritz cracker *from the box* – the hosts had made the crackers into peanut butter sandwich crackers and then put them back into the box and forgot about it, bringing out the box for us, even though they knew of the peanut allergy. This experience taught us that even the most well-meaning friends can forget or slip up. We no longer set foot into certain restaurants including Thai and Mexican, because of experience with sauces being flavored with peanut. We are vigilant about hot chocolate because we know a situation in which not chocolate was thickened with peanut butter. We stay away from the hors d’oevres at receptions, weddings and other occasions where food is offered and we have different traditions for Halloween because of all the wrappers that say “may contain traces of peanuts.” Every time it happens, you think: “I would never have thought of that as a source of peanut!” And then it is. Also, it’s worth asking about peanut oil. We were recently at a pancake house that used peanut oil to fry the hash browns. Also, peanut butter cookies can look like sugar cookies and will often be in the same tray or container as the safe cookies and cross contaminate. As the girls get older, you’ll want to check ingredients of cosmetics, too. There are some good sites that help identify safe vs. questionable products. Christy, I hope this helps. It’s always what we’re not expecting that trips us up.
Oh, thank you so much, I can definitely learn from your experience. I feel like we go through periods of not being on our game in avoiding peanuts, and then something happens and we are reminded to be vigilant.
Thankful you have shared your experience with others. The one that surprised me was the peanut flavored jelly bean (so easy to overlook), Mexican Restaurants, places with Curry,and peanut oils. This story about the teen and your comment definitely is a reminder to be as cautious as possible.
Ashley, I feel exactly the same way that you do. I have two peanut allergic children (both have different severities of reactions) and while I have an epi pen on hand, have always believed it would save my children’s lives. I’m just so scared now after what happened to poor Natalie.
I do not know very much about severe allergies such as this, please excuse if this is a dumb question. Is there a reason why you would NOT give the epi in an exposure incident? Does it reduce in effectiveness when used repeatedly or is it hard on people’s systems somehow? Doesn’t make sense to me why emergency personnel wouldn’t just give one to prevent catasrophe (as people in the comments have mentioned), seems scary to me that they would wait…
My prayers go out Natalie’s family. Our action an is give Benadryl , inject Epi, head to hospital . We have action plans from the allergist and a very wonderful school nurse. The school nurse has I service twice a year to instruct staff and teachers how to inject the epi pen and what symptoms to watch for. My sin is 12 years old and THANK GOD, his first reaction was his last at the age of 18 months. Educate educate and read everything!!
We were told to use the Epipen immediately for a peanut reaction, that there is a 20 minute window of safety, and to use the Epi within that. Of course, ask your MD. Benadryl alone will not help anaphylaxis. We’ve seen that it does not take long for a peanut reaction to become systemic, even when they spit it out. There is a lot of blood flow to the mouth, where contact occurs. Also: we were told that each new exposure is likely to cause a reaction more severe than the last.
I suffer from so many allergies it has made my life near impossible to be lived normally. Many sessions with all sorts of doctors have ended up reiterating that the Epi-Pen will save me. Now I’m even more anxious than before. My biggest concern though, is what will happen if I administer the Epi-Pen without it having been a severe attack? Maybe I’d be vomiting from bad food, or the flu, and if I think it’s an allergic reaction and use the Epi-Pen, what is going to happen? I am so fearful now I’m going to be afraid to eat again!
This should be the most troubling concern–a child takes a bite of anything, spits it out claiming it didn’t taste right. An Epi-Pen isn’t given, not knowing if an allergen was actually in the product, but if 20 mins later the child starts to react like Natalie did, you mean to tell me that it may be too late to administer the Epi-Pen?? Are we supposed to give them the Epi-Pen every time we suspect a product? I mean, if we only fed them the foods that clearly have the Peanut Free symbol, then it would be nothing but snacks!! I don’t see any cereal or breads claiming they are nut free! Can we really put our faith into assuming companies will always put a “may contain…” label on their foods?? And if a fatal reaction can occur 20 mins after eating, how are us allergic people supposed to trust anything?? Are we to touch our tongue to a food item, then wait 20 mins to eat it? By this article and the comments though, not giving the Epi-Pen right away, even with no reaction, can be the difference between life and death apparently! Going by this analysis, I should administer an Epi-Pen every time when I start eating!! How can anyone live this way, with this fear of food?? This is causing serious issues!!
This was certainly a tragic event, and my sympathy goes out to the family. But it does not seem to be that clear as to just what the rest of us should be learning from what happened. I can certainly see that giving a dose from the EPI pen would probably have been a better choice, but is that for certain? After all, we can’t carry around a hundred doses, and they are costly enough that we would not use them without reason. And, besides all of that, there is a finite amount of risk in using those pens, as there is at any time a serious medication is administered.
My point is that more specific information is helpful, while vague warnings really are not, and if we don’t learn from other folks tragedies we may have one of our own. What could be done differently, and what should be done differently are important things to know.
Sad sad sad.
A deeper look into this situation should be explored.
There doesn’t seem to be any lesson to learn here except allergies are bad, and the parents did everything right.
Urology is no where close to emergency medicine, and most doctors who are not ER physcians are totally inexperienced with pre-hospital emergency care.
Epi pens are susceptible to temperature(high and low), sunlight, and age(expiration). Benadryl is not a treatment, and epinephrine is a stop-gap measure, not a “fix” for anaphylaxis. Some of these posts from people who have epi pens are scary due to the lack of knowledge of their conditions. If you have an allergic condition please, please, please get real education about it.
Your life depends on it.
How is it that airlines like Southwest are still distributing packets of peanuts on flights full of children? I was on a flight recently where a child who has a pa stuck his hand down into the seat pocket and pulled out an empty peanut packet. Such close calls are entirely unnecessary!
From the questions I asked at my daughters first allergist appointment; after finding out she has a peanut allergy, epinephrine is only a short term life saving strategy. It in no way helps stop the allergic reaction completely, it simply contracts the blood vessels to keep the blood pressure from dropping. This can reduce the risk of cardiac arrest. This is why, after administering an epi pen, 911 should be called. I was told very strictly that even when you suspect peanuts were ingested to give an epi shot immediately. Reactions come on fast and go away quickly, with-in 20 minutes, so immediate attention and calling 911 are necessary. I’m saddened that not all are being given this advice b/c without information it can risk a persons life. I myself have had my own life and death allergic reaction due to a medication, and I know that getting medical attention asap is key. My only advice to other parents is don’t hesitate, ask plenty of questions to your allergist/have a detailed plan of action, and call 911 after giving epinephrine. Things can always go wrong, but waiting for signs or symptoms can often be a sign that it’s too late.