A study published today in the Canadian Medical Association Journal determined that anaphylaxis in children spikes during Halloween and Easter and that for tree nuts, most cases occurred in children that were previously undiagnosed.
Co-authors Dr Melanie Leung and Dr Moshe Ben-Shoshan provided the rationale for conducting the study:
Identifying certain times associated with an increased risk of anaphylaxis could help to raise community awareness, support and vigilance. This information would identify the best timing for public awareness campaigns to prevent allergic reactions.
The researchers compared the incidence of 1390 patients presenting at pediatric emergency departments with anaphylaxis between 2011 and 2020 in four Canadian provinces — Quebec, Ontario, Newfoundland and Labrador, and British Columbia — at Halloween, Easter, Christmas, Diwali, Chinese New Year and Eid al-Adha, the most celebrated holidays in Canada.
For peanut-triggered anaphylaxis, daily averages increased 85% for Halloween and 60% for Easter when compared with the rest of the year. For unidentified tree nuts, averages increased 70% for both Halloween and Easter. The researchers found no appreciable increase in incidence of anaphylaxis at Christmas, Diwali, Chinese New Year or Eid al-Adha.
Anaphylaxis induced by peanuts and tree nuts was more likely in children aged 6 years or older than in younger children.
The authors surmise:
The difference in the anaphylaxis incidence among holidays may have been due to the social setting in which each holiday takes place. At Halloween and Easter, children often receive candies and other treats from people who may be unaware of their allergies. The absence of such an association at Christmas may be because Christmas is a more intimate celebration among family members and close friends, who are more vigilant regarding allergen exposure.
The authors indicate that a contributing factor may be Canadian regulations regarding the labeling of common allergens which are not required for prepackaged, single-bite snacks and candies. Such allergen labeling for miniature products sold in bulk is also not required in the US, where the disclosure must appear on the bulk packaging only.
The authors conclude that education and increased awareness may help reduce the incidence of anaphylaxis:
Our findings suggest that educational tools to increase vigilance regarding the presence of potential allergens is required among children with food allergies, their families and laypeople interacting with children who have food allergies. Newer strategies targeting intervals associated with high anaphylaxis risk are required.