News Release 

Spike in new nut anaphylaxis in children at Halloween and Easter

Canadian Medical Association Journal

Research News

A new study looking at the link between peanut and tree-nut anaphylaxis in children and holidays found spikes at Halloween and Easter. The study, published in CMAJ (Canadian Medical Association Journal) found that most were previously unknown allergies, calling for increased awareness http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200034.

"Identifying certain times associated with an increased risk of anaphylaxis could help to raise community awareness, support and vigilance," write Dr. Melanie Leung, 4th-year medical student at McGill University and Dr. Moshe Ben-Shoshan, McGill University Health Centre, Montreal, Quebec, with coauthors. "This information would identify the best timing for public awareness campaigns to prevent allergic reactions."

Researchers compared anaphylaxis at Halloween, Easter, Christmas, Diwali, Chinese New Year and Eid al-Adha.

The study included 1390 patients visiting participating pediatric emergency departments between 2011 and 2020 in 4 Canadian provinces: Quebec, Ontario, Newfoundland and Labrador, and British Columbia. The median age of patients was 5.4 years and 62% were boys.

For peanut-triggered anaphylaxis, there was an 85% increase in daily average cases during Halloween and a 60% increase during Easter compared with the rest of the year. For anaphylaxis triggered by unknown nuts, there was a 70% increase during Halloween and Easter compared with the rest of the year. However, the researchers did not find an increase at Christmas, Diwali, Chinese New Year or Eid al-Adha.

"The difference in the anaphylaxis incidence among holidays may have been due to the social setting in which each holiday takes place," write the authors. "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."

Canadian labelling may also be a factor, as individual packages of candies and snacks, which are exempt from labelling requirements listing ingredients, are popular at Halloween and Easter.

The authors suggest education and awareness may help reduce the risk 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 lay people interacting with children who have food allergies. Newer strategies targeting intervals associated with high anaphylaxis risk are required."

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Visual abstract: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.200034/tab-related-content

"Risk of peanut- and tree-nut-inducted anaphylaxis during Halloween, Easter and other cultural holidays in Canadian children" is published September 21, 2020.

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