Fatal nut anaphylaxis in a 16-year-old male: case report

A case of fatal nut anaphylaxis in a 16-year-old atopic, steroid-dependent asthmatic male is reviewed. He had large positive skin tests (scratch) to walnuts and peanuts. Serum was positive for specific IgE antibody measured by solid-phase radioimmunoassay to pecans. The importance of the immediate use of epinephrine is emphasized. Accidental ingestion of foods to which patients are sensitive is a common error for which patients must be prepared with preloaded epinephrine syringes.