Food Allergens Most Likely to Cause Anaphylaxis in Asthma Patients
In patients with asthma, peanuts and tree nuts pose the highest risk for fatal anaphylactic reactions, followed by fish and shellfish, with asthma itself being the single most important risk factor for severe or fatal food-induced anaphylaxis. 1
High-Risk Foods by Age Group
Children with Asthma
The foods most frequently causing anaphylaxis in children are:
- Peanuts (highest risk for fatal reactions) 1, 2
- Tree nuts (walnuts, pecans, hazelnuts, etc.) 1, 2
- Milk 1, 3
- Eggs 1
- Fish 1
- Shellfish 1
Adults with Asthma
The foods most frequently causing anaphylaxis in adults are:
Critical Risk Amplification in Asthma
The presence of asthma is the factor most commonly identified with severe reactions, especially with peanut or tree nut allergy. 1 This relationship is particularly dangerous because:
- Patients with both food allergy and asthma are 2-4 times more likely to experience severe reactions 1
- A high prevalence of asthma has been reported among people who died from food-induced anaphylaxis 1
- Food-induced anaphylaxis fatalities disproportionately affect adolescents and young adults with peanut and tree nut allergy who have asthma 2, 4
- Asthma increases the risk for fatal or near-fatal food reactions regardless of asthma severity 1, 5
Additional High-Risk Considerations
Foods Frequently Implicated in Fatal Anaphylaxis
Peanut, tree nuts, fish, and shellfish are classified as foods frequently implicated in fatal and near-fatal food-induced anaphylaxis. 1 These foods warrant heightened vigilance in any asthmatic patient.
Cross-Reactivity Caution
Clinical cross-reactivity with other foods in the same group is unpredictable 1. For example, while peanut and soy share immunologic epitopes, they may not cross-react clinically 1. Each food must be evaluated individually.
Food Additives
Sulfiting agents can cause respiratory reactions, occurring primarily in patients with underlying asthma, particularly those with more severe disease 5. White wine contains approximately 160 mg% of metabisulfite and can precipitate asthma symptoms in up to 5% of adults with asthma 6.
Clinical Pitfalls to Avoid
Any food is capable of inducing severe anaphylactic reaction, including fruits and vegetables, despite being less commonly implicated. 1 The patient's previous reaction history should guide risk assessment, not just statistical frequency data.
Asthma of any severity—not just poorly controlled asthma—increases anaphylaxis risk. 1 Even patients with well-controlled asthma require aggressive precautions when they have food allergies to high-risk foods.
Adolescents and young adults with asthma and peanut/tree nut allergy represent the highest-risk demographic for fatal reactions. 2, 4 This age group requires particularly intensive education about epinephrine auto-injector use and strict avoidance.