A London coroner’s inquest into the death of Karanbir Cheema, 13, has heard testimony that sheds light on medication issues and medical factors contributing to the apparent anaphylaxis tragedy.
The reaction that Karanbir, known as Karan, suffered in June 2017 followed a schoolyard bullying incident, which involved another 13-year-old either flicking cheese onto Karan or putting it down the back of his shirt. (While other students had reported flicking of cheese, Karan had told school officials it was down his neck/upper back.) Dairy was among Karan’s food allergies.
On May 2 at the inquest, a school administrator described how, in a matter of minutes in the health office, Karan went from scratching his neck to panicking, violently scratching the neck area, and struggling to breathe. A report in The Guardian said the boy was given an antihistamine and, as his condition worsened, an EpiPen was administered. It was past its expiration.
However, on Friday, May 3, a senior paramedic who attended to Karan at the William Perkin Church of England High School in west London said she was not informed of the food allergy issue. Unaware of it, she instead treated Karan for a severe asthma attack, administering 2 grams of magnesium sulfate.
“If I had known about the specific details of the history about the allergens, I wouldn’t have given it,” paramedic Alexandra Ulrich told the inquest, according to the BBC. She also admitted to some panic among those involved in the escalating emergency.
A puzzling factor in Karan’s death has been that he didn’t actually eat any cheese. Rather, it touched the skin on his neck.
Dr. Adam Fox, a pediatric allergist testifying as an expert witness, called Karan’s death “unprecedented” in news reports. He found a few cases in the medical literature of severe bronchospasm related to allergen contact with the skin. But he could find no reports of allergen contact-related fatalities.
Yet, he suggested Karan did suffer anaphylactic shock. In two news reports, he noted that the boy also had chronic eczema and asthma and that these may have been contributing factors. Fox said that the fact that Karan’s scratching grew so extreme that he was drawing blood before he even got epinephrine. This might have led to residual allergen on his neck becoming exposed to his bloodstream.
“Further scratching and degrading of the skin barrier could well have led to further contact [with the allergen],” The Guardian quotes Fox as testifying.
“If it was skin contact alone that caused, in this case, fatal anaphylaxis, I believe that would be unprecedented … I have never seen it before,” the news outlet cites the allergist saying. He also noted that the pollen count was high that day, which could also have affected the severity of the boy’s reaction. The teen died in Great Ormond Street Hospital several days later.
While saying he wasn’t criticizing school staff, Fox said the epinephrine auto-injector should have been administered sooner.
Karan’s mother Rina Cheema has said previously that her son had multiple allergies, including dairy, wheat, eggs and nuts, as well as asthma and eczema.
The inquest continues. See testimony from last year’s hearing here.