In the first report of its kind, a peanut-allergic teen died after experiencing a severe allergic reaction during an intimate act, oral sex, which researchers believe exposed him to his allergen.
The teen, who lived in Canada, began wheezing while he was engaged in an intimate act with another teen. According to the case report, the second teen had eaten peanut butter hours before their encounter. The two young men met using an online dating app, and the allergic teen did not disclose that he had a severe peanut allergy.
When the allergic teen began experiencing symptoms while receiving oral sex, he reached for his asthma rescue inhaler. He did not use his epinephrine auto-injector, even though he had carried one since being diagnosed with a peanut allergy as a toddler, says senior study author Dr. Samira Jeimy, program director for allergy and immunology at Western University in Ontario, Canada.
The teen soon collapsed and was unconscious when EMS arrived, 45 minutes later. He received treatment from EMS on site, but died in the hospital.
The teens never kissed. Jeimy and her colleagues conclude in their report that the most likely route of allergen exposure was through the mucus membrane on the tip of the penis during oral sex.
“This is a very traumatizing case, for the family and the partner,” Jeimy says. “When the severe reaction occurred, the partner had no idea, and the patient couldn’t advocate for himself.” It’s not known exactly why the other teen waited to call for help, but “there was panic,” she added.
What haunts all involved is why the deceased teen, who had severe asthma, didn’t use his epinephrine auto-injector. “It’s one of the most traumatizing things of all,” Jeimy says. “He’d carried it all his life.”
Allergen Exposure and Dating Risks
Dating and intimacy pose special concerns for teens with food allergies. Past research has shown that peanut allergen lingers in the mouth for hours, meaning that the food-allergic need to exercise caution when there will be an exchange of saliva.
A study by Dr. Scott Sicherer and colleagues found that after people ate peanut butter, eating a peanut-free meal and waiting four hours reduced the allergen in the saliva to undetectable levels. Teeth brushing, mouth rinsing and chewing gum also reduced levels, but not by as much, says Sicherer, director of the Jaffe Food Allergy Institute at Mount Sinai in New York.
Other food allergens likely hang around in the mouth too, he adds. Surveys find that 5 to 12 percent of patients with food allergies say they have experienced kissing-related allergic reactions.
There have also been rare reports of anaphylactic reactions tied to the transfer of semen during sexual activity. A woman with a Brazil nut allergy experienced an anaphylactic reaction following intercourse with her boyfriend, who had eaten Brazil nuts earlier. There’s also a report of a woman in Spain who was allergic to amoxicillin and had an anaphylactic reaction after an intimate act with her boyfriend, who was taking the drug.
While uncommon, there have also been reports of people being allergic to a partner’s semen. Allergy to the latex in condoms also occurs. But the Canadian case is the first report of anaphylaxis in someone receiving fellatio, researchers say.
“Anaphylaxis from intimate relations is already exceedingly rare, and this particular scenario has never previously been reported,” Jeimy says.
Before concluding the cause most likely was peanut exposure, researchers investigated other possibilities. The teen had no drugs or alcohol in his system. Blood tests showed high levels of tryptase, an enzyme released by mast cells in anaphylaxis. They considered an asthma exacerbation or postcoital asthma attack, known as “sexercise-induced” asthma. But recent medical records showed the teen’s asthma was well-controlled, Jeimy notes.
Still, Sicherer says it’s impossible to know for sure whether the cause of death was exposure to peanut-allergen through the mucus membrane of the genitalia. “It’s theoretically possible, but it has to be exceptionally rare,” he says. “And in this particular case, there is no way to know for sure what happened.”
He adds: “Nonetheless, there are a number of important lessons from this tragedy, such as communication about one’s allergy and prompt treatment with epinephrine, which can help others to stay safe.”
Disclose Allergies, Always
The tragic death is a terrible reminder of how important it is for young people to tell their sexual partners about their food allergies, in all circumstances, especially before engaging in intimate acts. In surveys, teens also often fail to carry their epinephrine auto-injectors.
“Discussing safe practices around sex is an uncomfortable conversation, but as parents, we have to have it with our kids,” Jeimy says.
Use of dating apps, especially among gay and transgender youth, is growing. Teens meeting up with people they don’t know well may be less likely to talk about their food allergy than they would with a boyfriend or girlfriend. Stigmatized groups, who are already more likely to be subjected to bullying and social isolation, may be especially hesitant to bring up food allergies, Jeimy says.
“When we’re bullied, we have our walls up and we don’t disclose information about ourselves,” the allergist notes. “I don’t find it hard to imagine that someone stigmatized for their food allergies and their sexual orientation isn’t the most outspoken about their food allergies.”
“Dating apps are more and more popular, and we all need to be educated in advocating for ourselves and our patients,” she says.
The family of the deceased teen agreed to have their son’s case published to help raise awareness among teens, their families and medical professionals.
“We are so grateful to the family for giving their consent,” Jeimy says. “It’s a horrendous situation, yet they are still willing to try to help others from having to go through this.”
Full Case Report on This Tragedy
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