Milk allergy death- should the book be thrown at the staff involved?

[mids2019]

....or if you are minimum wage staff member working in a stressed environment without English as a first language there should be leniency. Doctors are paid for life and death decisions but are Costa staff?

Yes

If you buy from a supermarket then someone has prepared it, even if it is a bag of uncooked rice. It could be contaminated, if you want to give a pedantic example.

The ignorance I have seen about the Pret case is astonishing. The sandwich was labelled with ingredients. They read the label. What she did not know was that the in-house made sandwich bread had sesame in it and was not required by law at the time to be on the label, Hence Natasha’s Law.

If they were issued an epipen,they’d have been given training. And told administer promptly at first sign of reaction. Absolutely advice & training os given when epipen prescribed it’s a prescription medication

I would too.
And presumably if this girl had survived then the mother would have done similar going forward. But unfortunately it seems that they didn't realise just how bad her allergy actually was

This means never going on holiday, never going far from home.

Really, it is the fault of Costa, there should be clear notices in every establishment about the content of their drinks.
Many food outlets are excellent in their communications and staff training now but not all are nor do they seem to care.

There is always the risk of human error or in fact staff who dismiss allergies and auto-immune conditions such as coeliac disease as fads or fussiness.

Yes but again they don't prescribe for every allergy. They expire after about a year and are in short supply. This girl presumably didn't have them because they didn't understand that she needed it.

I'm vegan, which I know is a choice and I don't have any allergies, which I know is not a choice for those that do.

I keep a keen eye on what milk is being served if I'm in a coffee shop, just because I don't want to pay for milk that has come from a cow, and after being vegan for so long, I know the taste is not very nice now (accident at work).

I do think though that people who are selling food and drinks have a massive responsibility to safeguard those with allergies. Not only is it a legal requirement, it is also a moral obligation. I haven't read the article, but I do think that people providing such a service should be trained extensively on food allergies l, and whilst humans are not infallible, causing the death of someone due to negligence should not be taken lightly.

Come on. They said they would make the drink with soya milk, and in a clean jug. And they didn’t.

As an epipen wasn’t carried it does sound like the allergy Hannah had was mild, the findings of the inquest will determine this.
Although rare, a mild allergy can suddenly turn into life threatening on exposure. Sometimes a trigger prior to exposure can increase the severity, such as exercise, alcohol or another factor.
As they had left the dentist to go to a pharmacy it was most likely not severe at that stage, then sadly escalated.

As a parent of allergy children I’ve drummed into them to always carry a bag with epipens and antihistamines. We do go to coffee shops but only ones that are safe, Costa are meant to show you the allergy book and use a designated non dairy jug. At our one they also run it though the dishwasher first before making ours. We’ve also had some places say they use the same equipment and it’s just not safe.

Unfortunately it does seem miscommunication played a part because the mother and employee are saying different things.

So difficult. I had to give up dairy as my baby has CMPA and was reacting to my breastmilk if I had dairy (thankfully not life threatening though). Within a week he had a reaction and it was the day after I'd been to a Costa. Even at home can be hard as also happened after a condiment I had checked before had a 'new recipe' and had added milk powder.

I stopped eating out a lot very quickly but it's really hard to do! Soon after I had multiple weddings to attend, a couple of family milestone birthdays where they wanted to go out for a meal to celebrate etc. So much of life and people around want to meet up for a coffee or go for a meal. It's ridiculously limiting if you trust no one.

Now I get bottled drinks in cafes. But the food is still an issue. You have to trust people. I ask for dairy free and stuff comes with obvious spread on, I ask if it's butter and they say non dairy spread. It could be, they could be lying.

I would even argue that Costa isn't really at fault, this seems like the sort of thing everyone tries to prevent but in the end there will always be a few occasions where errors happen and result in tragedy. The only way to protect against fatality from severe allergies is to have treatment to counteract a severe reaction such as adrenaline. My friend has a severe peanut allergy and so is very careful and avoids any 'may contains', but he was once on holiday and got out of a taxi to find the town he was in was having a peanut festival and people wee throwing peanuts around in the street! Obviously he didn't know about that beforehand but it goes to show how you can be exposed at any time and in so many ways, so the best protection is really emergency medication, as well as being very cautious.

Yes, it should be standard practice everywhere that serves food that an allergic customer asks for a blank "allergy card"/whatever you want to call it, the customer fills in what their allergy is, and what their order is, and that stays with the order from counter to server/chef and back to counter, exactly like your name does now when you order from a coffee shop. It would be easy to have some type of program designed into the ordering system which cross checked what you'd ordered with what you indicated your allergy was, and if it wasn't safe then a big red cross or something would come up on the screen, at each stage.

Goodness gracious thanks for this! I have chronic urticaria with sudden onset of mouth and throat swelling and breathing difficulties. They haven't identified all the triggers. Was prescribed epi-pen by hospital emergency consultant, but did not follow up with GP afterwards or request a repeat prescription from either them or the allergy clinic. Didn't even know you could get them via routine repeat prescript. So I'm carrying around epi-pens that are out of date. Often left them behind when swapping bags. Got lax because not been as severely triggered, but past couple weeks have been seeing an escalation in symptoms and difficulty breathing.

I honestly hadn't considered it properly. You don't tend to go running to get medicines you don't seem to utilise often IYSWIM?

Great post.

Yeah that's what I meant.
Some of them say contains milk and obviously have it listed in the ingredients.
But others say that they may contain milk, milk products haven't been added but they could have got there from the factory.

My point being that anyone with a milk allergy should be extremely cautious about hot chocolate in general because they either contain milk or state that there is a risk they they might contain it, regardless of whether you go on to make it with dairy or soya.

I disagree. It means preparing your own food and not putting the onus on busy chains and their staff. If I had an allergy that could kill me I wouldn't eat or drink in cafes. Far too risky.

In wagamamas if you say you have an allergy your order can only be put through by a manager, and it comes out a separate part of the window and a manager brings it to you.

Not all chains are equal. The best one by far, imo, is Bills.

Dairy is the leading cause of fatal anaphylaxis in children, in part because it is hard to avoid.

From reading around there are a number of possible factors relevant in this tragedy:

• Obviously, the mistake with the milk in the coffee shop. This has been the focus of the media but I think it is what followed (not administering adrenaline in time) that could realistically be learned from to save lives in future.

• Reading between the lines she was not carrying her own EpiPen (I could be mistaken) - this should never be the case for somebody with multiple allergies and known anaphylaxis. Thinking of possible reasons it could be that previous anaphylaxis was not severe or occurred years ago and there was a perception an EpiPen was not needed, a mistake by professionals (failure to identify anaphylaxis risk and prescribe an EpiPen + educate), sometimes just a tragic misfortune (accidentally left at home) or sometimes just a totally unforseeable first episode of anaphylaxis (though to be honest, any IgA symptoms and complete avoidance of dairy = epipen in my opinion)

• It seems that the EpiPen that was given was significantly delayed for various reasons (possibly including reluctance/refusal) and then a single underdose was given. She could have been given twice the dose, and that could have been repeated after 5 minutes - but perhaps even more importantly, it needed to be given earlier. That's the intervention that saves lives and sadly did not happen. I feel terrible for whatever pharmacist was involved in the underdosing because that really is a training issue. For whatever reason they lacked the confidence or feared giving "too much" adrenaline.

Unfortunately there is a lack of awareness/education around anaphylaxis. People do not understand that you can die from anaphylaxis (due to circulatory failure) without developing swelling around the mouth or breathing difficulty, for example (obviously these can also be signs of anaphylaxis but don't have to be present).

Anaphylaxis tends to progress in severity with each exposure. A previous history of milk exposure causing flushing and vomiting (which may also have qualified as anaphylaxis but could have been downplayed or not identified) that settled with antihistamines, may have led to false reassurance. If people do not understand the signs they may decline an EpiPen when they really need one.

Once somebody has already had an arrest, paramedics would then have to give adrenaline IV (which is a further delay) alongside effective compressions for it to have much effect, and that's obviously going to be a terrible situation that's hard to get back from. It's very important to give the adrenaline quickly to halt the process before the person completely collapses.

I believe the average time for cardiac arrest from anaphylaxis is 30 minutes without treatment if the allergen is ingested. A fit teenage may present as simply "unwell" for a lot of that vital time, walking, talking and then suddenly decompensate. It is really hard to imagine how bewilderingly fast 30 minutes is to go from totally fine to in cardiac arrest unless you've been in that situation. Hard to think straight. This is why education and training is vital so that no thinking is needed, it's just drummed in. Give the EpiPen. And if you're not sure, after 5 minutes give it again.

I feel terrible for that poor, poor girl and her mother. Allergy UK has a lot of information and have been desperately trying for a number of years to raise awareness particularly around lowering the threshold to prescribe and administer adrenaline.

That was more about the BA staff who would not allow mum to retrieve an epi pen when they were on approach.

Funnily enough, a year one Doctor is paid around about the same a barista in Costa

This sounds awful but no way would I ever risk any sort of coffee shop. This risk is far too high.

I agree with this. Absolutely tragic for the family & poor girl, however with allergies this severe, I'd be so afraid to eat anything outside the home or that isn't prepackaged.

Sounds like both mum and the barista made mistakes in the ordering of the drink PLUS the child had never had such a serious reaction before and it wasn't obvious at first (in the dentist) that she was having an anaphylactic reaction.

As of August 2023, the average full-time earnings for junior doctors in their first year of practice in England are around £41,300. This is based on a basic salary of £32,398 for Foundation Year 1 (FY1) doctors, which increases to £37,303 in year two. In addition to their basic salary, doctors in training receive pay for extra hours worked, weekend allowances, and on-call allowances.

According to Indeed, the average hourly rate for a barista in the UK is £10.81, but salaries can vary by city. For example, as of July 2024, the average hourly rate for a barista in London was £11.63. The .majority of baristad in the UK are not offered full-time or permanent contracts.

Cool story you’ve made up in your head there….

we have kept my DD’s correctly prescribed epipens which expire in 12m despite the fact she doesn’t need them any more.
if I returned them to a pharmacy they’d be disposed off, not redistributed.
No GP is going to prescribe epipens for a nonexistent allergy 🤨