Potentially severe and life-threatening, a food allergy reaction requires quick-thinking crew.
The preference sheet called for a good old-fashioned clambake during the Cape Cod charter, so the chef enlisted the help of a local catering company. Under a moonlit sky, the deckhands transformed the beach into an ethereal lantern-lit private dining experience, while clams, lobster and mussels steamed in a pit in the sand. The night had all the makings of a fairytale evening. Until it didn’t.
Within minutes of digging into the feast, the primary’s wife complained of nausea and then vomited. Everyone paused between bites, wondering if the seafood was bad. Then her husband pointed out the hives erupting on her arms and that her lips looked swollen. Confusion ensued. As the crew wondered if they should fetch the medical kit, she swore she wasn’t allergic to shellfish.
“I think a lot of times people who are unfamiliar with this hesitate. What I tell people is if you’re at the point where you’re thinking, ‘Should I give this person epinephrine?’ the answer is probably yes,” says Dr Adam Rutenberg, of GW Maritime Medical Access, a telemedical service based at George Washington University that works with commercial vessels and superyachts.
Food allergies are on the rise globally. The US Centers for Disease Control and Prevention reported in 2023 that the prevalence of food allergies had increased 50 percent since the 1990s, and the UK’s NHS saw a 154 percent spike in hospital admissions for food-related anaphylaxis when comparing figures from 2002 and 2022.
These aren’t just small children having reactions to peanuts. “Allergies can develop at any point in life,” says Dr Rutenberg. A 2018 survey of more than 40,000 adults published in Annals of Allergy, Asthma and Immunology revealed that close to half of adults with food allergies developed at least one of them as an adult; food they had eaten their whole lives without a problem suddenly becomes a big problem, like in our hypothetical worst-case scenario. Shellfish, in fact, tops the list of adult-onset allergens, according to the survey.
While yacht chefs are well versed in preventing cross contamination, a previously unknown allergy manifesting itself, a preference sheet lacking the necessary detail or new crew not declaring an allergy all present risky scenarios.
CHIRP Maritime, a confidential incident and near-miss reporting program, received a report of a yacht crew member who unknowingly consumed citrus on board; their throat swelled and they ended up in the hospital. Neither the captain nor the chefs were aware the crew member had the allergy.
Dr Rutenberg points out that not every reaction to food is an allergy. Many are actually intolerances, and toxic reactions from scombroid poisoning or ciguatera can mimic an allergy. A true allergy, he says, is the body’s immune system reacting to the food. The most severe allergic reaction is anaphylaxis, which involves, as Rutenberg says, “two things going on in two separate systems,” with possible gastrointestinal, vascular, airway and/or skin symptoms.
“Allergy, in general, is something that every boat should have a plan for,” he says. “Know where the EpiPen [epinephrine] is, know when to give it and know how to use it. Everyone probably knows what to do if there’s a fire on board or a man overboard, but they don’t always drill for a medical emergency.”
He adds that the plan needs to be put into action before calling telemedical support. “Food allergy can be severe and rapidly life-threatening. By the time you make a connection and give us a little history, it potentially could be too late,” he says. “So the plan should be rapid assessment, and if somebody is having severe life-threatening allergic reactions, they should be treated with an EpiPen right away. That’s something that no boat should ever be without.” In fact, he recommends having at least two of the auto-injectors on board in case repeat dosing is needed.
He lists life-threatening reactions as: “issues with the airway — so severe wheezing, any swelling of the tongue, swelling of the lips, swelling of the throat — or things that would suggest that the person’s blood pressure is low.” While he says you don’t want to waste time getting a blood pressure cuff, signs include flushing and feeling lightheaded or as if they are going to pass out.
“Epinephrine, given quickly and appropriately, will almost always avoid the need for further care and really can be a lifesaving medication.”
That said, Dr Rutenberg stresses that it’s vital to follow up with shore-side help. A physician should explain how to monitor the patient, what signs to look for, whether to give repeat dosing and what other medications should be given.
“A lot of what we do is risk stratifying and trying to figure out if the situation can be managed on board — and most of the time it can — versus does this boat need to find additional resources or get somebody evacuated.”