Food Allergy

An 18-year-old basketball player with a known peanut allergy and moderate, persistent, controlled asthma has just played in a collegiate game. Cough, shortness of breath, and sneezing develop 10 minutes after he ingests a homemade sugar cookie at a party after the game. He immediately takes 50 mg of diphenhydramine, but hoarseness, throat tightness, worsening shortness of breath, rhinorrhea with copious clear mucus, and repetitive emesis continue to progress. He then administers 0.30 mg of epinephrine with the use of an autoinjector into his upper lateral thigh and four actuations of an albuterol inhaler (at a dose of 90 mu g per actuation). The use of these agents results in immediate relief of the throat tightness and full resolution of the other symptoms within 15 minutes. What would you advise at this point? Could his symptoms have been prevented?