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Seasonal choking in Japan: Japanese rice cake (mochi), ehomaki, and beans for Setsubun

      Dear Sir
      In Japan, nearly 10,000 people died because of foreign body airway obstruction (FBAO) that was the leading cause of accidental death.
      • Ministry of Health, Labour and Welfare
      Current population survey in 2015.
      According to the Utstein Osaka project, 7.0% of out-of-hospital cardiac arrests were caused by FBAO.
      • Kiyohara K.
      • Sakai T.
      • Nishiyama C.
      • et al.
      Epidemiology of out-of-hospital cardiac arrest due to suffocation focusing on suffocation due to Japanese rice cake: a population-based observational study from the Utstein Osaka Project.
      Various foods that are consumed daily cause FBAO, including rice, bread, and meat. Seasonal and traditional custom foods also cause FBAO, including Japanese rice cake (known as mochi), ehomaki, and beans for Setsubun. In particular, mochi accounted for 9.5%–13.9% of all FBAO cases.
      • Kiyohara K.
      • Sakai T.
      • Nishiyama C.
      • et al.
      Epidemiology of out-of-hospital cardiac arrest due to suffocation focusing on suffocation due to Japanese rice cake: a population-based observational study from the Utstein Osaka Project.
      • Igarashi Y.
      • Norii T.
      • Sung-Ho K.
      • et al.
      Life-threatening foreign body airway obstruction: case series and new classification proposal.
      In Tokyo, 482 patients were transferred to hospitals due to FBAO with mochi over a period of 5 years.

      Tokyo Fire Department. Public relations. December 2018.

      Mochi is a traditional food that is made from the following two main ingredients: water and mochigome, a particularly sticky variety of Japanese rice. It is likely to adhere to the larynx and trachea and be difficult to remove because of its chewiness and stickiness. Japanese people eat mochi traditionally as part of celebrations, especially New Year’s celebrations. Among the 314 people who choked because of mochi during 8 years in Osaka, 43 (13.7%) choked on January 1 and 77 people (24.5%) experienced choking for 3 days, starting on January 1.
      • Kiyohara K.
      • Sakai T.
      • Nishiyama C.
      • et al.
      Epidemiology of out-of-hospital cardiac arrest due to suffocation focusing on suffocation due to Japanese rice cake: a population-based observational study from the Utstein Osaka Project.
      Ehomaki is a long sushi roll that is eaten on the last night of winter (on February 3 according to lunar calendar, also known as Setsubun) and is filled with seven different ingredients to represent the seven foods of happiness (Fig. 1). It is believed to bring good luck when people eat ehomaki rapidly facing the direction of best luck specified each year. Although people usually eat a slice of sushi roll, it is regarded good to open the mouth wide and bite into ehomaki. Moreover, people also throw beans to exorcize the devil or demon and eat beans in a number that is obtained by adding 1 to their age, on the same day. However, a child aged <3 years is at risk of choking with the beans. Many accidents have been reported each year.
      In Japan, choking occurs more frequently during the winter season; 36.1%–61.5% of all choking incidences happen during the winter.
      • Kiyohara K.
      • Sakai T.
      • Nishiyama C.
      • et al.
      Epidemiology of out-of-hospital cardiac arrest due to suffocation focusing on suffocation due to Japanese rice cake: a population-based observational study from the Utstein Osaka Project.

      Tokyo Fire Department. Public relations. December 2018.

      Among the 512 choking patients in Tokyo, 69 (13.5%), 199 (38.9%), and 47 (9.2%) were transferred in December, January, and February, respectively. Compared to that in Tokyo, the number of patients with choking is consistent in London.
      • Pavitt M.J.
      • Nevett J.
      • Swanton L.L.
      • et al.
      London ambulance source data on choking incidence for the calendar year 2016: an observational study.
      Although these traditional customs have been designed to make the upcoming year happier and healthier, they include a high risk of choking. Choking is a preventable incidence; therefore, greater awareness among family members and among medical aides who care for the elderly is needed to prevent the incidences of choking.

      Conflict of interest

      None.

      Disclosure of funding

      None.

      References

        • Ministry of Health, Labour and Welfare
        Current population survey in 2015.
        2018
        • Kiyohara K.
        • Sakai T.
        • Nishiyama C.
        • et al.
        Epidemiology of out-of-hospital cardiac arrest due to suffocation focusing on suffocation due to Japanese rice cake: a population-based observational study from the Utstein Osaka Project.
        J Epidemiol. 2018; 28: 67-74
        • Igarashi Y.
        • Norii T.
        • Sung-Ho K.
        • et al.
        Life-threatening foreign body airway obstruction: case series and new classification proposal.
        Am J Emerg Med. 2019; 37: 2177-2181
      1. Tokyo Fire Department. Public relations. December 2018.

        • Pavitt M.J.
        • Nevett J.
        • Swanton L.L.
        • et al.
        London ambulance source data on choking incidence for the calendar year 2016: an observational study.
        BMJ Open Respir Res. 2017; 4e000215