Like most children with a food allergy, Natalie Giorgi was raised with a keen understanding of how careful she had to be.
At 13, she knew that her peanut allergy could be deadly, and her parents were exceedingly cautious about what she ate.
"She never put any dessert or anything that was questionable into her mouth without consulting someone," said Augusta Brothers, a family friend.
But Friday night, years of caution couldn't save her.
The redheaded teen died early Saturday, the result of an apparent allergic reaction after she bit into a Rice Krispies treat at Camp Sacramento on the final night of the family camp.
Natalie was attending the camp along Highway 50 in the Eldorado National Forest with her parents, two sisters and brother, all of Carmichael.
On Friday night, during a group gathering, she went into the lodge for a treat. The lights had been dimmed and three varieties of Rice Krispies treats prepared by the camp cook were brought out for the group, said Brothers, who was there with her own family.
"After every campfire, they provide snacks, cookies and ice cream," Brothers said, and Friday night Natalie tasted a treat topped with icing.
She spit it out right away, Brothers said, and went to find her mother to tell her she had tasted something with peanuts.
Her parents, Sacramento urologist Dr. Louis Giorgi and his wife, Joanne, responded immediately. Natalie's mother tasted the treat and also detected peanuts. The girl was given a dose of Benadryl to offset an allergic reaction, Brothers said.
They monitored Natalie, who at first seemed fine, still smiling and enjoying herself, Brothers said. Twenty minutes later, she vomited and began to have trouble breathing.
Natalie's father administered an injection with an EpiPen, a device used to deliver epinephrine that is commonly carried by individuals with serious allergies.
Frequently, an EpiPen can ward off a severe allergic reaction, but the injection had no impact. Brothers said Natalie's father ended up using three EpiPens over the course of several minutes before she stopped breathing.
Paramedics arrived at the camp at 10:40 p.m. and performed CPR to no avail. She was taken by ambulance to Barton Memorial Hospital in South Lake Tahoe, where she was pronounced dead at 12:30 a.m. Saturday.
The El Dorado County Sheriff's Office said the cause of death was severe laryngeal edema – a swelling in the throat – as a result of a presumed allergic reaction.
Camp Sacramento is a popular summer getaway for families that is operated by the city of Sacramento parks and recreation department. Camp manager Tim Holland declined to comment Monday on where the snacks had come from, referring inquiries to the city.
Linda Tucker, a city spokeswoman, said in an email that "staff is not aware of a death of a camper ever (before) occurring in its 90 year-plus history."
"Our thoughts are with the family," the city statement added. "As the child is a minor and the case does involve a medical situation, we are limited in the information we can provide."
Tucker added that "Camp Sacramento staff acted swiftly" and that "we are doing our own internal research and will be reviewing all the factors surrounding this tragic incident." The statement did not address the origin of the snacks.
The girl's parents attended a vigil service Sunday night at Our Lady of Assumption Church in Carmichael for Natalie, who would have gone into eighth grade next year at the parish school.
"They are devastated," Brothers said. "They did everything they could to save her."
Natalie loved reading and Disneyland. She dreamed someday of becoming a neonatologist so she could care for babies born prematurely, as were she and her twin sister.
Her parents issued a statement asking that Natalie's death focus attention on the dangers of food allergies.
"While our hearts are breaking over the tragic loss of our beautiful daughter Natalie, it is our hope that others can learn from this and realize that nut and food allergies are life-threatening," the statement said. "Caution and care for those (afflicted) should always be supported and taken."
Natalie's Sutter Medical Group allergist, Dr. Mark Grijnsztein, spoke with the family Monday, and said they responded to the incident in textbook fashion.
"The family did all the right things," he said. "The child ate peanut butter and looked fine, and she had no history of such a severe reaction.
"I deal with families who don't even have epinephrine pens and teens who don't have the pens on them. They'll come rushing in to me because they have hives.
"This family was as prepared and knowledgeable as a family can be. It's a tragic scenario."
Food allergies have become so common that area schools routinely track susceptible students, posting "no nuts" signs outside their classrooms, sometimes providing separate eating tables and keeping EpiPens available.
Last year, when a senior prank at C.K. McClatchy High School left toilet paper, eggs and graffiti at the campus, the principal took fast action because part of the prank included smearing peanut butter on walls.
Students with peanut allergies were called and told to stay home, and one who arrived at school suffered an allergic reaction.
Roughly 3 million American children under the age of 18 – four of every 100 children – had food allergies of some sort in 2007, according to the U.S. Centers for Disease Control and Prevention.
And numbers have been rising: In the decade ending in 2007, the prevalence of food allergies in that age group had risen 18 percent, the CDC said. Researchers have theories about why that is the case but, so far, no solid answers.
Almost all food allergies result from exposure to eight kinds of foods: eggs, milk, peanuts, tree nuts, soy, wheat, shellfish and fish. Egg allergies are the most common, doctors say.
"Peanut allergies are not the most prevalent, but they're the most dangerous," said Grijnsztein.
Reactions can vary in severity from mild tingling around the mouth to anaphylactic shock, which can lead to death.
"A lot of grandparents and older adults never had to deal with this, so they don't understand the severity," said Grijnsztein. "They say, 'I raised five kids, and this seems overblown.'
"The answer is, the world has changed. This is what this new generation has to face."
While researchers know that people can outgrow many allergies to food, that's true of only 20 percent of people with peanut allergies.
Food allergies result in more than 200,000 emergency room visits each year, according to the Food Allergy Research & Education, a Washington, D.C., nonprofit.
"This is a lifelong issue," said FARE's chief executive officer, John Lehr. "Obviously, avoidance is the only way to avoid a reaction, but we know accidents happen. That's the insidious nature of food allergies.
"We tell people that their last reaction is not an indication of their next reaction. Don't think because you have not had a severe reaction that you can't have one."
Call The Bee's Sam Stanton, (916) 321-1091.
Editor's note: This story was changed July 30 to correct the prevalence of children under age 18 diagnosed with food allergies and to clarify the name of FARE, Food Allergy Research & Education.