ORIGINAL ARTICLE

How dangerous is food allergy in childhood? The incidence of severe and fatal allergic reactions across the UK and Ireland

C F Macdougall¹, A J Cant², A F Colver³

¹ Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK
² Paediatric Immunology and Infectious Diseases Unit, Newcastle General Hospital
³ Northumbria Health Care Trust and University of Newcastle upon Tyne, Donald Court House, 13 Walker Terrace, Gateshead NE8 1EB, UK

Correspondence to:
Correspondence to:
Dr A Colver, Senior Lecturer in Community Child Health, Northumbria Health Care Trust and University of Newcastle upon Tyne, Donald Court House, 13 Walker Terrace, Gateshead NE8 1EB, UK;
allan.colver{at}ncl.ac.uk

Aims: To discover the incidence of fatal and severe allergic reactions to food in a large population of children.

Methods: A retrospective search for fatalities in children 0–15 years from 1990 to February 1998, primarily of death certification at offices of national statistics. A prospective survey of fatal and severe reactions from March 1998 to February 2000, primarily through the British Paediatric Surveillance Unit. Main outcome measures were deaths and severe reactions. A case was deemed severe if one or more of the following criteria was met: cardiorespiratory arrest; need for inotropic support; fluid bolus >20 ml/kg; more than one dose of epinephrine; more than one dose of nebulised bronchodilator. A case was deemed near fatal if intubation was necessary.

Results: The UK under 16 population is 13 million. Over the past 10 years, eight children died (incidence of 0.006 deaths per 100 000 children 0–15 years per year). Milk caused four of the deaths. No child under 13 died from peanut allergy. Two children died despite receiving early epinephrine before admission to hospital; one child with a mild food allergic reaction died from epinephrine overdose. Over the past two years, there were six near fatal reactions (none caused by peanut) and 49 severe ones (10 caused by peanut), yielding incidences of 0.02 and 0.19 per 100 000 children 0–15 years per year respectively. Coexisting asthma is more strongly associated with a severe reaction than the severity of previous reactions.

Conclusions: If 5% of the child population have food allergy, the risk that a food allergic child will die from a food allergic reaction is about 1 in 800 000 per year. The food allergic child with asthma may be at higher risk. Prescribing an epinephrine autoinjector requires a careful balance of advantages and disadvantages.

Keywords: death; severe reaction; food allergy

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Apps, J. R, Beattie, R M. (2009). Cow's milk allergy in children. BMJ 339: b2275-b2275 [Full Text]  
• Body, R., Doshi, D. (2008). BET 1. EPINEPHRINE SELF-INJECTION FOR ANAPHYLAXIS IN CHILDREN. Emerg. Med. J. 25: 163-165 [Full Text]  
• Colver, A. (2006). Are the dangers of childhood food allergy exaggerated?. BMJ 333: 494-496 [Full Text]  
• Hourihane, J. O. (2006). Are the dangers of childhood food allergy exaggerated?. BMJ 333: 496-498 [Full Text]  
• Knowles, R. L., Smith, A., Lynn, R., Rahi, J. S., on behalf of the British Paediatric Surveillance U, (2006). Using multiple sources to improve and measure case ascertainment in surveillance studies: 20 years of the British Paediatric Surveillance Unit. J Public Health (Oxf) 28: 157-165 [Abstract] [Full Text]  
• Reading, R (2005). Managing medication in schools. Arch. Dis. Child. 90: 1253-1255 [Abstract] [Full Text]  
• Baral, V R, O'B Hourihane, J (2005). Food allergy in children. Postgrad. Med. J. 81: 693-701 [Abstract] [Full Text]  
• Hu, W, Kerridge, I, Kemp, A (2005). Risk, rationality, and regret: responding to the uncertainty of childhood food anaphylaxis. Med. Humanities 31: 12-16 [Abstract] [Full Text]  
• Roberts, S (2005). Challenging times for food allergy tests. Arch. Dis. Child. 90: 564-566 [Full Text]  
• Hu, W., Kemp, A., Kerridge, I. (2004). Making clinical decisions when the stakes are high and the evidence unclear. BMJ 329: 852-854 [Full Text]  
• Velissariou, I, Cottrell, S, Berry, K, Wilson, B (2004). Management of adrenaline (epinephrine) induced digital ischaemia in children after accidental injection from an EpiPen. Emerg. Med. J. 21: 387-388 [Full Text]  
• Rosenthal, M (2004). How a non-allergist survives an allergy clinic. Arch. Dis. Child. 89: 238-243 [Abstract] [Full Text]  
• Clark, A T, Ewan, P W (2004). Food allergy in childhood. Arch. Dis. Child. 89: 197-197 [Full Text]  
• McLean-Tooke, A. P C, Bethune, C. A, Fay, A. C, Spickett, G. P (2003). Adrenaline in the treatment of anaphylaxis: what is the evidence?. BMJ 327: 1332-1335 [Full Text]  
• Colver, A F, Macdougall, C, Cant, A (2003). Food allergy in childhood. Arch. Dis. Child. 88: 742-743 [Full Text]  
• Sampson, H. A. (2003). Anaphylaxis and Emergency Treatment. Pediatrics 111: 1601-1608 [Abstract] [Full Text]  
• Al-Muhsen, S., Clarke, A. E., Kagan, R. S. (2003). Peanut allergy: an overview. CMAJ 168: 1279-1285 [Abstract] [Full Text]  
• (2003). Injectable adrenaline for children. DTB 41: 21-24 [Abstract] [Full Text]  
• Clark, A T, Ewan, P W (2003). Food allergy in childhood. Arch. Dis. Child. 88: 79-81 [Full Text]  
• Marcovitch, H. (2003). Atoms. Arch. Dis. Child. 88: 1-1 [Full Text]  

eLetters:

Read all eLetters

How dangerous is food allergy?

Jane Salter, et al.

ADC Online, 29 Apr 2002 [Full text]

The importance of managing food allergy among children

David M Reading

ADC Online, 7 May 2002 [Full text]

Incidence of Severe and Fatal Reactions to Foods

S Allan Bock, MD, et al.

ADC Online, 3 Jul 2002 [Full text]

Authors reply

Allan F Colver

ADC Online, 18 Jul 2002 [Full text]