How dangerous is food allergy in childhood? The incidence of severe and fatal allergic reactions across the UK and Ireland
- 1Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK
- 2Paediatric Immunology and Infectious Diseases Unit, Newcastle General Hospital
- 3Northumbria Health Care Trust and University of Newcastle upon Tyne, Donald Court House, 13 Walker Terrace, Gateshead NE8 1EB, UK
- 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;
- Accepted 12 December 2001
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.
AC had the original idea for the study, and with CM, coordinated the study. All three authors were involved in study design, analysis, and writing of the paper.