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Preventing food allergy fatalities
  1. Ru-Xin Foong1,2,
  2. Nandinee B Patel3,
  3. Paul Turner3,4,
  4. Graham C Roberts5,
  5. Adam T Fox1,2
  1. 1 Paediatric Allergy Department, Evelina London Children's Hospital, London, UK
  2. 2 Department of Women and Children’s Health, King's College London, London, UK
  3. 3 Section of Paediatrics, Imperial College London, London, UK
  4. 4 Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
  5. 5 University Child Health, Southampton University Hospitals NHS Trust, Southampton, UK
  1. Correspondence to Professor Adam T Fox, Paediatric Allergy, Evelina London Children's Hospital, London, SE1 7EH, UK;{at}


Fatal anaphylaxis to food is thankfully rare, but every death is a potentially avoidable tragedy. Usually, there will be a coronial inquest to establish the ‘how and why’ for each death. Reviewing these food allergy-related deaths identifies a number of common themes and risk factors. While some are non-modifiable (such as age, gender and ethnicity), others are and include delayed epinephrine administration and communication difficulties in allergen avoidance. This review highlights the key messages in food allergy-related fatality prevention for healthcare professionals and patients alike, and where available, we explain the evidence behind such recommendations. We describe the data behind the good practice points to facilitate their adoption in routine practice without generating additional anxiety for what is a comparatively rare event. We also propose an information leaflet for patients and carers, developed with patients and endorsed by two major allergy charities, to facilitate dissemination of the recommendations in this review.

  • Allergy and Immunology
  • Paediatrics
  • Paediatric Emergency Medicine

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  • R-XF and NBP contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PT reports grants from the UK Medical Research Council, NIHR/Imperial BRC and J.M. Charitable Foundation and personal fees from UK Food Standards Agency, Aimmune Therapeutics, Allergenis and Aquestive Therapeutics, outside the submitted work. GCR has received consultant fees from ALK-Abello, Viatris, DBV and AstraZeneca. ATF is a member of the Indedendent Drug Safety Monitoring committee for 2 ALK-Abello commercial trials and has received consultancy fees from Aimmune, GS1 and LG.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.