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Allergy is being seen more and more commonly. A recent review of accident and emergency admissions in England reported 415 anaphylactic cases (adults and children) from 100 000 referrals in 1991/92, but 876 in 1994/95.1 Death following anaphylaxis is most feared but fortunately remains a very rare event, currently estimated at less than one case per year per million of the UK population.2 There is always the instinct that these fatal incidents could and indeed should have been avoided or prevented, especially in children. A widely quoted North American study of 13 children and adolescents following fatal or near fatal food related anaphylaxis,3 concluded that “epinephrine should be prescribed and kept available for all children and adolescents with IgE mediated food allergies”. Applied literally, that is a huge number of cases. A telephone survey estimated a 1% prevalence for peanut allergy alone in the United States.4 Detailed review of data referred to above3 reveals that adrenaline had been prescribed for three of the six fatal cases of food related anaphylaxis and three of the seven non-fatal cases, but was only actually used in …
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