• food allergy

We thank Colver, MacDougall, and Cant for their response to our paper.¹ The message underpinning our paper was that severe allergic reactions to foods are not as uncommon as MacDougall et al suggested.² However, we are not comparing like with like and the problem lies in the definition of a severe food reaction. MacDougall et al only identified the extreme end of the clinical spectrum (children who have suffered cardio-respiratory arrest, received at least two doses of epinephrine (adrenaline), a fluid bolus, inotropic support, or at least two doses of nebulised bronchodilator—all unvalidated and unreferenced outcome measures). Having set the threshold for inclusion so high, it is hardly surprising that the incidence of this extreme outcome is so low. What was the authors’ purpose in identifying this extreme population? If it was reassurance about the low incidence of life threatening reactions, then it should be appreciated that in a recent American series,³ 8/10 children who died of food allergy had previously reacted to the food that caused the fatality. Also, in a UK survey, 21/92 (23%) of peanut allergic patients with a history of a …