HOW DANGEROUS IS FOOD ALLERGY IN CHILDHOOD? THE INCIDENCE OF SEVERE AND FATAL ALLERGIC REACTIONS ACROSS THE UNITED KINGDOM AND IRELAND
Macdougall C, Cant A, Colver A. Arch Dis Child. 2002;86:236–239
Purpose of the Study.
To evaluate the incidence of fatal and severe allergic reactions to foods in a large population of children.
A retrospective search for fatalities in children 0 to 15 years old from March 1990-February 1998 and a prospective survey of fatal and severe reactions from March 1998-February 2000 were performed.
Details of death certificates from the offices of national statistics were reviewed for fatal allergic food reactions via codes from the International Classification of Diseases, Ninth Revision (ICD-9), and inquiries were sent to pediatricians asking them to report on patients under 16 who died or were admitted to the hospital for an allergic reaction to food.
Eight children died in a population of 13 million children, yielding an incidence of 0.006 deaths per 100 000 children. Milk caused 4 of the deaths, peanut, 2; egg white, 1; and mixed food, 1. Two children died despite receiving early epinephrine before admission, and 1 child with a mixed food reaction died from an epinephrine overdose. Over the 2-year prospective period, there were 6 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 per year, respectively. All fatal cases and 5 of 6 near-fatal cases had a clear history of asthma. Those suffering the most severe reactions tended to have had severe previous reactions, but it was notable that in 2 of 3 fatal reactions and 5 of 6 near-fatal reactions, the previous event had not required urgent hospital treatment.
The finding of so few deaths in such a large population should reassure parents and doctors that the risk of death is small. The child with food allergy and asthma may be at particular risk. Although a previous mild reaction may not be as reassuring as had been thought, the absence of asthma may be. Early administration of epinephrine may not prevent death, and concomitant treatment for the asthmatic component of an allergic reaction may be very important.
Although the risk of death from food allergies may be small, parents and physicians should not be lulled into a false sense of security regarding the potential severity of adverse reactions to foods. Concomitant asthma places patients with food allergy at particular risk of a severe reaction. Although some foods more commonly cause severe reactions, it is important to note that any food theoretically can cause a severe life-threatening reaction, and the fact that milk caused more food-related deaths than peanut in this study emphasizes this point. The authors also mention that early epinephrine use may not prevent death, but it is still the general consensus that early and proper use of epinephrine in severe food reactions is associated with a better prognosis.