Fatal/severe allergic reactions to food ingestion
This study took place from March 1998 to February 2000. It aimed to estimate the incidence of fatal and very severe allergic reactions to food in children. To describe the circumstances in which these reactions occurred and describe the clinical course and management of these cases. Additionally, the study wanted to determine whether such children had previous reactions and whether the severity of these previous reactions predicted later severe reactions.
Lead investigator
Dr C F Macdougall
About the study
Several studies (at the time of surveillance) suggested that allergic reactions to foodstuffs in children may have become more common.
Some of these studies used proxy measures such as skin prick tests and radioallergosorbent test (RAST) levels. Other studies used weak methods. These studies used imprecise case definitions, restricted case ascertainment to those referred to a clinic or made comparisons with unreliable historical data.
Some reactions to food were very severe or even fatal. Little evidence existed about the incidence of such severe reactions at the time. Case series suggested fatal allergic reactions in children under eight were extremely rare. No population-based studies existed in the United Kingdom or North America. A preliminary search by the Office of National Statistics (ONS) revealed only one death of a child from an allergic reaction in England and Wales in 1993 and 1994.
Most paediatricians had no experience with a case of a very severe reaction. There may have been a gross mismatch between the perceived risks and the actual incidence of severe allergic reactions.Despite the absence of reliable data, prescriptions of adrenaline (in the form of inhalers or auto-injection devices) became more common, the assumption being that it may have saved lives and/or prevented severe symptoms.
There was uncertainty as to whether adrenaline was life-saving. If it was assumed that it might help, there were disadvantages to using adrenaline, including:
- Potentially dangerous side effects if administered on an ‘if in doubt, give it’ basis. These side effects may have been more dangerous than the possible allergic reaction.
- Teachers were anxious about having to decide when to administer adrenaline. They would need special training, which required reinforcement each year.
- The prescriptions had the potential to be needed for life.
- Although relieving parental anxiety in situations where there was considerable risk, prescribing adrenaline may have created unnecessary anxiety if the risk had been exaggerated.
Objectives
- To estimate the incidence of fatal and very severe allergic reactions to food in children.
- To describe the circumstances in which these reactions occurred.
- To describe the clinical course and management of these cases.
- To determine whether such children had previous reactions and whether the severity of previous reactions predicted later severe reactions.
Duration
March 1998 – February 2000
Published papers
Macdougall CF, Cant AJ, Colver AF. How dangerous is food allergy in childhood? The incidence of severe and fatal allergic reactions across the UK and Ireland. Arch Dis Child. 2002 Apr;86(4):236-9. doi: 10.1136/adc.86.4.236. PMID: 11919093; PMCID: PMC1719140.
BPSU 14th Annual report 1999-2000
Support Group
Anaphylaxis Campaign
Web: https://www.anaphylaxis.org.uk Email: info@anaphylaxis.org.uk