Food allergy-related hospital admissions on the rise, but fewer deaths

Hospital admissions for food-induced anaphylaxis have risen three-fold in 20 years – while fatalities have fallen.

A study published in the BMJ, which was part funded by the Food Standards Agency, analysed 101,891 hospital admissions for anaphylaxis across the UK. It found that 30.1% were coded as due to a food trigger. Between 1998 and 2018, food anaphylaxis admissions increased from 1.23 to 4.04 per 100,000 population per year. The greatest increase was in children under 15: from 2.1 to 9.2 per 100 000 population per year.

Deaths from food anaphylaxis fell slightly over the 20 years. Researchers added data from 1992-98 to identify triggers in fatal cases, and found cow’s milk responsible for 26% of deaths in children under 16. For adults, nuts were the most common identifiable trigger (23% of deaths).

Dr Hazel Gowland, one of the study’s authors and director of Allergy Action, highlighted milk allergies as an area of concern. “A quarter of children who died from food anaphylaxis had a reaction to milk. Milk contamination is a growing problem because it’s cheap and ubiquitous. This is a key message for both food businesses and inspectors,” she said.

The Natasha Allergy Research Foundation (NARF) welcomed the analysis, but said that it captured only part of the problem. “It may be an underestimate – the lack of allergy specialists means that anaphylaxis is being underdiagnosed and underfollowed up; hence anaphylactic deaths, all of which are preventable,” said Professor Sir Stephen Holgate, Professor of Immunopharmacology at Southampton University and a trustee of NARF.

“This study only looked at UK hospital admissions and we know that many people who experience a severe food allergy will be treated as an outpatient in A&E. Therefore, the true toll of severe and life-threatening food allergies in the UK is likely to be much higher especially since anaphylaxis masquerades as other clinical conditions such as asthma, angioedema and urticaria (hives).”

Gowland said the rise in hospitalisations could be “partly because there’s more awareness and also possibly more caution: for example, as reactions can be unpredictable, patients or carers might want to be sure all symptoms have been controlled. I think a lot of that is due to increased awareness of allergy.”

She pointed out that at around 4 per 100,000 population per year, food-induced anaphylaxis admissions are still rare. “Picking up these cases is not easy because they are rare but some EH officers are doing fabulous work, especially in partnership with trading standards, coroners and the police. It’s important that EH teams are ready to collect timely evidence including details of symptoms, timings and food samples, and notifying food and health authorities in the same way they would for food poisoning.”

A formally supported register of food-related anaphylaxis deaths and near-misses – which CIEH is calling for – would help assess and collate that information, and enable it to be shared easily among organisations that need it, including local authorities and researchers.

“Allergic reactions are unpredictable and only by listening and recording carefully what happened with timings, labels, food samples and information about symptoms and treatment will we get a better understanding of whether or how food was involved. This will inform food allergic people, food businesses, clinicians and regulators, reduce risks and ensure better public protection. ”

An FSA spokesperson said: “This important FSA-funded research will help us understand more about severe food-induced allergic reactions and provides valuable data to inform our campaigns and policy making.

“It is able to show who is most at risk, which types of food are responsible and how this is changing over time.

“As a result, our upcoming campaign will be encouraging young people, who are most at risk, to always ask for allergen information when ordering food.”

Look out for our feature on calls for an allergic reactions register in the March issue of EHN (login required).