Sep. 1, 2006 Two child health experts go head to head in this week’s BMJ over whether the dangers of childhood food allergy are exaggerated.
Professor Allan Colver from the University of Newcastle upon Tyne believes that the dangers are overstated, and that the increasing prescription of adrenaline injector kits fuels anxiety rather than saving lives.
Food allergy is often thought to be more dangerous and frightening than pneumonia, asthma, or diabetes, he writes. In reality, the risk of death is very small. Eight children under 16 years died from food allergy between 1990 and 2000 in the UK. That is one death per 16 million children each year. Yet childhood food allergy is being diagnosed more often and the number of prescribed adrenaline kits has greatly increased.
A diagnosis of food allergy creates much anxiety for all who care for the child, so it is important to get the diagnosis right, take sensible measures to reduce risk, and reassess regularly to check whether the child has grown out of their allergy, he says.
It is unclear what proportion of children with food allergy should be prescribed an adrenaline kit. The main argument in its favour is that reactions are best treated within a few minutes rather than waiting for medical assistance. But Colver suggests that they cause unnecessary anxiety, may not prevent death, and should be prescribed only when a diagnosis of food allergy has been confidently established.
The dangers of food allergies are not exaggerated, argues Professor Jonathan Hourihane from University College Cork, Ireland. Food allergy is common – 2% of adults and up to 6% of preschool children are affected and, although deaths are rare, other reactions are almost inevitable over time.
No tests are available to predict who will or will not have a severe allergic reaction, so management consists of empowering patients and providing rescue drugs. Delay in use of these drugs is associated with a worse outcome in severe reactions.
Proper management in allergy clinics means that most patients never have to use these drugs, but it is wrong to say that they are not needed, he says. Nobody is advocating “more general use” of adrenaline. What is advocated is increased availability of adrenaline kits for people who might need to use them. They should not be withheld because of the medical uncertainty surrounding allergy.
Food allergy is here to stay, he writes. The disease is a killer (though rarely); it can erode or inhibit normal formative experiences in childhood, and it impairs a child’s quality of life. Let’s get allergy services out of the academic centres and into the community, which is where food allergy is really “dangerous,” he concludes.
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