Childhood food allergies exaggerated, expert argues

Prescribing adrenaline-injecting EpiPens tochildren with food allergies may be fuelling anxiety in parents unnecessarily, a child health expert says.

Pro/con commentaries in Saturday's issue of the British Medical Journal debate the question: are the dangers of childhood food allergy exaggerated?

Food allergy is thought to be more dangerous and frightening than pneumonia, asthma or diabetes.

In reality, the number of deaths is small, at less than one per year on average in the United Kingdom, and only some are preventable, said Newcastle University child health professor Allan Colver.

Media headlines such as "One bite and he dies" and prescriptions for epinephrine injections fuel anxiety, Colver said.

"Autoinjectors generate anxiety in children and carers, and they should be prescribed only when a diagnosis of food allergy has been confidently established," Colver concluded.

Parents should be told how and when to give the injections, but one survey found half of families questioned had expired adrenaline on hand, and two-thirds could not use the autoinjector properly.

Last week, a coroner in Quebec warned one EpiPen may not be enough to save people with severe allergies. The coroner's inquest wasfor a doctor who died after he was stung by a wasp,despite receiving one shot of adrenaline that was past its expiry date.

Kits useful

Jonathan Hourihane, a professor of pediatrics and child health at University College Cork in Ireland, defended the use of the kits.

"Nobody is advocating 'more general use' of adrenaline," Hourihane wrote. "What is advocated is increased availability of adrenaline kits for people who might need to use them."

There is no way to predict who will have a severe allergic reaction, but delay in use of the adrenaline is associated with worse outcome in severe reactions, the journal noted.

"Food allergy is here to stay. The disease is a killer, though rarely, but it can erode or inhibit normal formative experiences in childhood and it impairs quality of life, " Hourihane said.