Cow’s Milk Most Common Cause of Fatal Anaphylaxis in School Children

Dawn O'Shea

February 18, 2021

Cow’s milk is the most common cause of fatal anaphylaxis amongst school children in the UK, shows a study published in The BMJ.

The study included 101,891 people were admitted to hospital for anaphylaxis between 1998 and 2018. Of these, 30,700 (30.1%) were coded as due to a food trigger.

The data revealed that food anaphylaxis admissions increased from 1.23 to 4.04 per 100,000 population per year from 1998 to 2018, an annual increase of 5.7% (95% CI, 5.5%-5.9%; P<.001). The largest increase in hospital admissions was observed in children younger than 15 years, which rose from 2.1 to 9.2 admissions per 100,000 population per year, giving an annual increase of 6.6%. In comparison, the annual increase in people aged 15-59 years was 5.9% and was 2.1% in those aged 60 years and older.

Among deaths where the fatal event was probably caused by food-induced anaphylaxis, the case fatality rate decreased from 0.7% to 0.19% for confirmed fatal food anaphylaxis over the study period (rate ratio, 0.931; 95% CI, 0.90-0.96; P<.001).

In children, 14% of deaths were linked to peanuts and 9% were linked to tree nuts. However, the most common single cause of fatal anaphylaxis was cows’ milk, which was responsible for 26% of cases.

The authors said more education is needed to highlight the specific risks posed by cow’s milk to people who are allergic, to increase awareness among food businesses.

Commenting via the Science Media Centre Sir Stephen Holgate, professor of immunopharmacology, Southampton University and trustee, Natasha Allergy Research Foundation, said: "While we welcome this valuable analysis, the three-fold increase in anaphylaxis hospital admissions caused by food allergies over the past 20 years only captures part of the problem and 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."

He continued: "It is imperative that we understand the full scale of food allergies in the UK so that those with a food allergy can get the care they need to prevent unnecessary anaphylaxis and deaths.

"The introduction of a national register of anaphylaxis fatalities would provide this essential information."

Conrado AB, Ierodiakonou D, Gowland MH, Boyle RJ, Turner PJ. Food anaphylaxis in the United Kingdom: analysis of national data, 1998-2018. BMJ. 2021;372:n251. doi: 10.1136/bmj.n251 View full text

This article was adapted from Univadis, part of the Medscape Professional Network.

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