“Cow’s milk is increasingly being identified as an allergen to fatal food reactions, and is now the most common cause of fatal anaphylaxis in children,” writes Alessia Baseggio Conrado, PhD, a biochemist from the National Heart and Lung Institute at Imperial College London, United States. Kingdom, and colleagues. “Further education is needed to highlight the specific risks that cow’s milk poses to allergic people to raise awareness among the food business.”
While recognition of the risks posed by peanut allergies has increased, people think dairy allergies are mild, says senior author Paul. J. Turner, BM BCh, PhD, allergist / immunologist at Imperial College. “This often occurs in very young children, but school-age children who still have a milk allergy tend to have a larger allergy profile, often with other allergies, including asthma, “Said Turner Medscape Medical News. “Additionally, milk is very common in our diet, and you don’t need a lot of milk to reach a decent dose of allergens.”
During the study period, 101,891 people were hospitalized for anaphylaxis; 30,700 cases (30%) were coded as being triggered by food.
This food-related income showed an increase from 1.23 to 4.04 per 100,000 population per year, with an annual increase of 5.7% (95% CI, 5.5 – 5.9; P. <0.001), write the authors.
The greatest jump was among children under 15, whose enrollment increased from 2.1 to 9.2 per 100,000 population per year, an annual increase of 6.6% (95% CI, 6.3 – 7.0) . The annual increase was 5.9% (95% CI, 5.6 – 6.2) among people aged 15 to 59 years and 2.1% (95% CI, 1.8 – 3.1) among people those aged 60 years and over.
Researchers used data from England, Scotland, Wales, and Northern Ireland to track temporal trends and age and sex distribution for admissions to hospital admissions whose primary diagnosis was anaphylaxis due to food and non-food triggers. These data are compared with nationally reported deaths.
Over a 20 year period, 152 deaths were associated with possible food-induced anaphylaxis. During that time, the case fatality rate for confirmed fatal food anaphylaxis fell from 0.7% to 0.19% (rate ratio, 0.931; 95% CI, 0.904 – 0.959; P. <0.001) and fell to 0.30% for suspected fatal food anaphylaxis (rate ratio, 0.970; 95% CI, 945 - 0.996; P. = 0.024).
Between 1992 and 2018, at least 46% of all anaphylactic deaths were thought to be triggered by peanuts or tree nuts. Among school-aged children, 26% of deaths from anaphylaxis are caused by cow’s milk.
Not surprisingly, during the study period, there was a 336% increase in prescriptions for adrenaline autoinjectors. Such prescriptions increase by 11% per year.
The data extends the findings of Turner and colleagues reported for England and Wales in 2014 about the entire population of England and in line with epidemiological trends in hospital admissions for anaphylaxis in the United States and Australia.
The investigators say better recognition and management of anaphylaxis could partially explain the reduction in mortality, but the increase in hospitalizations remains confusing. “Whether an actual increase in the prevalence of anaphylaxis has occurred (rather than a decrease in the threshold for admitting patients with anaphylaxis) is unclear due to a lack of evidence for an increase in the prevalence of food allergy in the UK (and elsewhere) over the same time period,” they wrote.
Ronna L. Campbell, MD, PhD, an emergency doctor at the Mayo Clinic in Rochester, Minnesota, has noted a similar trend in the United States. “Perhaps the introduction and diagnosis of anaphylaxis has increased, so the drug administration is earlier epinephrine, “Said Campbell Medscape Medical News. “So, as cases increased, earlier recognition and treatment resulted in reduced mortality.” He is not aware of any new guidelines recommending increased hospitalizations that would explain the confusing increase in admissions.
According to the study authors, the clinical criteria used to diagnose anaphylaxis in the UK did not change during the study period. Although national guidelines recommend that hospitalization of children under 16 years of age suspected of having anaphylaxis were introduced in 2011 and may have increased patient admissions, the year-over-year rate of increase has persisted since 2014. “Therefore the increase over the past five years cannot associated with the impact of the guide, “they wrote.
The study was funded by grants from the UK Medical Research Council and the UK Food Standards Agency. Two co-authors have disclosed financial links to industry outside of the jobs that are sent. Conrado did not disclose the relevant financial relationships.
BMJ. Published online February 17, 2021. Full text
Diana Swift is a medical journalist based in Toronto.