Patients at risk of severe allergic reactions ‘do not have adrenaline pens’

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A third of people in England who have experienced a severe allergic reaction to food are not carrying live-saving adrenaline pens, analysis shows.

Prescriptions for adrenaline auto injectors (AAIs) – devices given to those who are at risk of life-threatening reaction (anaphylaxis) – are also less common for people living in more deprived areas of the country, researchers from Imperial College London found.

The study, published in the journal The Lancet Public Health, showed that between 2008 and 2018, only 975 of 1,524 children and young people and 1,346 of 2,456 adults had AAI prescriptions.

Dr Paul Turner, professor of paediatric allergy at Imperial College London’s National Heart & Lung Institute, who led the research, said there is an “urgent need” to “better support GPs and primary care staff” to care for patients at risk of severe food allergy.

He said: “The most surprising finding is that 90% of patients are only looked after by GPs.

“That means we need to make sure that staff working in primary care have the training and resources to provide the best care and advice to people with food allergy.”

Food allergy occurs when the immune system overreacts to certain foods, such as cows’ milk, peanuts, eggs or shellfish.

In severe cases it can lead to anaphylaxis, which can cause swelling of the airways, breathing difficulties and cardiac arrest if not treated urgently.

AAIs, which contain a fixed dose of adrenaline, are prescribed to people with allergies who are at risk of anaphylaxis.

For the study, the team used data from GP practices in England covering 13 million patients.

They found the number of people with food allergy more than doubled during the 10-year period, from 76 cases per 100,000 people in 2008 to 160 cases per 100,000 people in 2018.

The largest increase was seen in preschool-aged children, with 4% of under fives having some form of food allergy in 2018.

Food allergy prevalence in children aged five to nine was 2.4%, for 15 to 19-year-olds was 1.7% and 0.7% for adults in 2018, data showed.

These rates are likely representative of the UK, the researchers said.

But data also suggests that newly-diagnosed cases of food allergy may be levelling-off in some age groups, although it is unclear whether this might be due to changes in infant feeding guidelines, the researchers said.

Prof Turner said the analysis “paints an important, if mixed, picture of food allergy in the UK”.

He added: “The good news is that while the prevalence of food allergy has increased, the numbers of new cases occurring each year look to have plateaued.

“However, more than one-third of patients at risk of severe reactions do not carry potentially life-saving rescue adrenaline autoinjectors, like EpiPens.”

Commenting on the study, Nadim Ednan-Laperouse, co-founder of The Natasha Allergy Research Foundation, the UK’s food allergy charity, who was not involved, said the research confirms there has been “an exponential rise” in the number of people with food allergies.

He said: “It is shocking and alarming to discover that more than a third of people who have experienced anaphylaxis – the most severe allergic reaction – have not been prescribed an adrenaline auto-injector (AAI), and the poorest in society are less likely to have prescriptions of this life-saving medicine.

“This is totally unacceptable, and will inevitably put lives at risk.

“Anyone who has a serious food allergy should carry two AAIs with them at all times.

“It is also worrying that so few people with a food allergy receive specialist hospital allergy care.

“Again this is unacceptable and we need urgent Government action to address these gaps in care to prevent avoidable ill health.”

Amena Warner, head of clinical services at Allergy UK, who was not involved in the research, said: “There has been a lot of data over the years which looks at rates of food allergies and related anaphylaxis episodes at hospital admission level.

“However, there has been limited robust data on the incidence and prevalence of food allergies which paints a complete picture of the burden of food allergy, so the data from this study is long overdue and very welcomed.

“Although this study is limited to England, the data evidences why there is a need for improved access to specialist allergy knowledge at primary care level, a call Allergy UK has been making for over a year now.”

She said it was worrying that the data shows there are low prescription rates for life-saving adrenaline for people who have previously experienced anaphylactic episodes, adding that more needs to be done to better understand why there is a disparity in allergy care in more deprived areas.