Third of patients at risk of severe allergic reaction 'don't have adrenaline pens'

One in three people in England who have suffered a severe food allergy are not carrying life-saving adrenaline pens, analysis reveals.

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 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 and 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.”

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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 allergies more than doubled from 2008 to 2018, 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 those under five 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.”

Nadim Ednan-Laperouse, co-founder of The Natasha Allergy Research Foundation, a UK food allergy charity, commented on the study, saying it confirms "an exponential rise" in the number of people with food allergies. He was not involved in the research.

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.

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