Food Allergy Deaths: Less Common Than You Think

In her December 8 New York Times article, "Researchers Put a Microscope on Food Allergies," Karen Ann Cullotta cites a statistic commonly used in articles about food allergies: "Up to 200 deaths each year are attributed to the most severe reaction, food-induced anaphylaxis," she writes. A similar statistic appears in Nicholas A. Christakis' recent British Medical Journal article, "This Allergies Hysteria is Just Nuts," which is referenced in the Times' "Well" blog today. Dr. Christakis writes in the BMJ that "Only 150 people (children and adults) die each year from all food allergies combined." Having seen these statistics used over and over again in the media and the medical literature, I wondered: how many people really die of food allergies? 150 or 200? As it turns out, the real number of food allergy deaths is much smaller: just 11. The 150-200 death estimate comes from the media resource kit of the Food Allergy and Anaphylaxis Network, a lobbying and educational group headed by a former marketing executive at Dey Pharmaceuticals, the maker of the EpiPen adrenaline injector (which is prescribed to millions of food-allergic patients). It's time for journalists and doctors to stop using FAAN's exaggerated statistic.

We don't need to rely on estimates for numbers of food allergy deaths because we have actual data. Since about 1998, the Centers for Disease Control (CDC) have been tracking the number of food allergy deaths just as they track all the other causes of death across the United States. When someone dies in the US, his death certificate data is pumped into a massive database and indexed according to the 10th revision of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-10), a standardized system developed by the World Health Organization. ICD-9, the previous standard, did not have a code for food allergy deaths, but now we have solid data for almost ten years. The underlying number of food allergy deaths according to ICD-10 codes isn't publicly available in CDC databases because it is so small--statistically insignificant, according to the CDC. A call to the CDC press office revealed that the number of deaths from food allergies, as collected from 2.5 million death certificates across the country, is miniscule. Only eleven people died from food allergies in 2005, the last year for which we have data available. More people died from lawnmower accidents.

FAAN justifies its exaggerated estimate by citing a 1999 article from the Journal of Allergy and Clinical Immunology called "Epidemiology of Anaphylaxis in Olmsted County: A Population-Based Study." Deaths from anaphylactic shock are quite rare--so rare that the Olmsted County study is one of the very few studies that provides any rough numbers suggesting prevalence.

The study gives us useful data on the potential prevalence of anaphylaxis, meaning a severe or multi-system allergic reaction. It does not give us very good data on anaphylactic shock, the most severe consequence of anaphylaxis. Not a single person in the Olmsted County study died from food allergies. Of the 133 Olmsted County residents who had allergic reactions over the course of five years, and furthermore out of the six people admitted to the hospital for allergic reactions, not a single person died of anaphylactic shock subsequent to a food allergy.

Only one person in the Olmsted County study died. The cause of death: his throat swelled up while exercising. Yet we see schools calling for bans on peanuts, not gym class--even though, as Dr. Christakis points out in his BMJ article, about 10,000 children are hospitalized each year for sports-related traumatic brain injuries.

The flawed food allergy death statistic has been questioned, investigated and debunked in articles published in Forbes, Child, the New York Times, and in a piece I wrote for Harper's earlier this year. I understand why the inflated number persists: 200 annual deaths make food allergies seem like a terrifying potential health crisis. Health crises attract research dollars. Pharmaceutical firms can profit substantially from health crises: concerned parents are happy to buy a device like an Epi-Pen (and renew the prescription every six months for the next twenty years) if it means preventing a child coming to harm. But our world is already terrifying enough. Do we really need to exaggerate the threat of a health condition as manageable as food allergies?

The time has come to stop using FAAN's wildly exaggerated estimate of food allergy deaths. Food allergies are real, and certainly deserve respect and research, but stretching the truth about food allergy deaths creates unnecessary anxiety and fear for everyone. Especially those of us with food allergies.

Comments

[loular]

Okay...I'm getting sick of this tone. And it's pretty annoying, but not nearly annoying as Joel Stein's idiotic, poorly written piece called "Nut Allergies -- a Yuppie invention.­" (Yuppie? People still use this word? Wow. Like docksiders? ha. funny.)

And then there's Ms. Broussard's only slightly more polished piece here on Huffington Post, suggesting that anyone who carries an Epi Pen is only doing so as an "accessory?" Like, what? Using a walker is just a ploy for sympathy? Right.

Nice. So, once again in the media people are not only taking down the subject of food allergies as not worthy of respect, they are actually being called pretentious for taking the only proven cure to combat fatal food reactions.

Nice. Again.

Anaphylaxis from food allergies are a huge problem. They are getting more and more common and nobody knows why. This is scary. And, therefore, I do realize it's hard to get one's brain around this fact, and rationalizing the validity of it being a really frightening reality is easier than, say, respecting it.

But -- it's easy to pick on an issue like "food allergies.­" They just sound stupid, I guess. And people often pick on issues and people who are "different" or inconvenient to care about. (Like having to feel worried about a favorite food! Oh, no.)

Well, pick on this issue, and you'll get an argument: Read more here.
http://louiselarsen.blogspot.com/2009/01/nut-allergies-yuppie-invention-as-if.html

[ainserro]

"....conce­rned parents are happy to buy a device like an Epi-Pen (and renew the prescription every six months for the next twenty years) if it means preventing a child coming to harm."
Actually, epinephrine prevents a child from coming to "death," not merely harm, and it is the only treatment for severe allergic reactions. Epinephrine should last for a year (not six months); and yes, I am happy to renew my prescription because we have used it four times in my son's five years.

"Do we really need to exaggerate the threat of a health condition as manageable as food allergies?"
Manageable for who, adults or children? You can advocate and manage yourself. A small child, especially one with multiple food allergies, cannot.

[music1]

As a school nurse and a mother of a child with a life threatening peanut allergy, I am offended by Ms Broussard's use of the phrase "only 11 deaths per year" as one of those deaths could very easily happen at the school I work at, and could also very easily be my daughter. Her life is valuable as is every life that has the potential to be lost through anaphylaxis related to food allergies. Minimizing the threat of death raises the risk to every child walking around with a life threatening allergy. I am fortunate enough to work in and have my child attend a school that takes these allergies seriously. She is provided a peanut free table, parents are alerted each year as to what snacks not to send in, and treats that are safe for her are kept in the classroom in the event that a treat is brought in that she can not have. Each and every life is a gift and special needs that they may have, especially ones that could be potentially fatal, should not be taken lightly.

[scottjh1012]

I can only assume that Meredith Broussard does not have any children, let alone a child with even a hint of a food allergy. The fact that it is stated in this article that "only 11" people die from food allergies is ridiculous. If there was only 1 it would still be a tragedy. This is not only a problem because of the deaths but also because the number of people with food allergies is growing exponentially. Think for a minute if you will about how difficult it is for a 5 year old to be in a school lunch room or in the classroom at a holiday party and have to be completely aware 100% of the time of what he is eating as well as the children around him. While at 5 years old knowing that if a child with a peanutbutter sandwich sitting next to him or a carton of spilled milk would send him into an anaphylaxic reaction that would cut off his breathing, cover him with hives and swell him from head to toe. I don't think there is anything exaggerated about that reaction or trying make people aware to keep everyone safe!

[jtolpin]

I don't care what number is used. ANY number above 1 death, is inexcusable. The number of 'potential deaths of school aged kids who could have a reaction to a food because the school is NOT being made safe for them', could never be determined.

[EileenMF]

I think it is very reasonable to examine whether our fears as parents are being fueled unnecessarily. Raising questions does not hurt education; it enhances it. This piece actually inspired me to write a related blog post at http://imperfectserenity.blogspot.com/2008/12/media-distortions.html

[JulieIFAEA]

Ms. Brossard should educate herself and read the data that the CDC just released this October wherein food allergies have doubled in the last 10 years, 29 per cent of food allergy sufferers have asthma and that 9500 children 18 and under were hospitalized for food allergy issues in 2004-2006. She should also familiarize herself with the data which indicates that teenagers and young adults are the most at risk and that age group does not consistently carry their epinephrine auto-injector. Ms. Brossard should also read the data from New York, Connecticut and Massachusetts which record how often a students in those states receive epinephrine. There is no national ad campaign to educate and remind the teenagers to carry their medicine. Articles like hers only make the job of those of us who are educating communities about food allergies more difficult. The Illinois Food Allergy Education Association uses studies to educate people on how to clean hands and tables of allergens, how a child might describe a food allergy reaction, and how anaphylaxis can manifest.

[ewolff]

Has the author of this article ever seen a child who is having a reaction and is having difficulty breathing? I am a school nurse and even if there was "only " one death from food allergies per year it would be too many if the reaction could have been prevented.­Watching a child having a reaction is awful! and thank heavens that Dey makes a product that is easy to administer to counteract a reaction. Thank heavens that they fund research into food allergies.

[ahugon]

As the mother of a child who spent THREE DAYS in bed last week, with horrible stomach & head pain, because someone near her ate a peanut butter cracker - one kid is too many.

I realize my child is the rarity. I realize that most people are not that sensitive. I realize that many people don't react to simply smelling the allergen.

That doesn't mean my child is irrelevant, unimportant, or unnecessary. I find the article offensive. The number of appropriate deaths from anaphylaxis should be zero.