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.