Surge in food allergies sparks call for better GP training

Researchers from Imperial College London (ICL) have published a new analysis revealing that the number of people living with food allergy in the UK has more than doubled since 2008.

The analysis, published in the journal Lancet Public Health, found that the number of people living with food allergies in England has increased significantly between 2008 and 2018, with the largest increase seen in young children.

The total estimated prevalence of food allergy in the UK increased from 0.4% to 101% from 2008 to 2018, researchers found. The estimated new cases of probable food allergy in the UK doubled in that period, from 76 cases per 100,000 people in 2008 to 160 cases per 100,000 people in 2018.

The highest prevalence of food allergy was seen in children under the age of five (4%). School-aged children had a lower prevalence (2.4% for children aged five to nine, and 1.7% for 15 to 19-year-olds), while adults had the lowest prevalence (0.7%).

Researchers also highlighted that many patients who have severe reactions to food allergies (known as anaphylaxis) were not prescribed “adrenaline autoinjector (AAI) ‘pens’”, also known as EpiPens, which can save their lives.

The authors of the analysis added that there is an “urgent need” to make sure GPs and other primary care staff receive adequate training and support to care for people at risk of severe food allergy.

Dr Paul Turner, professor of paediatric allergy at the National Heart and Lung Institute at ICL, who led the research, said: "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 lifesaving rescue adrenaline autoinjectors, like EpiPens.

"We urgently need to address this, and better support GPs and primary care staff who end up looking after the vast majority of food-allergic patients in the UK."

‘We have a long way to go’

Commenting on the analysis, Hannah Whittaker, specialist dietitian and expert in milk allergy, tells Yahoo UK: "Working as a dietitian in the NHS and also privately I can relate to the findings within this paper.

"I have seen a rise in allergies within my clinical practice - however, there still needs to be better provision for allergy within primary care as the children I see have been frequently misdiagnosed or there hasn't been correct follow-up which can impact quality of life and also tolerance in the future. This is more so the case with non-IgE allergy where a food challenge would need to be completed and can be done at home."

The researchers at ICL suggested that the incidence of new cases may have slowed, in part because of changes in guidelines on what to feed infants. The guidelines no longer recommend delaying the introduction of foods like peanut into a baby’s diet.

A recent study found that introducing children to peanuts from infancy is crucial to reduce the rate of an allergy developing in later life. Until 2008, parents were told to avoid giving children peanut products and other foods that may trigger allergic reactions, but the new research reveals that children actually benefit from being exposed from an early age.

Whittaker says: "We were previously advised of late introduction of common allergen foods, however a landmark study LEAP and EAT have changed this advice. Parents are now advised on early introduction which has been shown to reduce allergy rise, more so with egg and peanut."

She added: "As allergy is becoming more prominent, I would suggest that it can also be misdiagnosed due to increased awareness as there are some overlapping features which can be common in infants - functional gastrointestinal disorders such as colic, reflux and change in bowel habits. Appropriate and timely follow-up is essential to ensure correct diagnosis.

"From practice and private work I can see how GP knowledge can be poor and I am aware that training within allergy is now starting to be embedded in university programmes however we still have a long way to go.

"At present I am working on education of GPs as this will look to enhance patient experience, primary care knowledge but also streamline pathways."

Food allergy deaths in the UK

It comes after several deaths caused by food allergies in the UK. Last year, 13-year-old Hannah Jacobs died within hours of taking a sip of a hot chocolate from Costa due to her severe dairy allergy.

An inquest concluded earlier this month that Jacobs died after a "failure to follow the processes in place to discuss allergies" and a "failure of communication" between her mother and the staff at the Costa Coffee branch in Barking, east London, where the hot chocolate was purchased from.

Jacobs’ mother, Abimbola Duyile, is calling on the government to raise awareness about how EpiPens. She told BBC Breakfast: "If we can get the government at least [to] let people know the symptoms of someone having an allergic reaction, it will be amazing. They can save a life.

"Teach everybody how to use an EpiPen, whether it’s a kid or an adult."

In 2016, Natasha Ednan-Laperouse died at the age of 15 from an allergic reaction after eating a Pret A Manger baguette she purchased at Heathrow airport. The cafe franchise was found to have "inadequate" labelling on its products after Natasha’s father Nadim Ednan-Laperouse blamed it for failing to list ingredients, including sesame, which she was severely allergic to.

The incident led to the UK Food Information Amendment, also known as Natasha’s Law. It requires any foods pre-packed for direct sale to be labelled with the food name, full ingredients in descending order of weight, and allergens to be highlighted in bold.

Nadim, who co-founded the Natasha Allergy Research Foundation, told the Guardian that it was "shocking and alarming" that the research revealed more than a third of people who have experienced anaphylaxis have not been prescribed an EpiPen.

"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."

Dr Turner and Professor Adnan Custovic, also from the National Heart & Lung Institute at ICL, launched the Frankland-Kay Centre for Allergic Diseases, which is dedicated to advancing allergy research and reducing the impact of allergies on people and their families.

"Food allergy can have a huge impact on people’s lives, and in some tragic cases, can cut lives short. By better understanding the prevalence of food allergy in the UK and working with affected people, their families, scientists and clinicians, we are working together to reduce that impact," Dr Turner said.

Read more about health and allergies:

• Feeding your child peanuts from a young age can help reduce allergies later, new study claims (Yahoo Life UK, 5-min read)

• Your baby's eczema may be a sign they'll develop asthma and allergies in later life (Yahoo Life UK, 5-min read)

• What food should you introduce to babies to reduce the risk of intolerances and allergies? (Yahoo Life UK, 5-min read)