"Everyone's Gone Nuts" -- A doctor responds to the Harper's Magazine article

Statistical information on deaths caused by food anaphylaxis is reliant on appropriate coding, interpretation of death certificates, and the correct diagnosis of cause of death (Neugut et al. ARCH INTERN MED/VOL 161, JAN 8, 2001) .

Even with imperfect methods of data collection and reporting, it is clear from the existing studies that food-related anaphylaxis is a real and growing global issue.

The European Academy Of Allergology And Clinical Immunology recently published a position paper on the management of anaphylaxis in childhood. In this paper, they review several studies supporting an increase in cases of anaphylaxis in North America and Europe. They reference studies that support an increase in anaphylaxis and food allergies in the United Kingdom and Canada.

In looking at the literature, it is clear that food-induced anaphylaxis is very real.

These studies have additionally shown us what risk factors are associated with death:

• delayed epinephrine administration
• being an adolescence or young adult
• asthma
• peanut allergy
• tree nut allergy
• prior minor reactions
• not asking about ingredients when dining out (Bock at al. Journal of Allergy and Clinical immunology. V119 (4) 1016-1017)

The studies have also shown us what we can do to prevent these tragedies.

SM: Ms. Broussard implied that FAAN's medical board and advising doctors are in some way colluding to disseminate exaggerated evidence. Do you know anything about FAAN's studies' objectivity?

MP: FAAN's medical board and advising doctors are many of the leaders in food allergy and academic allergy and have been responsible for many of the studies leading to information that has dispelled fear and has increased patient safety. The studies published by these authors have been in well respected, peer reviewed journals which are scrutinized by other allergists and experts in the field prior to their publication. This identical process goes for studies that have received funding by FAAN. This process leaves little room for the dissemination of confabulated or manipulated data for self gain.

SM: Ms. Broussard wrote, "...exaggerating the threat may actually do as much harm as the allergies themselves. The peril is now perceived as so great that psychosomatic reactions to foods and their odors are not un-common". Are you seeing this in your practice?

MP: I have experienced fear first hand while watching my own child have a severe, life threatening allergic reaction and not having the appropriate medication that could save his life. After my son recovered and my family had time to process what had happened we put into place well thought-out strategies, based on existing literature, to attempt to prevent this from happening again (avoidance strategies) and in the event that it did, a treatment plan to save his life (allergy action plan and epinephrine). Although we have a healthy respect for his allergy and are vigilant we are no longer afraid.