New studies suggest that airway and breathing failures are the primary causes of death in childhood food anaphylaxis, requiring a shift in emergency management protocols.
RT’s Three Key Takeaways:
- Respiratory Failure Focus: Analysis of fatal food anaphylaxis cases in children revealed that lung failure was the primary cause of death in nearly all instances, suggesting a need to prioritize airway management over circulatory issues.
- Adrenaline Administration Delays: Research indicates that many fatal outcomes are linked to delays in administering adrenaline or a lack of access to adrenaline auto-injectors during the critical minutes following exposure.
- Increasing Allergy Prevalence: Hospital admissions for pediatric food allergies have risen by 600% over the last two decades, highlighting an urgent need for updated clinical guidelines and improved pre-hospital care.
Fatal food-induced anaphylaxis in children is strongly associated with airway and breathing compromise, according to research presented at the Royal College of Emergency Medicine Conference. Researchers from the University of Bristol and Bristol Children’s Hospital analyzed data from the National Childhood Mortality Database (NCMD) to identify interventions that could prevent future fatalities.
The research examined 19 deaths occurring between 2019 and 2023. In an analysis of 17 cases where the specific bodily system failure could be identified, lung failure was the primary cause of death in 16 instances. These findings suggest that current National Health Service (NHS) guidelines, which focus on heart and circulatory failure, may not prioritize the most frequent cause of death in pediatric food anaphylaxis.
“Anaphylaxis from a food allergy is a life-threatening emergency requiring immediate adrenaline,” said Tom Roberts, academic clinical lecturer in emergency medicine at Bristol Medical School and an emergency clinician, in a news release. “While EpiPens work quickly to reverse symptoms by reducing swelling and opening up airways, our research reveals that in many cases, children did not receive enough adrenaline before cardiac arrest, and some didn’t carry an adrenaline autoinjector (AAI) at all.”
The study emphasized that there is a very short window of time, often just minutes, in which treatment can alter the clinical course of an allergic reaction. Delays in delivery, or the failure to administer a second dose when necessary, can result in fatal consequences.
“Our research also found that airway and breathing problems were the most common causes of fatal food-related anaphylaxis in children,” said John Covney, lead author from Bristol Children’s Hospital, in a news release. “NHS guidelines currently focus on heart and circulatory failure in emergency management, our findings suggest that the focus should be on breathing issues, which were by far the most frequent cause of death in the cases we analysed.”
The findings align with Australian research also presented at the conference. Experts noted that healthcare workers must prioritize getting oxygen into the body during these emergencies.
“We need to promote the chain of survival in anaphylaxis – get help, give adrenaline, and for healthcare workers – get oxygen into the body as a priority,” said Ben McKenzie, emergency medicine doctor from the University of Melbourne, in a news release.
The urgency for updated guidelines is underscored by a 600% increase in hospital admissions for food allergies in children over the past 20 years. Additionally, a study published in The Lancet indicated that food allergy rates doubled between 2008 and 2018, with a significant rise in childhood cases.
“Every child’s death is a profound loss,” said Karen Luyt, programme director for the National Child Mortality Database, in a news release. “By learning from every child death, we can identify where systems, services, and support need to be improved to protect children’s lives.”
