Incidence of severe and fatal reactions to foods * Authors' reply

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Abstract
Although the article by Macdougall et al 1 regarding the incidence of severe and fatal reactions to food would be seem to be reassuring, we would like to express some concerns and raise some questions about the data presented. The first question is whether the ascertainment of cases is really as complete as the authors suggest. We acknowledge that the UK medical system may allow better reporting and access to mortality data than that of the US. However, the records acquired as described seem to represent the same underreporting issues as those in the US. Is it really unlikely that the BPSU misses a significant number of cases? Based upon a well characterised population in Olmstead county Minnesota and extrapolating the data to a US population of 280 million, it may be estimated that there are 200 deaths from anaphylaxis reactions to food each year.2 A paper published in 2001, described methodology in which a National Registry had been established and was well publicised to US allergists 3 Very few reports were made by allergists and none by other physicians. No cases were initially reported by physicians who conduct research in food allergy. Nearly all the cases were ascertained from the press. These news articles appeared in local newspapers and were not reported in media with a large regional or national circulation. In an earlier effort to account for all cases of food anaphylaxis, only in Colorado, a significantly higher number of cases were reported from rural regions as compared to metropolitan areas strongly suggesting either misdiagnosis or inaccurate recording of cases in the emergency department …

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