Unpicking an allergy scare

Last Sunday The Observer published an article headlined “Shock rise in number of fatal adult allergies”.  

It claimed that in the past year alone, there had been more than 30,000 admissions to hospital of those suffering anaphylaxis, an extreme and occasionally fatal allergic condition.(In the online edition, the version read “Sharp rise ….”.
 
Readers may well have been alarmed, but they need not have been. As a result of enquiries by Straight Statistics, The Observer will tomorrow publish a correction acknowledging that the actual number is less than 4,000. The NHS Information Centre, which provided The Observer with the data for this article, says the true figure for hospital admissions for this condition in 2008-9 was 3,595.
 
Undoubtedly the mistake was genuine. Stray zeros can lead to gross errors. While a correction is welcome, however, the original headline was not news.
 
It has been known for some time that the number of people suffering from allergies and anaphylaxis is rising significantly year-on-year, along with prescriptions for adrenaline injectors. On 16 April 2006, The Observer itself published an article about this, focusing on children and  headlined “Big rise in patients with deadly allergies”. And on 16 July 2007, The Times reported a “Huge rise in allergy sufferers but too few specialists”:
 
In June 2003, UK allergy rates were described as epidemic in a report by the Royal College of Physicians, which quantified the economic impact on the NHS: ''Allergic disease currently accounts for 6 per cent of general practice consultations, 0.6 per cent of hospital admissions, and 10 per cent of the GP prescribing budget. The cost (in primary care, excluding hospital services) to the NHS is £900 million per annum.”
 
Compare that with figures quoted by The Observer last Sunday: “Medications for allergies cost almost £1bn annually, 11 per cent of the total NHS drug budget”. Big figures certainly, but hardly evidence of a vast increase since 2003.
 
So was the report at least right in identifying increasing allergy deaths among adults? Such deaths are, thankfully, rare. In 2008 the ONS recorded a total of 6 deaths as a result of “anaphylactic shock due to adverse food reaction”, 11 from “anaphylactic shock unspecified”, and 9 from “anaphylactic shock due to adverse effect of a correct drug or medicament properly administered”. It is perhaps worth noting that, in the same year, 6 deaths were apparently caused by “antiallergic and antiemetic drugs”. 
 
The ONS mortality tables helpfully break down the data into narrow age bands, but these numbers are too low to draw any conclusions about, say, anaphylaxis mortality trends for people over 40 in the past five years.
 
A breakdown by age of Hospital Episode Statistics for 2004-09 supplied to Straight Statistics by the Information Centre suggests annual increases of between 2 and 7 per cent for anaphylaxis admissions of those aged 41 and over. These increases are broadly in line with the overall increases in admissions, which range from 3.4 to 9 per cent a year. Older people, for want of a more precise expression, do not seem to be harder hit.
 
These statistics may not capture those who arrive at casualty departments with a severe allergic reaction, but who are treated and discharged a few hours later. Indeed, on itswebsite about asthma and allergies, the NHS Information Centre warns: “It is not possible to draw conclusions about any increase in the prevalence of asthma and allergies from HES data. The increases in all the diagnoses counts of FCEs [finished consultant episodes] for asthma and allergies may be affected by changes in clinical coding practice”.
 
The Observer take note.