Another allergy death (UK)

[Jessica]

http://www.dailymail.co.uk/news/article-2524593/Music-teacher-died-nut-allergy-eating-piece-wholegrain-bread.html

No epi. After so many stories in the news I just can't fathom why someone wouldn't have an epi pen prescribed. Is it normal in the UK for allergists/doctors to not insist on one?

[jschwab]

I think it's scary given how many kids are diagnosed at just that same age with testing and just try to be careful. I know kids in that situation, in fact, lots of them. It's odd it had not come up before and then such a bad reaction? He was 38 so if they got a protocol that did not include an Epi when he was a kid, it may never have become normal for him? My mom has one of my food allergies and does not carry an Epi and she won't even consider it since she has not had a reaction in years. Remember that girl in Chicago with the pediatrician mom who did not carry one? I don't think it's all that uncommon for people to think they can manage strictly with avoidance. It works for most people most of the time, in fact, so I can see how people can come to believe they can manage that way.

[GoingNuts]

Jessica, I had to ask for one for my now 19 year old, here in the U.S..  That was 17 years ago.  Indeed, if this was an adult who was dx'd in childhood, he may have never had one. 

[rebekahc]

I grew up with food allergies and had several ana reactions, but never an epi - it was just rush me to the doctor or hospital.  Those of us whose allergies pre-date the EpiPen didn't have much choice.  There was an AnaKit with a vial of epi and a syringe, but I don't remember ever seeing one of those until the late '80s or early '90s and they were usually only prescribed for venom (sting) allergies.  I got my first epi prescription when DS (17 years old now) was a baby.  His pedi was going over family history with me and asked about my epis.  I told him I had never had one and he insisted on prescribing one for me.  Had DS not been allergic/atopic, I still might not have an epi even with my severe history.

[CMdeux]

I think that this problem is greatly exacerbated in the UK, too, where there was  reasonably prominent physician/author asserted quite pointedly that epipens were VASTLY over-prescribed, and that they made people "anxious" unnecessarily.

BMJ op-ed, dated 2001

Obviously, it would have been far better if the 'damage-control' version had seen similar widespread attention

BMJ has now been playing both sides of the fence on this one for an embarrassingly LONG time, frankly--

Another rebuttal to another bad op-ed

It seems that the underlying problem is a failure to account for the risk-benefit analysis with "death" as an outcome, coupled with an absolutely appallingly poor grasp of statistical thinking.

Not everyone in the world IS at significant risk of death from anaphylaxis.  So just because deaths are rare doesn't mean that the risk is low among the population which is at risk.  This is like denying that patrol officers require protective gear simply because officer-involved shootings or stabbings are rare, and justifying it by pointing out that the majority of people are made "anxious" by wearing a kevlar vest to work.



It just doesn't make sense, that line of thinking.  But it is unfortunately quite common, and it angers me NO END that a prominent medical journal has seen fit to increase its own media footprint by promoting this kind of wrong-headed thinking, which is clearly COSTING LIVES.

[jschwab]

Oh, I'd like to read that later, CMdeux. One other thing that never seems to come into play in what happens when ana doesn't end in death - there are still huge consequences. I spoke with a woman who told me her relative now have brain function impairment because of too many ana reactions. I had never heard of that, but it stands to reason that cognitive impairment could be the consequence of frequent reactions. It seems like it's always presented as "either you are fine or you die" but what about the costs to the person who is hospitalized for a few days? It feel like ana is handled in a very black and white way other medical conditions are not.

[twinturbo]

The opinion pieces always feel like Colbert's version of feeling the news at me with truthiness. Bored?