Using NHS Data to Monitor Trends in the Occurrence of Severe, Food-Induced Allergic Reactions Work Package 2

People with food allergies may experience food allergic reactions due to accidental exposure. These reactions are commonly categorised as non-severe, fatal food anaphylaxis and near-fatal food anaphylaxis. Non-severe allergic reactions to food are more common with an incidence of up to 1,000 times greater than fatal food-related anaphylaxis. However, obtaining accurate data relating to the circumstances under which these reactions occurred is challenging under the current diagnosis coding system used in the National Health Service (NHS). This project addressed two key questions: 1. What are the trends in the occurrence of food hypersensitivity (FHS) reactions and their consequences in terms of healthcare encounters (both to hospital and primary care)? 2. What are the circumstances surrounding severe, life-threatening reactions to food? Approach • A UK arm of NORA was established using the same online platform as the existing European Registry. • Participation of healthcare professionals and/or patients to enter relevant information was co-ordinated by BSACI in conjunction with the Paediatric Emergency Research in the United Kingdom Ireland (PERUKI) network. • Different versions of the questionnaire were developed to increase response rates: (1) a comprehensive form mapped to existing NORA data fields for completion by Healthcare Professionals in the non-acute setting; (2) a shorter form with key data fields to increase data reporting in more pressured, acute healthcare settings; and (3) a form for completion by patients or their parent/guardian. Key Results The launch of the UK anaphylaxis registry faced delays and was impacted by significant pressures on NHS services due to the COVID-19 pandemic. This led to a lower than anticipated uptake of the Registry by clinics and Accident & Emergency departments. As a result, only a minority of accidental reactions (less than 5%) were captured in the registry, almost all in children and young people under age 18 years. Some indicative results of this analysis are the following: • 213 cases reported to be due to a food trigger and of these, 208 occurred in children/young people aged 18 years or under. • Common food triggers were peanut, tree nuts (especially cashew), cow’s milk/dairy and hen’s egg. • 47% of reactions occurred after consumption of prepacked food products and in at least 59% of these cases, the allergen was declared as an actual ingredient. Further work would be needed to understand how to optimise reporting of data, for example by reducing the time burden for completion by clinicians and patients.