Letter from Dr A T Clark, Consultant Paediatric
Allergist and Dr P W Ewan, Consultant Allergist
House of Lords Science and Technology Committee:
Allergy inquiry
We thought it might be helpful to put in context
the recent media coverage, including a slot on "Today",
on severe food allergy, as it gave a misleading impression. This
followed an article in the British Medical Journal (BMJ) by Professor
Colver, titled "Are the dangers of childhood food allergy
exaggerated?". The message was that they are exaggerated.
This debate was based on data published by Professor
Colver in 2002 (Archives Disease of Childhood). This was criticized
by 2 groups (of international experts in childhood allergy), published
later in the same journal. Similarly there were published criticisms
of the recent BMJ article.
This highlights two issues. There is debate
and we do not have enough data to inform routine clinical decisions;
so high quality clinical research to answer basic questions in
allergy is much needed. Second, the author is commenting from
the position of a non expert in allergy (his expertise is in community
child health), and selectively quotes from the literature. Colver's
original study was poorly designed and biased, by both failing
to recruit children from major allergy centres and setting inappropriately
restrictive criteria for inclusion (for example a child requiring
one injection of adrenaline is not included—yet a
child would usually be very ill before adrenaline was given).
Colver's conclusions and much publicized opinions are therefore
based on flawed study design and misinterpretation of the findings.
An analysis of our data on 1,500 children with
nut allergy revealed a severe reaction rate of 1.93 per 100,000
population per year, a figure 10 times that suggested by Colver
for all foods.
Media publicity of poorly conducted studies
is misleading.
7 October 2006
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