title: Community healthcare professionals overestimate the risk of fatal anaphylaxis for food allergic children.
abstract: Fatal food anaphylaxis is rare, but a major concern for people with food allergy and their carers. We evaluated whether community healthcare professionals accurately estimate risk of fatal anaphylaxis for food allergic children, and whether accurate risk estimation is related to competence in recognizing and managing anaphylaxis.
  
  
  
  We enrolled 90 community healthcare professionals in a cross-sectional survey - 30 primary care nurses, 30 school first aiders, 30 community pharmacists. Participant risk estimates for fatal and non-fatal anaphylaxis, and all-cause fatalities, were measured using a risk ladder. Participant anaphylaxis knowledge was assessed by questionnaire, and practical skills using a simulated anaphylaxis scenario.
  
  
  
  In all three groups, participants significantly overestimated the risk of fatal anaphylaxis for food allergic children, by a mean factor of 13.5-fold (95% CI 5.0, 31.6), but did not overestimate non-fatal anaphylaxis risk or all-cause fatality risk. We found no evidence of a relationship between successful adrenaline administration and risk estimation.
  
  
  
  In conclusion, we have found evidence that community pharmacists, school first aiders and primary care nurses in the UK systematically overestimate the risk of fatal anaphylaxis for a food allergic child. This overestimation may result in increased patient and carer anxiety. Community practitioners who manage childhood food allergy and anaphylaxis need to be educated about the level of risk for fatal anaphylaxis in such children.
authors.affiliation: Department of Paediatric Allergy, Imperial College London, London, UK.
authors.forename: H J
authors.initials: HJ
authors.lastname: Hanna
authors.affiliation: Department of Paediatric Allergy, Imperial College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Emmanuel
authors.affiliation: Department of Paediatric Allergy, Imperial College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Naim
authors.affiliation: Department of Paediatric Allergy, Imperial College London, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Umasunthar
authors.affiliation: Department of Paediatric Allergy, Imperial College London, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Boyle
mesh_terms: D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology* / Q000401:mortality; D006282:Health Personnel; D006801:Humans; D051188:Knowledge Bases; D008297:Male; D008875:Middle Aged; D010465:Perception; D012306:Risk; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
keywords: adrenaline auto-injector; anaphylaxis; food allergy; risk estimation