As an anaesthetist one of my favourite tasks is to undertake something that's grandly called the, "pre-operative assessment". It's an opportunity to meet the patient before their operation, find out about their medical background and importantly, provide some support and reassurance. Sometimes the meeting will lead to a tweak in the drugs, equipment or monitoring that I'll use. My first question to the patient is, "Are you allergic to anything?" Sometimes the answers can be startling - I've heard people say they're allergic to water, the cold and even members of their family. Nevertheless, if the answer is "Yes" my next question is, "What does it do to you when you take it?" In some instances patients confuse an allergic reaction with a side effect. Itchiness with opioid analgesics, diarrhoea with antibiotics. That kind of thing. This experience is borne out by the results of a recent study of food allergies conducted in the USA.

Researchers sent out questionnaires to 40,443 adults and received replies from 51%. A total of 19% reported that they had a food allergy. The five most commonly self reported sources of food allergy were: shellfish, peanuts, milk, tree nuts and fin fish. However on closer scrutiny, it was clear that only 11% described symptoms that were consistent with a type 1 hypersensitivity reaction. Amongst those who were allergic, 48% developed symptoms as an adult and 38% needed treatment in an Emergency Department (ED). But despite these findings, only 24% were in receipt of a current epinephrine prescription.

For the mountain medic there's a few things to think about. Clearly, there's a lot of people out there who think they have a food allergy. About one half of them are right. In those who do have an allergy, many will present for the first time in adulthood and need treatment in an ED. But despite this, most will subsequently lack the treatment that is required to treat a further reaction. Therefore as medics we need to do all we can to identify those who have allergies, be aware that new allergies will present at any time and consider having the epinephrine available to treat a reaction should it arise.