Coroners Keep Raising the Same Concerns About Food Allergy Deaths. 52% of Organisations Do Nothing About It.
Chris Carter, Managing Solicitor, April 2026
WHAT YOU SHOULD KNOW
A King’s College London study analysed every Prevention of Future Death report issued by coroners in England and Wales over 12 years. The findings on food allergy deaths raise serious questions about whether the system is protecting people.
Coroners issued just 32 Prevention of Future Death reports involving anaphylaxis between 2013 and 2025. Researchers describe this as the “tip of the iceberg.”
Of the organisations that received these reports, 40 per cent failed to respond within the statutory 56 days. 52 per cent took no action at all.
Every anaphylaxis death examined in the study was preventable.
Hospital admissions for severe allergic reactions to food have tripled in the last two decades. The report calls for the appointment of a national Allergy Tsar to drive change.
When someone dies from a food allergy in England and Wales, a coroner can issue a Prevention of Future Death report. It is a formal instruction to the organisation responsible: fix the problem, or explain why you cannot. The organisation has 56 days to respond.
A study published by King’s College London in October 2025 examined what actually happens after those reports are sent. The answer is stark. In more than half the cases, nothing happens at all.
For anyone who lives with a food allergy, or parents a child who does, this is not an abstract policy failure. It is the system that is supposed to stop the next preventable death. And according to the data, it is not working.
What Did the King’s College London Study Actually Find?
The study, funded by the Natasha Allergy Research Foundation and authored by Dr Georgia Richards, analysed all 6,000 Prevention of Future Death reports issued by coroners since the system was formally introduced in July 2013. Of those 6,000 reports, just 32 involved anaphylaxis. That is roughly two per year.
Two per year. In a country where hospital admissions for severe food allergy reactions have tripled in the last twenty years.
Dr Richards, an epidemiologist at King’s Faculty of Life Sciences and Medicine and founder of the Preventable Deaths Tracker, described the figure as “the tip of the iceberg.” Not all anaphylaxis deaths are investigated by coroners, despite being sudden and unexpected. No national statistics are collected to determine how many involve anaphylaxis. The 32 reports are the ones where a coroner took the extra step of issuing a formal recommendation. The true number of food allergy deaths is higher. How much higher, nobody knows. Because nobody is counting.
52% Took No Action. What Does That Actually Mean?
A Prevention of Future Death report is not a suggestion. It is issued under Regulation 28 of the Coroners (Investigations) Regulations 2013. The addressed organisation has a legal duty to respond within 56 days, explaining what steps it intends to take. Here is what the King’s College London study found when it examined whether organisations actually comply.
6,000
Prevention of Future Death reports analysed across England and Wales (July 2013 to August 2025)
32
involved anaphylaxis. Roughly two per year. Researchers call this the “tip of the iceberg.”
40%
of organisations failed to respond within the statutory 56-day deadline
52%
of organisations that received reports took no action at all
The pattern Dr Georgia Richards identified is troubling. Across those 32 reports, coroners raised 189 individual concerns. Most related to a lack of education and training around allergies, and to the absence of national oversight. Coroners are raising the same concerns repeatedly, even referencing each other’s earlier reports to show the problem has been flagged before. The organisations receiving these reports are treating them as optional.
Something Most People Don’t Know
Prevention of Future Death reports are public documents. They are published on the judiciary.uk website and anyone can read them. That means if a restaurant chain or food business has already been told by a coroner to fix its allergen procedures, that report is sitting there in the public record. If the same business then serves an undeclared allergen to another customer, the existence of that earlier report is powerful evidence. It shows the business knew about the risk. It had been formally warned. And it still did not act. Most people with food allergies have no idea these reports exist, let alone that they can search them by category on the judiciary website.
The Report Calls for an Allergy Tsar. What Would That Change?
The study makes five recommendations. Each one addresses a specific gap in the current system.
“Every allergy claim we handle is a case where the system has already failed. The restaurant did not follow the law. The food was mislabelled. The staff were not trained. This report shows that even when a coroner spells out exactly what went wrong, more than half the time nobody does anything about it. That is why individual claims matter. They are the accountability that the system is not providing.”
Chris Carter, Managing Solicitor
Where Does Owen’s Law Fit Into This?
Owen Carey died in 2017 after eating a chicken burger marinated in buttermilk at a restaurant. He had told staff about his severe dairy allergy. The allergen information was not on the menu. The communication broke down between the front of house and the kitchen.
Owen’s Law is the campaign his family launched to require restaurants to provide written allergen information on menus, not just verbal assurance. The Food Standards Agency has recommended this change. Legislation has not yet been passed.
The King’s College London report adds weight to this campaign. If 52 per cent of organisations ignore coroner recommendations, voluntary guidance is not enough. The law needs to change. And the FSA’s own position supports that conclusion.
THE LAW THAT ALREADY PROTECTS YOU
While Owen’s Law has not yet been enacted, existing legislation already places duties on food businesses in England and Wales.
Food Safety Act 1990
Makes it a criminal offence to sell food that does not meet the purchaser’s requirements, including allergen requirements. Carries an unlimited fine.
Food Information Regulations 2014 (Natasha’s Law)
Requires prepacked for direct sale food to carry full allergen labelling. Introduced after Natasha Ednan-Laperouse died from an allergic reaction to a Pret a Manger baguette containing undeclared sesame.
FSA Allergen Guidance (non-prepacked food)
Requires all food businesses to provide allergen information for loose and non-prepacked food. Currently guidance rather than a legal mandate. Owen’s Law would make this a statutory requirement.
If a food business fails to meet these requirements and a customer suffers an allergic reaction, that customer has a right to claim compensation. The criminal law and the civil law operate in parallel. A prosecution by Trading Standards does not prevent a personal injury claim, and a personal injury claim does not require a prosecution to have been brought first.
I Had a Serious Allergic Reaction. What Should I Do?
Four steps, in this order.
Get medical attention
Everything else follows from this. If the reaction required an ambulance, A&E, or an adrenaline auto-injector, the medical records created at that point become the foundation of any future claim.
Report it to the food business
Ask for the incident to be recorded. Keep the packaging, the receipt, and any photographs of the food, the menu, or the allergen information that was or was not provided.
Report it to your local council
Contact Environmental Health or Trading Standards. They have the power to investigate and prosecute under the Food Safety Act 1990. An official investigation creates evidence that supports a civil compensation claim.
Speak to a specialist food allergy solicitor
Not a general personal injury firm. A specialist. The difference between a solicitor who understands allergen law and one who handles allergy claims alongside road traffic accidents and clinical negligence is the difference between a detailed investigation and a box-ticking exercise.
“Chris was fantastic when another big name firm refused to work on my claim he took the time to listen and fully understand my case. He got me a brilliant result, much better than expected. I would highly recommend to anyone.”
Rebecca Cayton
WHAT CARTER & CARTER CHARGES
10%
When your claim is settled
without court proceedings
(approximately 99% of claims do not proceed to a final court hearing)
25%
Only if court proceedings
become necessary
Which Allergen Caused Your Reaction?
Food allergy claims depend on the specific allergen involved. Find the guide that matches your situation.
RELATED GUIDES
Natasha’s Law: What It Means for Your Allergy Claim →
Restaurant Allergy Compensation Claims →
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Chris Carter is the Managing Solicitor at Carter & Carter Solicitors in Whaley Bridge, Derbyshire. Qualified in 1993, Chris has spent over 33 years handling personal injury claims, with allergy and anaphylaxis claims forming one of the firm’s four specialist practice areas. Carter & Carter is one of very few firms in England and Wales to publish its fee structure upfront and to handle every claim personally at senior solicitor level from start to finish. More about Carter & Carter →