“There is grossly inadequate provision of allergy services at the present time. About one third of adults and 40 per cent of children suffer from some form of allergy-related illness. Yet there are only six full-time specialist allergy clinics in the UK, supplemented by the part-time allergy clinics of individual disciplines such as dermatology, respiratory and ENT, which leaves millions without the opportunity for proper diagnosis and treatment. Training in allergy urgently needs to be introduced into the medical school curriculum, but is currently non-existent. Equally urgent is the patient’s need for help at the primary care level. Symptoms in the surgery warrant a greater allergy awareness, which special courses for GPs, practice nurses and other health professionals could do much to improve. Meanwhile, it is left to patient support organisations such as ours to provide information and advice which may help to alleviate the suffering, but is an unsatisfactory situation.”
Pat Schooling Executive Director, Action Against Allergy
“The lack of trained allergy consultants in the NHS has driven many allergy sufferers into the clutches of fringe ‘allergy practitioners’ who employ unvalidated and inaccurate tests to misdiagnose allergies and give inappropriate advice and treatment. This is even more disturbing when accurate allergy testing is readily available to allergy sufferers via their own GPs. Many GPs are unaware that accurate allergy blood testing is available through 90 NHS pathology laboratories nationwide. The most readily accessible of these are RAST blood tests, which are used to reliably and definitively diagnose common allergies to dust mites, pollens, pets and over 400 different substances. Life threatening food allergies, including milk, egg, fish and nut anaphylaxis, can be diagnosed accurately using these precise tests, which measure specific antibodies in a blood sample.”
Dr Adrian Morris Allergist, Surrey Allergy Clinic, London
“The Royal College of Physicians report, Allergy – The unmet need, gives evidence for the lack of allergy services in the UK. Allergy management can improve the quality of life of many allergic patients, whether by better pharmacological control of asthma, or by the identification of culprit allergens which, when avoided or removed, can reduce symptoms. The management of food hypersensitivity is important, because acute reactions, such as peanut allergy, can lead to anaphylaxis and death. Slower reactions, characterised as food intolerance, can lead to chronic symptoms. Here, an elimination diet can alleviate such symptoms as irritable bowel syndrome, rhinitis and urticaria. There are only a handful of specialist registrars being trained in allergy at the moment, whereas there should be many more to help the increasing numbers of allergic patients in the community: reaching 20 per cent or more at the current time.”
Professor Jonathan Brostoff Professor Emeritus of Allergy and Environmental Health, Kings College London
“Because allergy is a multi-system disease, it affects the immune system, which means it can affect any organ. Patients will often present with food allergy, but at the same time have very poorly controlled asthma; they may have eczema and severe hay fever, so it affects many different organ systems. The way that our health service works is that if you have a problem with your nose, you go to see an ENT surgeon; if you have asthma, you go to see a chest physician; but they are not prepared to treat all the other conditions at the same time, so they then have to refer you on to another specialist, for example. It has caught the health service by surprise. We are ill-prepared. We do not have the specialists to deal with an allergy or a person with allergic disease that affects multiple symptoms, and it leads to gross inefficiency and a waste of NHS resources.”
Dr Shuaib Nasser Consultant Allergist, Addenbrooke’s Hospital*
“The major problem is getting a referral. The general practitioners, because they do not have training in allergy, are either very dismissive or they will try to find out where an allergy clinic is, but then it often comes down to a funding issue or a distance issue. The main thing, though, is that the average patient is abandoned, so they turn to Allergy UK or the Anaphylaxis Campaign, and we really are propping up the NHS. We try very hard to support patients and to try to get them to see an allergy specialist, but it is very often that at primary care level it is simply not taken seriously. They can be dismissed as hypochondriacs.”
Muriel Simmons Chief Executive, Allergy UK*
“We need a specialist-led service. We cannot expect primary care physicians and nurses and pharmacists to start this on their own. We need to move this forward on two fronts, therefore, to generate allergy specialists geographically spread evenly across the country; secondly, to use that force to bring up the primary care – and by primary care I do not mean GPs here, I mean nurses and pharmacists as well. For this, we thought we would need to start with 20 specialist posts to get us going, but the issue, of course, is that there are no trainees. There is no shortage of enthusiasm in this subject, but there just are not the training slots available. The issue at the moment is that 82 per cent of the full-time allergy practitioners are paid from academic salaries and they are using their research time and their research money to deliver a clinical service. This is totally unacceptable. People like me, a Medical Research Council professor, whose salary comes from the MRC, are running allergy clinics because the NHS is not paying for it. We need the NHS to come behind this; we need better resources; and we are really only talking about £5.6 million to be able to do this, to get these first 20 consultants in place, so we are not asking for a huge some of money.”
PROFESSOR STEPHEN HOLGATE Chairman of the Royal College of Physicians
Committee and National Allergy Strategy Group, University of Southampton*
* Taken from evidence presented to the health select committee during an enquiry into the provision of allergy services
