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Last Updated: Tuesday, 22 May 2007, 16:00 GMT 17:00 UK
Allergy services 'badly lacking'
By Matthew Hill
BBC News

Anne Cole
Anne Cole went to Germany for tests
The UK has one of the highest rates of allergy in the world, and the number of cases has trebled in the last 30 years.

Yet while the numbers are rising, there is a crisis amongst specialists who treat allergies.

Reports from the Royal College of Physicians and even the Department of Health itself have warned there are not enough specially trained doctors: there are only six specialist centres in the UK.

Dr Pam Ewan, a consultant allergist at Addenbrookes Hospital in Cambridge and a member of the National Allergy Strategy Group, said: "The lack of provision is at a series of levels, first of all in primary care.

"GPs are not well informed about allergy at all, but particularly about food allergy and that is because they are not trained in it.

"So GPs have gained knowledge by self learning or self interest, then if a GP wishes to refer to a specialist he will have a problem finding a specialist because there is a very small number of these."

Poor advice

John Warner, Professor of Paediatrics at Imperial College in London, said studies which have been designed to try to prevent allergies had proved "incredibly disappointing".

Of the children who come to our clinic at least 10% and possibly up to 20% have received unsound advice
Professor Gideon Lack

"They have been either totally negative or have occasionally shown an increased risk of becoming allergic by having a low exposure," he said.

Professor Gideon Lack, at St Thomas's Hospital in London is carrying out a study to see if exposure to peanuts early in life may prevent allergy developing.

It's called the LEAP study and babies less than a year old with egg allergy and eczema are challenged with peanuts.

Nutritional problems

Professor Lack is also concerned about the lack of paediatric allergists and has done a survey of the advice parents have received before they come to his clinic.

"We found almost 50% had received alternative health care advice about allergies before coming to see us.

"I would say that of the children who come to our clinic at least 10% and possibly up to 20% have received unsound advice; these children will face nutritional problems."

We asked members of the British Dietetic Association if any of their patients had come to harm because of bad allergy advice. This is what some of their emails said.

  • "I have had patients who omit wheat from their diet and this can often result in constipation. If long-standing this can lead to long term bowel problems including bowel cancer."

  • "One nutritional therapist was diagnosing multiple allergies in autistic adults. Very long lists of foods to avoid are provided but NHS staff has to pick up the pieces."

  • "One person had Vega test and was advised on a severe unnecessarily restrictive diet. The lady had weight loss, was light headed and dizzy and felt she would collapse."

Problems with a diagnosis

Meanwhile, patients are fighting for NHS referrals to get diagnoses.

Some are even resorting to going abroad.

Peanuts
Peanuts can cause a severe allergic reaction

Anne Cole, from Somerset, was concerned that advice on a new asthma inhaler she was prescribed said she must check if she had any allergies.

But she said she was told it would not be possible to have such a test on the NHS.

"I didn't want to spend a great deal of money having it done privately so, as my daughter lives in Germany I went to visit her and saw a German community specialist who tested me very thoroughly for allergy and proved I was not allergic to anything," she said.

"It was expensive: I had to pay for the plane trip and it cost about 85 but it was much cheaper than it would have been if I had had it done in England I think."

Central funding call

Dr Ewan and her colleagues are asking for central funding for trainee specialists but control has been devolved to the local PCTs.

The NHS are spending money on allergy patients, but it is in a sense wasted because patients, if they are not properly diagnosed, are somewhere in the system being ill
Dr Pam Ewan
Addenbrookes Hospital

"The big problem there is that they are strapped for cash so that there is no way PCTs are going to be able to fund a new consultant or a new trainee post," she said.

In a statement, the Department of Health said it was considering asking the National Institute for Health and Clinical Excellence (NICE) to assess clinical guidelines on allergy care.

"We have also invited major research fenders to consider what gaps there are in present research around the causes and effects of allergies.

"On the clinical side, we have asked the Royal College of Paediatrics and Child Health to develop what are known as 'care pathways'. These would help improve knowledge and skill around allergies.

"One of the main issues that comes up around allergy services is the need for more, specialists. We have asked the NHS to look at whether they need to commission more local training posts for allergy."

Inquiry

The House of Lords inquiry on allergy and allergic diseases is due to report in July.

Dr Ewan said that funding allergy trainees would save the NHS money.

"The NHS are spending money on allergy patients, but it is in a sense wasted because patients, if they are not properly diagnosed, are somewhere in the system being ill," she said.

"They are either having acute reactions coming into A&E, there are hospital admissions, there is very good data showing a rise in hospital admissions.

"They are frequently attending their GPs with continuing illness.

"They are using a lot of drugs - now all that is a cost to the NHS and our argument is that a small investment in training more specialists which would enable both the specialist sector and primary care to develop would be actually a cost saving."

Allergic Reactions will be broadcast on Radio 4 at 2000 BST on Tuesday 22 May. You can also listen online for 7 days after that at Radio 4's Listen again page.


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