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A need to improve allergy services
Prof. S. T. Holgate
At present there is increasing demand by the public for allergy services, yet this is not being met either in primary or in secondary care. The British Society of Allergy and Clinical Immunology has identified 76 NHS consultant led clinics based in hospitals in the UK. However, only five of these offer a full-time NHS consultant led service. These centres have an international reputation for research into allergies and asthma and have most frequently developed their NHS service on the back of research. The remaining clinics are run by organ-based NHS consultants with usually only one clinic each week and limited access to diagnostic and treatment facilities. There also exists two nurse led clinics in Norfolk and Bognor Regis. Taken overall, the BSACI has identified 27.6 full-time NHS Consultant Allergist-led clinics for a population of 58.6 million, i.e. one full-time equivalent per 2.1 million population and represents only five allergy clinics in the UK offering a full-time comprehensive multidisciplinary service.
In the face of the rising trends in allergic disease and the increasing public concern in wishing to have access to diagnostic and treatment expertise in allergy, others have moved into the field. Many patients now directly consult practitioners of complementary and alternative medicine with common allergic diseases and are often subjected to, at best, inadequately tried diagnostic methods and treatments and, at worse, are frankly misled by diagnostic methods that have little or no basis in modern scientific thinking e.g. Vega testing, reflexology. However, what CAM practice can offer is an interaction with a practitioner who is willing to listen to their problems and, at least with their own repertoire, attempt to help such patients.
The soloution to this parlous state lies in strengthening clinical and laboratory allergy services throughout the UK. This means Health authorities and PCG(T)s need to respond to the public's cry for help to put in place a quality allergy practice based on the guidelines produced by the BSACI. A good start would be two specialist allergists in each Health Region of the UK with good access to the necessary clinical and laboratory diagnostic facilities and support from a trained Nurse Specialist, dietitian and a Clinical Immunlolgist. This would prove a ratio of one NHS specialist allergist-led service per 1.1 million population. More importantly, it would provide an even geographical distribution of specialist allergy services throughout the UK. This would enable local training for organ-based specialists at district general hospitals and primary care. Such training would be complimented by allergy training courses offered by charities.
While it is possible to say that there are greater priorities in the NHS for improvement of services, this does not mean that the provision of even a rudimentary service in allergy should be pushed to one side. Indeed, the development of novel molecular based approached for treating allergic disease that are soon to be introduced into practice e.g. anti-human IgE, genetically modified vaccines, DNA vaccines, mandates a greater investment in this specialty. Currently the excellent work undertaken by charities in the field continue to do their utmost to help the public and give appropriate advice. However, without adequate allergy specialist support and the improvements and dissemination in practice that this will bring, then the situation to provide the public with a service they deserve with equal access through the NHS will not occur. Clearly, the British public deserves better.
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