SUMMARY

  Many Departments of Dermatology in the UK provide an allergy service for patients with skin disease but there is a need to improve the provision so that all patients have access to a high level of service. Allergy testing includes patch testing for allergic contact dermatitis (including occupational dermatitis), prick testing or allergen-specific immunoglobulin E interpretation for latex allergy and prick testing or allergen-specific immunoglobulin E interpretation for allergies in patients with atopic eczema. The British Association of Dermatologists through the British Contact Dermatitis Society is actively involved in pressing for the improvement of allergy services for skin disease and in providing advice to allow governance of such services. The British Association of Dermatologists is not involved in the governance of independent sector providers except where such services are provided by its members.

  1.  Availability: Many Departments of Dermatology provide some sort of allergy services in relation to patients with skin diseases but the provision is not uniform and some centres do not provide the full range of expertise.

  2.  Skin allergies include the following:

(a)  Allergies—usually "immediate" type (type I), associated with atopic eczema, eg allergy to house dust mite, and food allergies particularly in children.

(b)  Allergic contact dermatitis ("cell-mediated"—type IV), eg to nickel, chromate, fragrance, rubber chemicals, preservatives and industrial chemicals.

(c)  Latex allergy ("immediate" type—type I), which can give skin symptoms (as well as respiratory effects and anaphylaxis).

  3.  Provision: Many Dermatology departments provide patch testing to assess for allergic contact dermatitis. This procedure involves the application to the patient's upper back of substances suspected of causing contact allergy. The testing requires the patient to visit the outpatient department three times in a week.

  4.  Atopic eczema and latex allergy: Testing for food allergy, house dust mite allergy or latex allergy is provided by some Departments of Dermatology and can be done by intradermal prick testing (on the arm) and/or by a blood test for allergen-specific immunoglobulin E, eg to latex protein (the so-called "RAST"). Some departments do not have the facilities or local expertise to provide this service.

  5.  Occupational disease: Skin disease caused by occupation is second only to musculoskeletal problems as a cause of loss of time from work, with a reported incidence of 13/100,000 workers/year. The commonest allergic causes are contact with rubber, nickel, epoxy resin, chromate, fragrances and preservatives.

  6.  Special interest: Larger departments normally have a consultant with a specific interest in skin allergies who oversees these tests. In smaller departments general dermatologists perform the tests. In many departments there are nurses with special expertise in the area of patch testing. Some nurses can do prick testing.

  7.  Training: The provision of patch testing services requires specialist training in Dermatology and specifically in the sub-specialty of contact and occupational dermatitis.

  8.  Priorities: The British Association of Dermatologists and the British Contact Dermatitis Society see the provision of allergy services for patients with skin disease as a priority and aim to improve these services by several steps including:

(a)  The development of better protocols for patch testing and the assessment of latex allergy.

(b)  The introduction of guidelines for investigating contact dermatitis including the availability of guidance on what series of allergens should be used for the test.

(c)  The use of computerized databases for the audit of patch test results.

(d)  The reporting of cases of occupational skin disease to the EPIDERM scheme based at the University of Manchester.

(e)  Through collaboration between centres in the UK and with colleagues in Europe, particularly with dermatologists in Germany whose data collection system is compatible with the British one.

(f)  Through lobbying for allergy services to be available to all patients with skin disease and not just those who are served by larger departments.

  9.  Independent sector: The British Association of Dermatologists are not aware of the extent of the provision of allergy services for patients with skin disease in the independent sector but expect such of these services provided by BAD members to be of a reasonable standard.

May 2004