We face a major epidemic of allergy within the UK at present. There has been a two—fourfold increase in allergy related disorders including asthma, rhinitis and anaphylaxis. Allergy services within UK are grossly inadequate in the face of this serious public health problem which affects around 30% of the UK population. For example, there are only six full time specialist allergy clinics throughout the whole of England and no such service in Wales, Scotland or Northern Ireland.

  My clinic at Royal Brompton Hospital is one of three such clinics in London and, like elsewhere, specialist allergy services are focussed in academic centres when much of the provision for NHS services is obtained piecemeal and dependent inappropriately, on university funding. My post is only funded 2/11ths by the NHS, together with one full time Specialist Registrar in Allergy and the support of a dietician with an interest in food allergy. Nonetheless, the service is supported largely by my clinical research fellows and specialist research nurse who provide a major service role for NHS patients. This situation is clearly unsatisfactory and not feasible outside an academic setting.

  A major problem is that the typical allergic patient has diseases affecting the multiple organ systems including eyes, nose, chest, skin, gastro-intestinal tract with or without the risk of potential life-threatening anaphylaxis. A good example is the peanut sensitive child (currently 2% of children in the UK are peanut allergic). These patients are at risk of life threatening anaphylaxis, particularly in those who have associated bronchial asthma. A second example is the patient who has a life-threatening adverse reaction under general anaesthesia. Such cases require obsessional evaluation and investigation in a day care specialist allergy setting. A third example is the 5-10% of adult asthma patients who have an occupational cause for their asthma which requires detailed evaluation.

  These cases emphasise the need for a multi-disciplinary approach which can only be provided by a specialist allergy centre. The current piecemeal service provided at secondary care level by individual organ specialists is inadequate. For example, a chest physician may be competent to evaluate the allergic component of asthma. He may or may not recognise that the patient has associated distressing allergic rhinitis requiring separate management. Almost certainly, he would not be equipped to investigate and diagnose associated food allergy. Neither could he deal with associated urticaria or difficult eczema. Such a patient requires one consultant allergist with a multi-disciplinary approach to diagnosis and treatment rather than the alternative, namely, four to five organ specialists to deal with multiple allergic problems.

  The priorities should be as follows:

1.  Establishment of regional centres throughout the UK, including Wales, Scotland and Northern Ireland. Such a regional centre should comprise two Consultant Allergists, a minimum of one Paediatric Allergist, a full time allergy nurse, two specialist trainees in allergy and a half time dietician with a specialist interest in food allergy.

Such a service should provide:

(a)  a supra regional service for tertiary referrals from organ-based specialists; and

(b)  a local service for primary referrals of patients with multiple allergies.

2.  Such a regional centre would be committed to training Specialist Registrars in Allergy for the future. Equally important, the regional service could provide training in allergy for organ-based specialists at secondary care level. A third important aspect of training involves education at primary care level of General Practitioners and Practice Nurses.

3.  Finally, regional centres should ensure that allergy is a proper part of the under-graduate medical student curriculum in order to ensure that future doctors in all specialities and within general practice are aware of the current epidemic in allergy within the UK and the need for appropriate reform.

  In Cambridge Dr Pamela Ewan has provided a role model for how an NHS-Funded regional allergy centre can provide a supra-regional and regional service and training at tertiary, secondary and primary care level. As a first step such NHS-funded centres could be set up throughout the 11 regions within the UK.

May 2004