EXECUTIVE SUMMARY

  1.  In 2007, the Surrey Federation of Women's Institutes resolved to campaign for the return of allergy testing, especially for children, in all GP surgeries. Twenty years ago GPs commonly used allergy testing to confirm a diagnosis and to help patients identify and avoid triggers. By 1992, support for this clinical investigation in asthma management was withdrawn. Despite reversal of the policy three years later, today only 4% of GPs make allergy testing available to their patients. In consequence, most allergic disease is treated with drugs, with little attention being paid to establishing triggers or avoidance techniques.

  2.  The 2007 House of Lords' report Allergy stated that approximately 1 in 9 of the population are diagnosed with an allergic disease at some time. The fact that so few GPs offer these patients allergy testing represents an inequality in primary care that needs to be reversed to help tackle UK's noted allergy epidemic. All GPs should be offering this simple cost-effective investigation because, without the knowledge of allergy triggers, patients and doctors alike are disadvantaged when seeking solutions.

  3.  The WI Resolution not only highlights the inequality in allergy testing, but also describes an NHS solution. It calls for local Primary Care Trusts to become involved in allergy management, including allergy testing and patient education, and that the findings from the investigation be referred back to the patient's GP to form a "loop" of healthcare. A visiting allergy specialist nurse, funded by PCTs, could perform this task within GP surgeries thus saving disruption in the lives of the patients, cost to hospitals and consultants' fees. One simple allergy test (skin prick) costs the NHS 15p

  4.  Women from Thames Ditton WI will be presenting their Resolution and petitions from WI members across the country to the Prime Minister at Downing Street in late January.

BACKGROUND INFORMATION

  5.  Allergy testing, to confirm a diagnosis of an allergy or allergic disease, was established long before 1989 when a medical consensus on asthma management stated, "Skin prick tests and/or total IgE concentration may be useful in some children to reinforce a possible diagnosis of causes of asthma." This publication was part 1 of 2 of the first British Thoracic Society (BTS) Guidelines on the Management of Asthma.

  6.  In 1992, when the Guidelines were revised, support for allergy testing was largely withdrawn; "Skin prick tests and in vitro specific IgE measurements are rarely helpful in diagnosis and management and results should be interpreted by a physician familiar with such tests".2

  7.  The results of the policy change took allergy testing away from the domain of the family doctor and placed it in the hands of consultants. This meant that GPs were diagnosing an allergic disease without identifying triggers and, in some cases, a delayed diagnosis being made.

  8.  In 1995 the BTS Guidelines were again revised with support for allergy testing reinstated, "skin prick testing with relevant allergens can be helpful . . . "

  9.  Today there is no doubt as to the importance of allergy testing, indeed it has been called the "Cornerstone of Allergy Diagnosis" by opinion leaders in allergy. The loss of support by the BTS Guidelines in the early 1990s may have crippled the confidence of clinicians to perform allergy testing in primary care, but the lack of funding to encourage this procedure in all GP surgeries has been truly devastating.

SUGGESTED SOLUTIONS

  10.  A greater use of Primary Care Trusts (PCT) to help allergy patients identify triggers through allergy testing would be welcomed. According to the House of Lord's Report Allergy, most PCTs fund school nurses. Extending this primary care role into funding visiting allergy specialists available to all GP surgeries, is one possible solution for the NHS in tackling the allergy "epidemic". This course of action was identified in the WI Resolution on Allergy

How may this be achieved?

  11.  A visiting allergy specialist nurse working closely with a referring GP could:

(a).  Test and educate patients in allergen recognition and avoidance techniques

(b).  Improve health through allergen avoidance combined with properly prescribed medication

(c).  Encourage self-management of health, especially in chronic allergic diseases

(d).  Lessen disruption of family life, work or school by being easily accessible

(e).  Reduce time spent in GP surgeries seeking allergy treatments

(f).  Most importantly, establish a holistic picture of the patient for GP feedback and review to be updated as required

  12.  The visiting allergy specialist nurse could extend influence beyond advising patients on allergen avoidance. They can record and monitor changes in patient's stress levels, home and work environment, diet, exercise and quality of life.

  13.  Doctors have found that only 4% of GPs offer allergy testing to their patients. This statistic represents an inequality in healthcare that is not by postcode but extends across the country and needs to be remedied in the interest of public health.

14.   THREE SUPPORTING DOCUMENTATIONS

1.  The Surrey Federation of Women's Institutes Resolution on Allergy (passed, AGM March 2007). (Annex A)

2.  Example of the SFWI Petition (signed)[18]

3.  www.actionforallergy.org. A website that contains two short video clips by Drs Glenis Scadding and Jill Warner. To support the WI Resolution, a link to the site was posted on the Surrey Federation section of the National Federation of Women's Institutes website and remains there to date.

Nell Nockles,

on behalf of Thames Ditton Women's Institute

January 2008

RESOLUTION

In view of the increase in allergy related health problems we call upon H M Government to make funds available for allergy testing, especially for children, in all GP surgeries

INTRODUCTION

  In the UK, doctors report that allergy and allergic disease have reached epidemic proportions and that the NHS is not coping with demand for allergy treatments. They also report that children are the most vulnerable social group with many suffering from a combination of allergic disease symptoms. With too few allergy consultants available, busy GP's turn to drug remedies with little attention paid to identifying allergy triggers or developing effective allergen avoidance programmes. In order to remedy this situation doctors propose setting up a national network of fully staffed allergy clinics to treat symptoms, educate patients and inform NHS healthcare workers on the latest treatments and remedies. We believe there may be a more cost effective and immediate solution. Once an allergy trigger is clinically identified through testing in GP surgeries, doctors could refer patients to the local Primary Care Trusts in order to develop a personalised allergen avoidance programme and report progress back to the referring GP. Once established, the healthcare loop could encourage patients to self-manage their condition while recording an allergy and life style profile for the surgery's records as allergic conditions are known to alter through stress, environment, age and events.

The Allergy Epidemic

  Allergic disease affects about one in three in the UK population with children bearing-the-brunt of asthma, eczema, rhinitis, and conjunctivitis. In 2003, the Royal College of Physicians (RCP) published a report stating that allergy and allergic disease had reached epidemic proportions and that the NHS was not coping with demand for healthcare. In highlighting the rise of childhood allergic disease the doctors noted that, "In 13 to 14 year old children, 32% report symptoms of asthma, 9% have eczema and 40% have rhinitis" and that, "The UK ranks highest in the world for asthma symptoms, and is almost top for allergic rhinitis [hay fever] and eczema." Addressing the cause of the rise they identified genetic susceptibility and our changing life style and environment; "Increased exposure to allergens and air pollutants, over-use of antibiotics and other drugs, reduced fruit and vegetable intake, reduced early life exposure to bacterial products, and an alteration in bacterial colonization of the gut, have all been blamed". The RCP also noted a major shortage of allergy specialists, with only six fully staffed allergy clinics available in the UK and approximately one allergy consultant per 2 million of the population. No NHS allergy specialists centres exist West of Bournemouth or North of Manchester, allergy testing is poorly funded, consequently most allergic disease is treated with drugs with little attention being paid to establishing the cause of the allergy or developing allergen avoidance strategies.

  The report put forward a comprehensive strategy to reduce the burden of allergy on society through the setting up of a nationwide network of allergy centres fully staffed with at least four specialist consultants (2 adult and 2 paediatric) with appropriate support from specialist allergy nurses and dieticians. The new centres could also be training bases for primary care workers. The centres would be especially helpful for patients who are diagnosed with multiple allergic diseases affecting either lungs, nasal passages, eyes, skin or gut. Many of these "multi-presenting" patients are children who often receive "fragmented" specialist care leading to "steroid loading" treatments that risk unacceptable side effects including growth retardation. Approximately 10% of children diagnosed with allergic disease are in this multi-presenting category. The House of Commons Health Committee reviewed the RCP Report in 2004 and endorsed most of its recommendations calling for the Government, "to produce a strategy document to show that it really is serious about tackling the disease burden. The Government has agreed there is a problem but hasn't yet faced up to it. At the moment, the NHS is not a national health service at all so far as allergy is concerned."

  Considering the RCP Report and the Health Committee's recommendations, there is a clear urgency to remedy the situation. To remain passive while waiting for the Government to weigh up the cost of the clinics to the taxpayer and seek approval for funding before putting the wheels in motion to establish the clinics is not responsible citizenship, nor is it in the interest of public health, especially child health. We believe there is an alternative pathway.

What can be done?

  We suggest a greater use of Primary Care Trusts (PCT) to help shoulder the responsibility of reducing allergies in the UK. PCTs were established by the Government to support GP surgeries, encourage patients to self-manage their health, improve quality of life and to react to local public health concerns. By expanding their area of responsibility to create personalised allergen recognition and avoidance programmes for patients, they can help to ease the burden of allergy on the community. The PCTs could initiate group sessions designed to inform, encourage and empower patients to self-manage allergy conditions. Furthermore, we suggest that major causes of allergy including moulds, pollens and mites, be studied at schools, thus encouraging a greater understanding of the environmental causes of allergy.

How may this be achieved?

  Avoidance of clinically identified triggers is universally recognized as the first step in allergy treatment and there is good clinical evidence that patient education alone can bring about health improvements in allergy and quality of life. A qualified primary care worker could help to realize this aim by;

—  Educating patients in allergen recognition and avoidance techniques

—  Encouraging self-management of health, especially chronic allergic disease

—  Reducing symptoms by reduced exposure to triggers

—  Lessen disruption of work patterns, family life, or schoolwork.

—  Reduced time spent in GP surgeries seeking allergy treatments

—  Establishing a holistic picture of the patient for GP feedback and review

  The educational package created could extend beyond the commonly known environmental triggers (see below) to include other factors that can make allergic reactions worse. They include stress, emotional state, overall state of health, workplace environments or ingestion of food or food additives. One of the more puzzling aspects of allergy is that reactions can happen many hours after exposure to a trigger. In this case, good detective work by the patient is required to identify the offending allergen. An informed patient will have a better chance to understand and control adverse events such as late reactions and personal "events" that can make allergic conditions worse.

  All of these allergy triggers are largely avoidable. A blood test or skin prick test will help to identify the allergens responsible for reactions and once identified the patient or the patient's guardian can take steps to avoid exposure. Imparting this information in order to encourage self-management of health is a primary health care concern and PCTs are perfectly placed to take up this challenge. Considering the urgency to reduce the burden of allergy on society, the community teams could be utilized to spearhead this area of healthcare.

Patient's Financial Considerations

  The cost of purchasing recommended protective devices, such as bed covers against mite infestations, may be considered "expensive" and discouraging for many patients. Therefore, we recommend that the Government should create an incentive that would encourage patients to become actively involved in allergen avoidance. A scheme, such as a tax incentives for protective measures, could act as an incentive for patients who otherwise might be reticent in taking steps to guard against allergen exposure.

Resulting benefits

  The benefits would be a better-informed patient with a direct communication link to his/her GP's surgery whose role is to maintain a current perspective of the patient's overall welfare. An allergen avoidance programme, specifically designed for the patient from allergy testing could help control the symptoms of chronic asthma, rhinitis, eczema, or conjunctivitis. The resulting overall health gains will prove beneficial to society as a whole as an enlightened public acts to self-manage health through practical and evidence based information. The current cost to the Nation of allergies is unacceptable; with developing children most at risk from allergy symptoms.

  It is timely for WI members to act and campaign to reduce the emerging UK allergy "epidemic" by calling for allergy testing to be made freely available in all GP surgeries and allergen avoidance education to be made available through Primary Care Trusts. The Campaign could begin by petitioning the eleven members of Parliament who represent the people of Surrey.

RECOMMENDATIONS FROM THE HOUSE OF COMMONS HEALTH COMMITTEE'S REPORT ON ALLERGY

"We recommend that a network of primary care allergy providers be created with a named lead for allergy in each Primary Care Trust. We ask for improved incentives for GPs to treat allergy and for better training. We recommend that a framework is developed to facilitate the introduction of allergy into the GPs with Special Interest programme, and for the Department of Health (the Department) to support this initiative."

FOR REFERENCE:

  The Royal College of Physicians Report (2003) "Allergy-the unmet need: a blueprint for better patient care" The Lavenham Press, ISBN 1 86016 183 9.

  "Stolen Lives -The Allergy Report" The Impact of Allergies On People's Lives In The UK Today. Allergy UK—May 2003. www.allergyuk.org (open "Home Page" then seek "Features" scroll down to "Stolen Lives").

  The UCB Institute of Allergy. European Allergy White Paper; Allergic disease as a public health problem. Braine-l' Alleud: UCB Pharmaceutical Sector, 1997.

  House of Commons Health Committee's Enquiry into "The Provision of Allergy Services". Published November 2nd 2004, The Stationery Office Limited, HC 696-1.

For information and advice please contact;

  British Allergy Foundation, www.allergyfoundation.com

  The Anaphylaxis Campaign, e-mail: info@anaphylaxis.org.uk

  Asthma UK, www.asthma.org.uk.

  National Eczema Society, www.eczema.org