Memorandum by Queen's Medical Centre Nottingham,
University Hospital NHS Trust (AL 35)
Allergy services in the Nottingham area have
been developed over the last five years. Initially run by one
consultant and one specialist nurse, demand has led to the service
expansion and a further nurse specialist. Over 60 new allergy
referrals are made to the clinic every month. Each new patient
seen will require a 45-minute to one hour appointment. At this
level our team are continually struggling to keep patient waiting
times down to hospital acceptable levels
A recent application to the local PCT's to maintain
this service failed to secure funding, indeed recommendations
were returned to dissolve the allergy service currently provided.
This decision demonstrates the lack of prioritisation for allergy
services at a local level. At the present time we are striving
to maintain a specialist service and running additional clinical
sessions to meet waiting list targets. NHS funding started to
support one clinical nurse specialist in 2003. Commercial funding
has run out for the second nursing post. Clinical impact of the
lack of support for allergy services include:
— Increased waiting lists. Clinical
risk associated with those requiring urgent review.
— No capacity for training or the dissemination
of expert knowledge across other related hospital based specialities,
ie paediatrics, dermatology, ENT and respiratory medicine.
— GPs unaware of the service on offer.
The misdirection of GP referrals to inappropriate specialties,
resulting in waste of time (patient and NHS) and resources.
— Limited capacity to introduce specific
paediatric nursing support. Currently paediatric referrals are
seen by adult-trained nurses with little knowledge of the inter-disciplinary
problems that this special group of patients demonstrate.
The alternative allergy tests were reviewed
in detail in Chapter 9 "ALLERGY the unmet need". Patients
that look for allergy tests within the independent sector largely
fall into three groups:
1. Patients who suspect that they are having
food related problems.
— At least 20% of the UK population
perceive they have a food problem. A brief Internet search or
a visit to the local chemist reveals various alternative allergy
tests and a certain frequently accessed test costs £260.00.
On the basis of this non evidenced based testing, major and widespread
inappropriate dietary avoidance/rotations are often recommended
and these lifestyle changes can lead to clinical nutritional deficiencies
further impacting on the individuals health. Patients can and
do become prisoners in their homes consequent upon the food avoidance
measures recommended by these mail order companies. Reality—the
majority of food allergy patients only require limited albeit
strict food avoidance and are encouraged to live a normal lifestyle.
2. Patients with nettle rash and swellings.
— Urticaria (nettle rash) and angioedema
(swellings) affect 20% of the population at some stage of their
lives. Sufferers often implicate food, pollution, chemicals, food
additives etc and again alternative tests are readily available
in the high street. Reality—in the vast majority of patients
no cause will be found for these rashes and swellings and appropriate
treatment is antihistamines.
3. Patients with hay fever type symptoms.
— Symptoms of itchy, runny nose and
eyes whether seasonal or perennial can be exceedingly distressing
and embarrassing for patients. Establishing a cause for such symptoms
can be helpful in successful patient management. Unproven alternative
tests (eg VEGA testing) purport to identify causes and often suggest
expensive avoidance measures such expensive bed encasing covers
and cleaning products, Reality—The VEGA test cannot identify
allergic from non-allergic individuals hence the recommendation
of expensive avoidance measures (>£200) is utterly inappropriate.
Patients appear to resort to alternative testing
as conventional allergy advice at the General Practitioner level
is poor and easy rapid access to allergy specialists is simply
not available. Considerable anger is often manifested in NHS clinics
when the reality of these alternative tests is revealed particularly
when patients have spent considerable sums of money to no avail.
I acknowledge the value of some forms of complementary
medicine such as acupuncture and certain herbal remedies and hence
this paper is not part of a dismissal of complementary therapy.
Rather it is to highlight the real issues faced by patients when
trying to address their allergic problems without the ability
in most areas to access an expert in allergic conditions.
May 2004
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