Select Committee on Health Written Evidence

Memorandum by Dr Adrian Morris (AL 50)


  With increasing public awareness of allergy related diseases, the inadequate provision of National Health Service (NHS) allergy diagnostic and treatment clinics has become apparent. Even the few available NHS allergy clinics found mainly in and around London have waiting lists in excess of 12 months. In their desperation to seek alternate allergy services (after failing to get General Practitioner (GP) referral to NHS allergy services) many genuinely allergic people will end up in the hands of fringe allergy practitioners, where they receive poor advice regarding their allergies. They then endure years of unnecessary dietary restriction, inappropriate treatments and wasting income on costly and unnecessary food supplements.

  This obvious under provision of specialist allergy services in the NHS is highlighted in the Royal College of Physicians (RCP) Report and leaves no doubt that allergy specialist services in England are grossly inadequate.

1.  Royal College of Physicians, Allergy-the unmet need: a blueprint for better patient care: London RCP 2003


  Long-term solutions for improved services include: Better undergraduate allergy education as part of basic medical training, increasing General Practitioner allergy awareness during Registrar training and encouraging GPs to acquire better allergy diagnostic skills as part of ongoing Professional Development Plans (PDP). Central funding for more NHS specialist and nurse driven allergy clinics in community hospitals and regional hospitals is necessary. Creation of more Senior Registrar and Consultant posts for Clinical Immunologists and Allergists over the next few years will only have a positive clinical impact in five or more years' time.[2]

  Certain short-term strategies can implement immediate improvement in services. Many NHS allergy diagnostic services and allergy courses are available but this is not common knowledge.

  A number of organizations already offer accredited allergy training courses for GPs and Practice Nurses including National Respiratory Training Centre in Warwick, Allergy UK Allergy Days, Southampton Hospital MSc Course and the British Society for Allergy and Clinical Immunology (BSACI) Basic Allergy courses.

   Allergy testing is readily accessible at NHS pathology laboratories in the form of improved versions of the RAST (Radio-Allergo-Sorbant-Test) known as a CapRAST or UniCAP test—this blood testing facility is currently available to most private and NHS Specialists and General Practices in England.

  The GP simply has to complete a standard request form for the specific RAST test and send a clotted blood specimen in the usual way (as simple as requesting a cholesterol check). Utilising this facility, a GP would immediately be able to confirm the cause of suspected life-threatening food anaphylaxis and not have to wait one year for a specialist consultation in London or perhaps never be able to confirm the diagnosis if in North England (where no referral allergy clinics exist). Allergy self-test kits marketed by certain supermarket and pharmacy chains for home testing provide rather "hit and miss" results and are of debatable value.

   There are over 450 individual UniCAP RAST tests available for anything from Almond to Yeast. There are about 90 NHS pathology laboratories in the UK that offer these UniCAP RAST tests and those that don"t can refer the tests to reference laboratories. This has been confirmed by personal communication with the UK suppliers of UniCAP RAST to these 90 NHS Hospitals (Sweden Diagnostics (UK)).[3] RAST tests are relatively expensive at approximately £8 per allergen, but essential for allergy confirmation prior to a life-time of specific allergen avoidance and prescribing of expensive Epipen (or Anapen) adrenaline auto injectors (£72 as two are issued annually) for suspected anaphylaxis.

  As most NHS pathology departments provide fixed rate services to Primary Care Trusts (PCTs), it is currently not be in their budgetary interest to encourage the use of these little known tests. Most GPs are not aware that these tests are indeed widely available. The short-term solution to inadequate allergy clinic provision is to encourage use of existing test facilities in a controlled and responsible manner. To achieve this, GPs would need "information algorithms" on how to request the most appropriate RAST tests for each specific allergic condition.

  Recent reports indicate that many GPs are of the view that allergy testing is a futile and unreliable exercise, and are uncomfortable interpreting test results. Many feel ambivalent and lack confidence in (or have any interest in) Allergology. But simple management protocols and algorithms can be designed by organisations such as the National Institute for Clinical Excellence (NICE), BSACI and RCP. This simple strategy could facilitate large numbers of allergic conditions being adequately treated in the primary care General Practice setting. In this way existing allergy diagnostic services would be better utilised and the burden on specialist allergy clinics reduced.


  The unregulated private allergy sector is a source of great concern. Allergy sufferers despondent that they cannot get access to an NHS allergy diagnostic service then approach the unregulated private sector. Often practitioners are not even medically qualified and the testing methods usually have no scientific basis nor have been validated. These pseudo-diagnostic tests usually designed to identify multiple "sensitivities" include VEGA testing (black box), Applied Kinesiology (muscle test), Hair Analysis and the leucocytotoxic tests (marketed as Nutron or ALCAT tests), all of which have been discredited over the years. Unfortunately the plethora of these tests and pseudo-diagnoses are growing at an alarming rate. These practises provide no useful role in allergy diagnosis as they confuse the public about their allergies and put individuals onto unnecessary and sometimes dangerous diets. This leads to social deprivation, unnecessary anxiety and occasionally death from misdiagnosis of a severe underlying allergy.

  There is an urgent need to introduce regulatory bodies to act as gatekeepers to and check on unconventional practices. This should involve utilising reputable complementary health practitioners in a regulation process to ensure registration of all complementary practitioners purporting to diagnose and treat allergies. In this way only trained ethical practitioners would be allowed to practice independently and standards of service would improve. The public would then be protected in a similar way to which the General Medical Council operates in protecting the public from unscrupulous practitioners masquerading as allergy experts.

  1.  "Which" Report: Allergy Testing 1998.

  2.  Allergy: Conventional and Alternative concepts. A Report of the Royal College of Physicians Committee on Clinical Immunology and Allergy 1992.

  3.  Health shops stoke up fake allergy fears (page 8) Sunday Times Newspaper 29 December 2002.

  4.  Morris AJ Complementary medicine and allergy—a review of the facts Current Allergy and Clinical Immunology 1996:Vol 9 No 3.

May 2004

2   Levy ML et al: Inadequacies in UK primary care allergy services: national survey of current provisions and perceptions of need. Clinical and Experimental Allergy; 2004: 34; 518-519. Back

3   MacLachlan K, Manager. Sweden Diagnostics (UK)Ltd, CBX2 West Wing, 382-390 Midsummer Boulevard, Central Milton Keynes MK 9 2RG. Back

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