Select Committee on Science and Technology Sixth Report


13 December 2006

Members visiting the hospital were: Lord Colwyn, Baroness Finlay of Llandaff (Chairman), Lord May of Oxford, Lord Rea, Earl of Selborne, Viscount Simon, Lord Taverne. In attendance: Dr Christopher Johnson (Clerk), Miss Sarah Jones (Clerk), Professor A. B. Kay (Specialist Adviser), Dr Cathleen Schulte (Committee Specialist).

The Committee was welcomed to the hospital by Dr Edward Baker (Joint Director of Clinical Leadership and Medical Director, Guy's and St Thomas' NHS Foundation Trust), Professor Richard Trainor (Principal, King's College London), Professor Robert Lechler (Vice-Principal (Health), King's College London), Professor Gideon Lack (Head of Paediatric Allergy) and Professor Tak Lee (Director of the MRC-Asthma UK Centre). Parts of the hospital had been designed by children, who had named the floors and wards, and played a part in the design of the furniture.


Professor Trainor and Professor Lechler provided an overview of King's College London and how the Centre sat within the Health schools of the College. King's College London had more MRC centres than any other institution and placed great importance on asthma and allergy, hence its decision to partake in the development of the MRC-Asthma UK Centre for research. With regard to asthma and allergy, the most important area of research was translational work, which developed laboratory findings into practical treatments.

Professor Lee summarised the activities of the Centre which was a collaboration between the MRC, Asthma UK, King's College London, Imperial College London, and the NHS. The NHS provided a vital infrastructure and access to patients through the Guy's and St Thomas' NHS Foundation Trust, King's College Hospital Trust, Royal Brompton Hospital Trust and St Mary's Hospital Trust. This was the only centre of its kind in the country. Previously, research into allergic disorders had been fragmented between different units, but the development of the MRC-Asthma UK Centre meant that all the organisations had been able to combine their research strengths into one cohesive strategy for the first time. The centre employed 21 senior scientists of whom 11 were clinicians, and worked in partnership with a network of general practices in the East of London. Its mission was to make discoveries to inform new treatments and preventative strategies, and the priorities for research were informed by national consultations on asthma research convened by Asthma UK.

In addition, the Centre provided an environment for research training and had been awarded 10 PhD studentships by the MRC and Asthma UK. The Centre also supported NHS trainee allergists in partner hospital trusts by providing research experience. But although the centre was able to help train new allergy specialists, there were very few jobs within the NHS for them to take up.

Professor Lack explained that collaboration between clinicians and researchers was vital for translational research as it enabled clinical trials to be carried out in children, and allowed the fast tracking of discoveries into clinical practice. The Children's Allergy Service at the hospital was extremely valuable as it could see 3,000 outpatients a year, and around 500 day-cases. The hospital employed three paediatric allergy consultants, three paediatric allergy nurses and a paediatric dietician. King's College London employed an additional nine clinical research staff, scientists, and administrative staff who worked side by side with the clinical team. Allergic disorders often crossed the boundaries of specialist consultants. Therefore the hospital arranged weekly multi-disciplinary meetings involving nurses, consultants and dieticians, and the paediatric allergy service held joint allergy clinics with other paediatric services (such as gastroenterology, every two weeks) and with adult allergy services. This integration of services was important as it enabled research into the way in which lifestyle modifications in childhood could reduce the risk of allergy in later life.

Discussion focussed on the following points:

  • There were various types of asthma which needed to be treated in different ways. Although steroids were a common treatment for most types of asthma, "steroid resistant asthma" was resistant to this treatment. Current knowledge of this topic was limited, so further research was needed to develop an understanding of the various phenotypes, and to establish which patients responded to which treatments.
  • When the hospital had first opened, the majority of patients had been referred from local GPs. Over time there had been an increase in the number of tertiary referrals, and the number of referrals from outside London. There had also been an increase in the number of referrals from departments such as dermatology, gastroenterology, and ENT, which demonstrated the unmet need for allergy services. The number of complex allergy cases, where children were allergic to multiple allergens and suffered from multiple allergic disorders, had also increased.
  • The capacity for allergy treatment needed to be increased. There was no framework for allergy treatment within the NHS, so the disease burden was not fully known. When allergy specialists completed their training there was a lack of jobs in the NHS for them to enter, and the relative paucity of allergists in the United Kingdom meant that there were few people who could adequately train specialists and GPs. It was felt that PCTs did not have the money or resources to solve this problem, and as the full disease burden of allergic disorders was still unknown, PCTs would not be able to judge the services needed.
  • Allergy was not coded as a single disease for research purposes; the majority of funding was provided for asthma research. Allergy funding in general was focussed on projects examining the mechanisms of allergic diseases and, while this was essential, it was felt that additional funding should be allocated for research into clinical treatments. There was also a need to research allergy prevention and to establish reliable advice for the public on issues such as peanut allergy prevention.
  • It was felt that research into allergic diseases was justified because most of the conclusions did not recommend difficult, expensive solutions which would be unobtainable. Instead, the findings of allergy research usually recommended changes in lifestyle behaviours such as diet, smoking or pet ownership, which members of the public could easily and quickly respond to.
  • There was not enough data on the costs of allergy treatment. This needed to be addressed even though some aspects would be hard to measure. For example, a course of immunotherapy was very expensive and had to be administered by a specialist, but the effects were long-term and so could reduce the need for future treatments. Therefore immunotherapy could potentially save the NHS money in the long-term.

Tour of the hospital

The Committee visited the "Snowy Owl" unit, a clinical trials unit dedicated to the prevention and treatment of asthma and other allergic disorders in childhood. The unit had the capacity to evaluate 30 participants enrolled in clinical trials every week. The Committee talked to a young boy who was extremely allergic to egg. Because of the risk of anaphylaxis, this boy and many others received routine vaccinations in the controlled environment of the clinical trials unit, so that any reactions could be dealt with immediately.

Dr George Du Toit (Consultant) and Professor Lack briefed the Committee on recent research into food allergies. Cross-sectional epidemiological studies in countries such as Israel, had demonstrated that early peanut consumption during childhood was associated with a low rate of peanut allergy in the population. Professor Lack and his research team were testing these cross-sectional findings in the LEAP study, which intended to enrol 480 infants who suffered from either egg allergy and/or eczema who were aged 4-11 months. Half the participants would receive a diet which regularly contained peanut protein, whilst the other half would avoid peanut. The study intended to monitor these children until the age of five, to assess whether peanut consumption or avoidance caused an increased risk of developing peanut allergy. If the results showed that introduction of peanut at an early age helped to protect against allergy, then current DH advice which recommended peanut avoidance for infants, might actually have been contributing to the increase in peanut allergy prevalence.

Dr Adam Fox (Consultant), Dr Susan Chan (Consultant), Ms Patricia Kane (Asthma nurse), Ms Judith Searle (Asthma nurse) and Ms Hasita Prinja (Paediatric dietician) welcomed the Committee to the outpatient unit. It was vital that children received regular allergy testing because some allergies could be outgrown, rendering allergen avoidance unnecessary. For a diagnosis to be reliable, the results of allergy tests had to be analysed in the context of the patient's history.

Finally, the Committee met a seven year old hayfever sufferer who had been referred to the hospital by a paediatrician in Oxford. The boy suffered so acutely from sore eyes and itchy throat that he could not even play outside at school. Skin prick tests were carried out to establish which allergens caused a reaction, and it was suggested that the boy might receive sublingual immunotherapy in the future. This was a convenient treatment which would not require the patient to attend hospital, would reduce his reaction to the specified allergen, and could also possibly prevent the development of other allergic conditions.

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