Memorandum by the British Association
of Dermatologists
INQUIRY INTO
ALLERGY WITH
REFERENCE TO
SKIN DISEASE:
CALL FOR
EVIDENCE
1. Defining the problem: Several
skin diseases have an allergic basis or an allergy-associated
component. The most common can be summarised as follows:
Allergy in eczema:
(a) Diagnosis: in a patient with
eczema (dermatitis), it is often difficult to distinguish contact
dermatitis (allergic or irritant) from other types of eczema.
In fact, pure contact dermatitis is uncommon—almost always
constitutional and other factors are involved. This is one reason
why people with skin disease are best assessed by a dermatologist
as the specialist with a full education in the diagnosis and management
of skin diseases.
(b) Patient pathway: A Department
of Dermatology normally should be the first point of referral
for patients with eczema, for the reasons mentioned above. It
can be difficult to differentiate atopic eczema from contact dermatitis—indeed
the two not uncommonly co-exist. Departments of Dermatology provide
a holistic approach to the management of the eczemas including
allergic aspects related to the skin, often using clinics led
by specialist nurses.
Latex allergy: All dermatologists
who deal with contact dermatitis are competent to manage latex
allergy and will be called on to do so regularly. In many hospitals
the dermatologist is the first port of call for latex allergy.
Several dermatologists have written the latex policy for their
hospital, with collaboration from other specialities including
allergists and immunologists.
Urticaria and angioedema: All dermatologists
are trained to manage these conditions and, in most hospitals,
it is the dermatologist who mostly treats patients with these
diseases.
2. Treatment and management: Patients
with more than mild skin disease are best seen by a dermatologist
since:
(a) Training: The dermatologist
is trained to diagnose, investigate and treat all types of skin
disease including occupational aspects.
(b) Facilities: Departments of
Dermatology have the facilities and support for the full range
of investigation and therapies that are required to treat skin
disease.
(c) Specialist clinics: Most
large Departments of Dermatology have a consultant who specializes
in the diagnosis and management of contact allergic conditions
related to the skin. They are trained to do more than patch testing.
Activities include:
(i) Patch testing primarily, but also...
(ii) Prick testing, and frequently, the...
(iii) Interpretation of specific IgE tests
In addition, all dermatologists treat atopic
eczema and will be familiar with the IgE-mediated problems seen
in many patients with this condition. This will be particularly
the case for dermatologists who specialise in paediatric dermatology,
as IgE-mediated problems can be especially problematic in children.
3. Government policies
Allergy Networks/Centres:
Dermatologists with an interest in allergic problems in skin
disease would be pleased to be members of a network of specialists
who treat various allergic diseases. Dermatologists recognise
that other specialists may be needed in the management of patients
with skin disease that has an allergic basis, eg allergists, immunologists,
gastroenterologists and respiratory physicians.
Current debates on provision:
There is presently much change in the way that services for patients
with skin disease are being managed. Generally, the management
of more than simple allergic problems related to the skin is a
specialist activity that would be difficult to organise in a care-close-to-home
setting. For example, the performance and interpretation of patch
testing and prick testing requires a lot of training and experience.
Hence the management of patients with this type of problem should
continue to be based in secondary care.
4. Patients and consumer issues
Referral pathways: Dermatologists
are best placed to manage patients with more than mild skin disease,
with referral to other specialists in allergic problems as necessary.
Some patients with atopic eczema who have severe IgE-mediated
problems require to see an allergist. It is a matter of ensuring
that the right patient gets to the right specialist with the right
problem.
24 October 2006
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