Memorandum by Dr Mark Rosenthal, Consultant
Respiratory Paediatrician, Royal Brompton Hospital
There is an increasing demand from the public
for allergy services. This has stemmed from partly a modest true
increase which may be stabilising (Thorax, 2007; 62: 91-6),
the comparatively recent recognition that certain infant symptoms
may be manifestations of allergy, a greatly increased public awareness,
and all fuelled by the rare but well publicised deaths from food
allergy. This has been compounded by a large amount of lay literature
much of which is non-evidence based. There is a large body of
scientific data and clinical trials testifying to the value of,
for example, desensitization for hayfever and venom allergy. However,
there are a large number of "complementary" medicine
services from the clinic to the high street advertising allergy
testing services almost all of which are unproven; examples being
hair testing and passing magnets over the body. These represent
a danger to the public—for example, we have seen children
lose weight as a result of completely unnecessary exclusion diets.
There is also the danger which I have seen manifest in otherwise
sensible consultant clinicians that almost any symptom in a child
can have an allergic dimension placed on it.
Allergy is following a well known pattern of
medical inventions. Having been comparatively ignored in the past
and under-diagnosed, under-researched and indeed under-funded,
there is now tremendous (over)-enthusiasm, possible over diagnosis
and a surge in interest and funding. In a few years the pendulum
will swing back to an extent so that allergy takes its rightful
important but not cuckoo like place in the spectrum of childhood
disease.
Disentangling the true facts from misinformation
and hype is naturally problematic. Allergy suffers from a lack
of detailed understanding; for example why do 95 per cent + of
milk (and egg) allergic children grow out of their allergy whilst
only 15 per cent of peanut allergic children do so; and why do
the overwhelming majority of children not have food allergy? Apart
from tree/grass hayfever and bee/wasp venom allergy desensitisation,
the rest can only be prevented and managed given the current state
of medical knowledge. Does infant avoidance of risk foods especially
peanuts reduce or increase food allergy later is the subject of
a large study at its earliest stage. There is no formalised allergy
training programme for doctors in the UK certainly in paediatrics
and perhaps it should have greater prominence. Is the tremendous
increase in prescriptions for adrenaline injection devices (1/80
children in Manitoba, Canada carry one) serving children well
and protecting them or merely leading to social difficulties and
greater family anxiety. Out of countless prescriptions I have
written over the last 12 years for such devices only one has ever
been used.
This committee has assuredly chosen a minefield
to walk through.
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