House of Lords - Science and Technology

Select Committee on Science and Technology Minutes of Evidence

Letter from the Royal Pharmaceutical Society of Great Britain

The role of community pharmacists in allergic conditions

Community pharmacists provide support to people with allergic conditions in a variety of ways:

— By providing advice on how to take prescribed medicines for allergic conditions.

— By providing specialist medicines management services for allergic conditions.

— By prescribing and supplying prescription-only medicines for allergic conditions (this would apply to pharmacists who have successfully completed accredited training courses to become supplementary or independent prescribers).

I have attached at Appendix 1 a paper prepared especially for this response by Shailen Rao on the role of pharmacists in the management of allergic conditions. It reflects the personal perspective of a pharmacist who has been involved in medicines management and pharmacy development in the NHS.

Some pharmacies sell diagnostic tests for allergies. However, these test kits may also be stocked in non-pharmacy areas of larger retailers, eg with a range of other health-related items, and in those circumstances the sale will not be supported by the advice of a pharmacist.

The RPSGB has recently conducted detailed research on the contribution of pharmacists to managing three long-term conditions—asthma, diabetes and coronary heart disease. [11]Key findings of the research included the following:

2. Ten intervention trials of community-pharmacy based asthma services were identified and reviewed.

3. Seven of the 10 trials showed positive effects on asthma control.

4. The most effective use of community pharmacy resources will be to focus on those whose asthma is less well controlled, or could become uncontrolled.

5. Several models of community pharmacy based asthma care are offered in the UK, usually on a pilot basis.

6. Community pharmacists have identified asthma as an area in which they would like to offer a more clinical service.

What formal training do pharmacists receive in alergy at pre- and post-graduate level?

Registration as a pharmacist requires successful completion of a four-year MPharm degree, a further year of pre-registration training within a pharmacy workplace, followed by a registration examination. At undergraduate level, the pathological and immunological basis of allergy is covered, as is treatment for symptoms with prescribed and over-the-counter (OTC) medicines. Details of the relevant parts of the pre-registration programme and registration examination syllabus are attached at Appendix 2.

At postgraduate level, we are not aware of a compendium of courses, so to identify higher education courses of relevance to allergy would require examining the prospectuses of individual higher education providers. The Centres for Pharmacy Postgraduate Education in England, [14]Scotland[15] and Wales[16] have programmes that include allergy in several forms—as a discrete topic such as asthma and also as part of a wider topic—eg eczema in skin disease.

CPPE (England) does not have any specific courses) on allergy, but it is building one this year with Allergy UK (no further details are available at this stage). It has an open learning programme on respiratory disease which covers asthma (about 1,000 are sent out each year) and one on skin disorders which looks at atopic eczema (about 1,500 per year of these have been sent out). It hosts an allergy workshop but very few of these have been run in the last few years.

Do pharmacists feel they receive enough information and support in order to competently advise the general public about allergic diseases?

The RPSGB has produced a range of resources which pharmacists would find helpful advising the public about allergic diseases, eg

The RPSGB provides a Technical Information Service staffed by experienced information specialists. The Society also provides a Legal and Ethical Advisory Service. Questions from pharmacists about allergic disease would normally be dealt with by the technical information service. The Society does not have statistics on the volume of enquiries on specific medical conditions such as allergy.

Two departments of the Society, the Technical Information Service and the Research and Development Division, undertook literature searches for this response on the topic of pharmacists and allergy. Additional references which do not appear in the footnotes are attached at Appendix 3.

The Pharmaceutical Press (an imprint of RPS Publishing, which is owned by the RPSGB) produces a wide range of textbooks for pharmacists and pharmacy students. Those of relevance to allergic conditions include Asthma in Focus (2006) and Non-Prescription Medicines (2006). [19]

We have not found any evidence that pharmacists feel they have insufficient knowledge or support to competently advise the public about allergic disease. Allergies are among the most common conditions for which the public visit pharmacies and seek the advice of pharmacists, so pharmacists are likely to be familiar with allergic conditions and their management.

The Department of Health told this Committee that a new regulatory framework for pharmacists should be introduced this year. What will this involve? Does the Royal Society welcome this? What benefit will this have to the general public?

The RPSGB has welcomed the Pharmacists and Pharmacy Technicians Order 2007, which was made on 7 February 2007. The new legislation will overhaul and modernise pharmacist and pharmacy technician regulation and will update, strengthen and clarify the RPSGB's powers to protect, promote and maintain the health and safety of the public.

The main provisions of the Order are:

— Improved capacity to address fitness to practise issues and health matters.

— Reform of the Society's registration process.

— Updated provisions for education, training and continuing professional development (CPD).

— Statutory registration of pharmacy technicians in England and Wales.

The Order has been developed as a result of close co-operation between the Department of Health, the Royal Pharmaceutical Society of Great Britain and the UK devolved administration health departments. There are separate arrangements for the regulation of pharmacy in Northern Ireland.

Which treatments are most commonly bought in pharmacies for the treatment of allergic conditions?

The Proprietary Association of Great Britain provides total sales figures (supplied by Information Resources Inc) for OTC medicines but the figures do not distinguish sales from sales in other outlets. Most of the categories used in the figures do not distinguish allergic from non-allergic conditions. However, they show that £79.1 million was spent on OTC hay fever remedies in 2005, a rise of 4.5 per cent compared to the previous year. [20]The total OTC sales of hay fever remedies have doubled in the past six years. Hay fever remedies are sold for a range of allergic conditions and sales take place all year round. [21]

Another information provider, IMS Health®, has supplied figures for this inquiry. For the year March 2006 to February 2007, pharmacy sales of OTC medicines used for allergic conditions totalled £47,574,208, a rise of 5.45 per cent in the total value of sales compared to the previous year. The sub-totals for the four categories of medicines making up that total are:

— Asthma remedies (£490,122).

— Respiratory and general anti-allergics (£25,634,167).

— Skin irritation including topical antihistamines (£14,756,075).

— Eye anti-allergies and anti-inflammatories (£6,693,845).

The figures are for pharmacy independents and multiples but do not include mass market channels such as Boots, Superdrug and the supermarkets. [22]

What diagnostic tests are available over the counter for allergies and does the Royal Society recommend these?

The RPSGB's Technical Information Services published guidance on diagnostic testing in community pharmacy in 2006. [23]It includes information on providers of allergy and food intolerance testing. The Society does not make recommendations as such regarding particular tests or suppliers of tests. Additional information on diagnostic tests for allergies is attached at Appendix 4.

The RPSGB also produces general guidance on diagnostic testing and health screening in its Code of Ethics (Service Specification 14). [24]

APPENDIX 1

THE ROLE OF PHARMACISTS IN THE MANAGEMENT OF ALLERGIC CONDITIONS

Background

Community Pharmacists currently provide a wide range of services and support to patients with allergic conditions and associated conditions eg allergic asthma. The main role at present is the over the counter (OTC) diagnosis and supply of medicines to manage mild allergic respiratory and skin conditions eg hay fever and allergic contact dermatitis. Recent changes in NHS policy and a drive to extend the rota of health care professionals eg practice based commissioning, extended prescribing and the new pharmacy contract provide an opportunity to further enhance the role of pharmacists in the management of allergic conditions.

The Current Service

Pharmacists are already recognised by the public as a key resource in the treatment of mild allergic conditions. They are regularly consulted by patients who present with symptoms of allergy. Many of these patients prefer to see a pharmacist rather than to take time off work to visit a GP. In the first instance, many patients will not know that the condition is allergic in nature. Pharmacists are well skilled in using over the counter questioning techniques to establish potential allergic conditions and also have at their disposal a wide and growing range of first-line treatments, without the need for a prescription. These include oral antihistamine therapy, topical skin preparations eg hydrocortisone cream and cromoglycate eye drops. Pharmacists also provide information and education on prevention and minimisation of symptoms. Many of these patients will continue with over the counter treatment and others will see their GP for future treatments. Pharmacists also provide a very important role in referring patients suspected as having more serious conditions to their GP eg asthma and eczema.

By providing this comprehensive and patient centred OTC service, a huge number of GP consultations are probably avoided each day across the country. In addition, OTC purchasing by patients rather than seeking a GP prescription reduces the burden on the NHS drugs bill.

In some areas, allergic conditions are included as part of Minor ailments schemes commissioned locally by PCTs. In these schemes, patients with symptoms of minor illness are directed to pharmacies by GP practice reception staff. The pharmacist is enabled to triage the patients and either provide treatment or refer to the GP.

Many patients with allergic conditions will be on regular medication eg antihistamines. However, in many cases, compliance is likely to be poor, often caused by a lack of knowledge about the condition or the medication. Pharmacists could be well placed to utilise medicines use reviews (MURs), which are part of the national pharmacy contract, to improve adherence to medication. It is probably unlikely that this is being explored as a specific opportunity as yet.

In addition to community pharmacy, prescribing advisers in GP practices have been involved in the management of allergic conditions. This includes advice to GPs on drug choice and running audits within practices to review use eg antihistamines. In recent times, a number of prescribed antihistamines have come of patent and therefore reduced in price. Pharmacist involvement at practice level has helped GPs to endure that treatment remains cost-effective. Hospital pharmacists play a key role in identifying allergies, specifically drug allergies; recommending safer alternatives and ensuring appropriate use of medicines during hospital admissions. Pharmacist led NHS medicines information services also provide information and advise on identifying and managing patient drug allergies; for healthcare professionals and the general public.

A Potential Future Pharmacy Service in Allergy

Whilst pharmacists already provide a valuable role, it would be possible to enhance the value they add by better integration of within local NHS service delivery. A number of recent initiatives and policy documents would empower such a role:

— The pharmacy contract.

— Practice based commissioning (PBC)

— Extended prescribing rights.

— Practitioners with specialist interests (PwSIs).

— Choosing "Health Through Pharmacy".

Pharmacists could become a first port of call and specialist medicines support service, recognised by patients and health care professionals across the whole health economy. In order for this to happen, a local service specification would need to be drawn up.

A brief description of an example specification is given below:

1. Patients could continue to present over the counter (as they do now).

2. Pharmacists would run regular health promotion campaigns to raise awareness of allergies and the presence of pharmacy as a resource. This could fulfil part of the requirement to run health promotion campaigns under the pharmacy contract.

3. GPs would refer patients with allergies to be managed by the community pharmacist. This could be done either by use of a patient group direction (PGD) or where possible by utilising independent/supplementary prescribing. The pharmacist could then continue the management of the patient ensuring that the patient is complying and altering medication as required.

4. Patients already being treated by their GPs could be referred to the pharmacist for support with prescribed medication. The pharimacist could utilise MURs to ensure that the patient is gaining benefit whilst also minimising the potential for wastage caused by unused or unwanted medication.

5. The service could be broadened to include patients with allergic asthma. Pharmacists would be well placed to provide support on the use of inhaled medications.

6. In the future, it may be possible to commission an allergy testing service through pharmacy. Some pharmacies already provide a testing service but at present these tests are not always of a standard recognised by other health care professionals.

Potential Benefits of the service:

1. Improved access to services for patients.

2. Improved patient knowledge and understanding of the condition and treatments options.

3. Cost-effective utilisation of pharmacists—some of these resources eg MURs, health promotion campaigns are already funded but may be under utilised.

4. Workforce development of pharmacists—improved knowledge via training on PGD and extended prescribing.

5. Improved working relationships between GPs and pharmacists.

6. Reduced workload for GPs.

7. Improved effectiveness of prescribed medication and reduced wastage.

Conclusion

Pharmacists in all sectors of the health community are a valuable source of identifying and managing allergies, specifically drug related ones. Community pharmacists currently provide an extensive service in the management of allergic conditions. In the main, this is an OTC service dependent on the patient self-presenting in the pharmacy. Some patients will either suffer in silence with conditions that could readily be treated, whilst others will present at GP practices and possibly even in hospital.

With the changing NHS agenda, there is now a move to utilise a wider range of healthcare professionals, especially in primary care settings. These initiatives provide the means for engaging primary care pharmacists to improve the management of allergic conditions.

In order, for the potential to be realised, NHS organisations should be encouraged to develop care pathways for allergic conditions and explore how pharmacy services could be integrated within them. Although additional funding may be required, it is possible that much of the existing resource eg MURs and GP practice prescribing budgets could be better utilised making such a service cost-effective at the same time as being high quality.

APPENDIX 2

PRE-REGISTRATION EDUCATION AND TRAINING REQUIREMENTS FOR PHARMACISTS OF RELEVANCE TO ALLERGIES

Dr Nicola Tyers, Preregistration Manager, RPSGB

1. PRE-REGISTRATION PERFORMANCE STANDARDS (LEARNING OUTCOMES OF THE PRE-REGISTRATION YEAR)

Although there is not an explicit requirement for MPharm students to specifically cover allergy, this topic will definitely be covered within the area of Pharmacy Practice and specifically in Responding to Symptoms, and Clinical Pharmacy training.

Also, in the pre-registration Performance Standards there is not an explicit requirement for trainees to cover allergy, other than C2.10, which deals with emergency first aid. It is not realistic to provide a list of all topics that trainees should cover as part of their core Performance Standards, but rather a list of outcomes in dealing with differential diagnosis and recommendations of treatment.

Trainees are not specifically trained in diagnosis. The following Performance Standards do amount to assessing situations and providing solutions.

Trainees must show that they:

A3.1 Recognise and define actual or potential problems.*

* Problems include difficulties, minor and serious, needing resolution.

A3.2 Identify workable options to resolve the problem.

A3.3 Select the best solution, based on sound analysis* and appropriate evidence.

* Sound analysis will include:

— Exploring the strengths and weaknesses of options.

— Considering barriers to resolving the problem.

— Discussion with others.

A3.4 Suggest and, if appropriate, implement solutions to problems.

A3.5 Evaluate the outcome of the solution after implementation, and if necessary redefine the problem (see A3.1).

B1.11 Provide information and advice appropriate to the needs of the recipient(s)*.

* Recipients must include individuals, groups and those with particular needs, eg people with diabetes, asthma etc.

Unit C—Medicines and health standards encompass aspects of performance and behaviour that are specific to pharmacy practice and cover responding to symptoms. I would suggest that an integral part of dealing with responding to symptoms would be the diagnosis and treatment of allergy.

In this Unit, trainees must demonstrate their ability to provide an effective pharmaceutical service.

Development of the following characteristics will underpin their future role as a provider of pharmaceutical care:

— identifying health needs and understanding the opportunities for health promotion as well as treatment and care;

— working with patients and carers, to manage their medicines and ensure that they can play an active part in the decisions and choices affecting their treatment or care;

— understanding and making the most of the whole health and social care system—for the benefit of patients.

For this unit to be achieved, trainees must have experience or awareness of the following:

— supply of medicines from both community and hospital;

— provision of advice about medicines and health;

— use of patient medication records and histories.

Performance Standard C2—Provide additional clinical and pharmaceutical services Trainees must demonstrate the application of their clinical and pharmaceutical knowledge. Trainees must show that this knowledge is up-to-date. It must be used effectively in the following areas:

— the management of prescribed medicines, long term conditions and common ailments;

— the promotion and support of healthy lifestyles;

— the provision of advice and support to patients and other healthcare professionals.

Competence in this element will underpin trainee's ability to manage medicines and provide pharmaceutical care in the future.

Trainees must show that they:

C2.1 Provide considered and correct answers to queries, founded on research-based evidence*.

* Evidence sources will include clinical textbooks, journals and pharmaceutical company information (whether paper-based or electronic).

C2.2 Pro-actively* assist patients** to obtain maximum benefit from their treatment.

* This will include identifying opportunities to assist, providing information, positive reinforcement, reassurance, testing understanding and encouraging recipient to ask questions.

** Directly or via their representatives.

C2.6 Use medication histories correctly*.

* Access existing information, record new information and apply the information.

C2.7 Recognise possible adverse drug reactions, evaluate risks and take action* accordingly.

* This may include advising and informing patient or representative, discussion with colleagues and reporting to CSM.

C2.8 Provide appropriate information and advice on the management of minor and common ailments*.

* Information and advice must incorporate both appropriate self-medication and appropriate non-drug actions.

C2.9 Effectively use opportunities* to promote and support healthy lifestyles and prevent disease.

* With individual patients and at formal events such as presentations to patient or public groups.

The above includes Performance Standards that could be used to test differential diagnosis. Items highlighted in bold should cover allergy. It is important to remember that allergy could also include an allergic response from a medication.

2. REGISTRATION EXAMINATION SYLLABUS

Items highlighted in bold below should cover allergy, although not specifically mentioned.

SYLLABUS SECTION 2—CLINICAL AND PHARMACEUTICAL PRACTICE

Part I—Clinical Practice
(a) Evidence-based practice	You must be able to demonstrate an understanding of:
	— The principles of obtaining and applying evidence to inform and enhance practice.
(b) Action and uses of drugs	You must be able to demonstrate an understanding of:
	— The mechanism of action, administration, absorption, distribution, metabolism and excretion of commonly prescribed and purchased licensed medicines.
	— The principle uses of these medicines.
	— Correct dosages and dose adjustments for patients with particular needs because of their age or condition.
(c) Non prescription remedies	You must be able to demonstrate an understanding of:
	— The actions and licensed uses of medicinal products available without prescription that are commonly used to treat minor ailments.
(d) Differentiating minor illness from more serious disease	You must be able to identify and to demonstrate an understanding of:
	— The symptoms of conditions that require referral to a medical or other healthcare practitioner.
	— Conditions not requiring referral and how they may appropriately be treated by non-precription medicines, by short-term action that does not involve medication or by lifestyle change.
(e) Adverse effects of medicines	You must be able to demonstrate an understanding of:
(see also section 3, item e)	— the recognised adverse effects of commonly prescribed and purchased medicines.
(f) Contra-indications	You must be able to demonstrate an understanding of:
	— the circumstances in which commonly prescribed and purchased licensed medicines are contra-indicated.
(g) Drug interactions	You must be able to demonstrate an understanding of:
	— the principle interactions that can occur between medicines, prescribed and purchased, and between these medicines and foods or other substances.
(h) Counselling requirements	You must be able to identify and demonstrate an understanding of:
	— circumstances or situations in which patients or other clients require information.
	— the nature of that information and the most appropriate way to provide it to the individual.
(i) Optimising patients' drug therapy	Understanding of:
	— The purpose and principles of medicines management and pharmaceutical care.
(j) Interpretation of test results	You must know, demonstrate an understanding of and be able to interpret:
	— The normal ranges for blood pressure and key blood components.
	— The normal ranges for therapeutic blood levels of drugs with a narrow therapeutic index.
	— The normal ranges for key parameters of bodily function.
	— The implications of figures outside these ranges.
(k) Health promotion and disease	You must be able to demonstrate an understanding of:
prevention	— The concepts of health promotion and health education.
	— Recommendations for key health parameters.
	— The basis for health improvement programmes.
	— The social, environmental, lifestyle and dietary factors that influence health.
	— How awareness of the stages of behavioural change can help the pharmacist to make interventions appropriate to the individual.
	— Actions the pharmacist and pharmacy support staff can take to promote health and prevent disease.

Asthma is only mentioned as an example in the standards. We deliberately do not have a definitive list of topics as things are always changing. Trainees will be exposed to learning about allergy in practice.

The overarching information about Performance Standard C2 does state that trainees must know about the management of prescribed medicines, long-term conditions and common ailments. I would expect this to cover allergy in its broadest sense of both short and long duration. The assessment standards under C2 (below) would also cover this. The knowledge requirements under C2 deal with inhalers, which are integral to asthma treatment.

C2 Assessment requirements

Evidence that your trainee provides for assessment should include:

— proof that she has been involved in the provision of pharmaceutical services in both community and hospital practice.

— proof that she has provided advice or supplied non-prescribed medicines for a wide range of conditions, including those affecting:

— the respiratory tract;

— the gastro-intestinal tract;

— musculoskeletal and connective tissue;

— women;

— babies and children;

— elderly patients;

— patients with long term health management needs.

C2 Knowledge requirements

Most of the knowledge represented by the whole registration examination syllabus is needed to underpin these standards.

In addition, your trainee must show that she has a working knowledge of, and can apply, the following:

Compliance aids—availability and use.

Use of inhalers and other devices.

Dispensing for residential and nursing homes.

Emergency first aid.

Government healthcare priorities.

Local healthcare priorities.

Patient information leaflets.

How to evaluate literature and data.

Referral agencies in emergency or for provision of further advice.

Roles of healthcare professionals.

Sale of medicine protocol in your pharmacy (where the pharmacy sells medicines).

Techniques for effective questioning.

Information sources.

It must be remembered that none of the Performance Standards should be viewed in isolation, a trainee would not learn about inhalers in isolation—they would also learn about providing information to the patient about asthma management. I have attached the full list of Performance Standards including the underpinning assessment and knowledge requirements for your information.

APPENDIX 3

ADDITIONAL REFERENCES—PHARMACISTS AND ALLERGY/ALLERGIC CONDITIONS

Pharmacy practice

GSK Website www.pharmassist.gsk.co.uk/en120.htm

Carr A et al. A pilot study of a community pharmacist intervention to promote the effective use of emollients in childhood eczema. Pharmaceutical Journal 2007; 278: 319-322, www.pjonline.com/pdf/papers/pj_ 20070317_childhoodeczema.pdf

Dawn G. Allergy—Reacting to reactions. Independent Community Pharmacist 2006; Apr: 16-19.

Focus on Customer Care—Discussion subject: airborne allergies. Pharmacy Magazine 2004; 4: 40-41.

Allen, M. Scratch and sniff. Pharmacy Magazine 2005; 7: 40-41.

Geoffrey C Wall; Lisa Peters; Catherine B Leaders; James A Wille. Pharmacist-Managed Service Providing Penicillin Allergy Skin Tests. American Journal of Health-System Pharmacy. Posted 07/02/2004.

Education

RPSGB Pre-registration Performance Standards http://www.rpsgb.org.uk/pdfs/preregtrwb06-07.pdf

Centre for Pharmacy Postgraduate Education courses:

Skin Conditions, the Management and treatment of http://www.cppe.manchester.ac.uk/Bookings/Details.asp?TemplateID=Dermat%2DD%2D02&OnTab=0&Format=D

Pharmaceutical Care of the Eye http://www.cppe.manchester.ac.uk/Bookings/Details.asp?TemplateID= EYE%2DD%2D02&OnTab=0&Format=D

OTC Diagnostic Testing

Royal Pharmaceutical Society. RPS e-PIC References on; Diagnostic testing in community pharmacy www.rpsgb.rpsgb.org/pdfs/rpsepicdiagest.pdf

Consulting areas for Superdrug stores. Pharmaceutical Journal. 2003: 270: 465 http://www.pjonline.com/Editorial/20030405/news/superdrug.html

Moss offers food intolerance tests. Chemist-and-Druggist 2002; 257: 20.

Home allergy test kits for asthmatics. Chemist-and-Druggist 2002; 257: 28.

Imutest home allergy test. Pharmaceutical-Journal 2001; 267: 48.

Lloyds offers food intolerance tests. Pharmaceutical Journal 2001; 266: 243.

APPENDIX 4

ADDITIONAL INFORMATION ON DIAGNOSTIC TESTS FOR ALLERGIES

Consulting areas for Superdrug stores, Pharmaceutical-Journal 2003: 270: 465 (5 April). Superdrug is to introduce screened consulting areas to its stores following positive feedback from customers about the 20 stores that have private consulting rooms. Superdrug currently uses its consulting rooms for services from blood pressure monitoring to allergy testing. http://www.pjonline.com/Editorial/20030405/news/superdrug.html

Moss offers food intolerance tests, Chemist-and-Druggist 2002: 257: 20 (20 April). Moss Pharmacy is offering food intolerance and allergy tests in its 800 branches. The tests are approved by the British Allergy Foundation and produced by York Nutritional Laboratories.

Home allergy test kits for asthmatics, Chemist-and-Druggist 2002: 257: 28 (16 March). A range of home test kits has been designed to help asthma sufferers to diagnose their specific allergies. Individual test kits have also been developed to confirm cat, house dustmite, egg, milk and pollen sensitivity.

Imutest home allergy test, Pharmaceutical-Journal 2001: 267 (14 July): 48. Clinical Diagnostic Chemicals has launched Imutest, a range of six home testing kits for checking sensitivity to allergens. Imutest Allergy Check is for checking patients' sensitivity to allergens and is useful in those who have no idea what the causes of their symptoms are. Other products in the range test for five of the most common allergies: cat, egg, hayfever, house dust mite and milk. An allergy care nurse is available to provide support for users of Imutest.

Lloyds offers food intolerance tests. Pharmaceutical-Journal 2001: 266 (24 February): 243. Lloyds Pharmacy Ltd is offering its customers a food intolerance testing service which will allow them to change their diets to avoid foods they might be allergic to. Two types of test service are available. A 40-food screen (£99 sterling) tests groups of foods, such as citrus fruits, for reactions and provides results for the most commonly eaten foods. A 93-food screen (£245 sterling) offers more precise measurements for individual foods. The food testing is undertaken by York Nutritional Laboratory Ltd.

Unfortunately there is not a comprehensive list of diagnostic tests available for allergies; some of the products available are:

Home allergy test kit (Clinical Diagnostic Chemicals).

Imutest self tests for allergy (Clinical Diagnostic Chemicals).

Yorktest (Yorktest Laboratories).

Food Allergy and Food intolerance test kits (www.mypharmacy.co.uk—testing is carried out by Exeter Nutritional Clinic).

9 Bokma A (2006). Clearing the air for allergy sufferers-pharmacists ease patient confusion. Pharmacy Practice Canada 22(6); A13-A15. Back

10 The role of pharmacists in advising patients with allergies was recognised in the Department of Health's 2006 review of allergy services-Pharmacists need to advise public about allergies. Pharmaceutical Journal 277; 124, 29 July 2006. Back

11 http://www.rpsgb.org.uk/pdfs/ltcondintegcommphsumm.pdf Back

12 http://www.rpsgb.org.uk/pdfs/ltcondintegcommphreptl.pdf Back

13 http://www.rpsgb.org.uk/pdfs/ltcondintegcommphrept3.pdf Back

14 http://www.cppe.manchester.ac.uk Back

15 http://www.nes.scot.nhs.uk/documents/publications/classa/Pharmacy_newsletter_2004_spring.pdf Back