Medical services for allergies

Where do I turn for help?

Your GP is the first port of call if you suspect you have an allergy. About 3 million people a year are seen in primary care with conditions linked to allergies. Some patients will then be referred to allergy clinics for diagnostic tests and treatment.

The British Society for Allergy and Clinical Immunology lists more than 80 NHS allergy clinics in the UK. NHS trusts have to guarantee patients a wait of no more than 13 weeks to attend an allergy clinic.

Am I likely to get the help I need?

GPs get little or no training in allergies. Some individual GPs, who are interested in the subject, attend study days and read up on the subject, and some GP practices have good links with their local area allergy clinic and improve their skills through regular contact and training from specialist staff.

Despite this, the overall picture is poor.

There are no financial incentives for GP practices to treat allergy, unlike, for example, asthma where 'quality indicators' are included in the GP contract (which controls how much GPs get paid).

At worse, a patient with suspected allergies could be sent away from their GP undiagnosed. Allergy specialists are concerned that, without the necessary clinical training, GPs limit themselves to treating a patient's symptoms without diagnosing the allergy 'trigger'.

The House of Lords science and technology committee has warned there aren’t enough specialist allergy services. It has called for at least one allergy centre, led by a full-time allergy specialist, in each strategic health authority.

The House of Commons health select committee held an inquiry into allergy services in England in 2004. Many of the patients it interviewed reported scepticism, ridicule and disbelief from their GP when presenting with allergy symptoms. More than half weren’t referred to an allergy specialist.

Since the introduction of maximum 13-week waits for NHS outpatient appointments, more allergy patients are gaining access to specialist help, but the majority of these services are not run by doctors who specialise in allergies.

For example, you may see a skin specialist, an ear nose and throat (ENT) specialist, a general paediatrician or an immunologist. These are specialists with a high degree of knowledge in a specific area but they’re not allergy all-rounders. An ENT surgeon with an interest in rhinitis may get sent a child with suspected nut allergy, for example.

Specialists with an interest in allergies, such as dermatologists, have set up most of the current allergy clinics on an ad hoc basis to cope with patient demand.

There are six full-time specialist allergy centres, with none north of Manchester or west of Bournemouth.

There are only about 30 NHS allergy consultants and, currently, fewer than ten doctors are doing the five-year training to become an allergy consultant. This includes only half a dozen consultant specialists in child allergy, which means most children are treated in adult settings.

If your child has an allergy, she or he will most likely be referred to an allergy clinic run by a paediatrician. Dr Pamela Ewan, allergy consultant at the allergy and clinical immunology clinic at Addenbrooke's Hospital, Cambridge, says there's a danger the diagnosis may not be quite right and so the management of the allergy will not be quite right.

If allergy symptoms aren't controlled, this often leads to inflammation and chronic symptoms, and repeat consultations with higher medication costs.

Where does this leave me?

Ask if any of the GPs in your practice has specialist training in allergies. You can insist on being referred to the best allergy clinics. Under the government's Choose and Book policy you have a right to ask to be referred beyond your local area.

Dr Ewan says nearly 10 per cent of patients at her clinic are from outside its catchment area. Her advice to patients is: "Don’t assume everyone you see at an allergy clinic is an expert. Insist on seeing a proper specialist in allergy."

Do your homework. Try to find out who runs your local allergy clinic. If they aren't primarily an allergy specialist or a consultant with the appropriate skills, then find the names of relevant consultants and clinics.

Find out about the symptoms of different allergies to discuss with your GP if they seem to be sceptical.

Keep a diary of your symptoms and your exposure to any potential triggers - pollen, food, exercise, pets, cold air and so on.

Is it worth going private?

The lack of NHS allergy services means many people with suspected allergies turn to private clinics offering diagnosis and treatment, or buy allergy tests on the high street or over the internet.

You may also be able to get some help from your local pharmacy - the National Pharmacy Association and Allergy UK have recently established an allergy screening service which offers skin testing in some areas. This may be useful if you have a simple allergy but you will have to pay for it, and if your symptoms are complex you really need the help of a doctor to establish a clear diagnosis.

Only independent allergy centres staffed by doctors are monitored by the Healthcare Commission.

Some treatments offered outside the NHS have been shown to be ineffective, expensive and even dangerous.

Avoid any preparations with unknown ingredients. Diets that require you to exclude important food groups should not be started without the advice of a qualified dietician.

Thanks to Royal Brompton & Harefield NHS Trust for allowing BBC Health to take photos.