Written evidence submitted by Allergy UK (RTR0148)

1. About us

Allergy UK is the UK’s leading national charity and patient organisation for allergy. We provide advice and support to people living with allergic disease and we work with professional bodies and healthcare professionals to improve the lives of the millions of people in the UK with allergic disease.

We have focused our response to the call to evidence on those areas where we have a particular perspective.

2. Overview

There is widespread recognition that allergy services across the UK are poor and underfunded. There are still too many tragic and avoidable deaths of people from allergy. Allergy UK’s vision is that ‘no one should die from allergy’.  

During the last 60 years ‘allergic diseases have increased globally in prevalence, complexity and severity’, becoming a global public health concern.  

• 44% of the adult population (21 million people) and 50% of children have one or more allergic disorders. In the UK around 5-8% children have at least one food allergy.  
• The prevalence of cow’s milk allergy in children living in the developed world, is approximately 2% to 3%, making it the most common cause of food allergy in the paediatric population. 
• There has also been a staggering 615% increase in hospital admissions related to allergic disease throughout the last 20 years.  
• Allergy and related conditions are estimated to cost the UK NHS about £1 billion a year.   

The last time the Department for Health and Social Care undertook a Review of Allergy was in 2006, over 15 years ago.  The House of Commons’ Health Committee last looked into Allergy back in 2004 and the House of Lords’ Science and Technology looked into Allergy back in 2007. The vast majority of their recommendations, including those relating to recruitment and training of specialist allergists, remain outstanding and the issues identified from 14-17 years ago persist.  

3. Workforce shortages

Despite the fact that the UK has among the highest prevalence rates of allergy in the world, the APPG on Allergy highlighted the ‘missing workforce’ in specialist allergy care within the NHS. According to the APPG on Allergy, the NHS only has 11 posts in England for doctors to train in allergy (outside immunology routes).

In its recent report ‘Meeting the Challenges of the Allergy Crisis’, the APPG on Allergy found that there are few allergy consultants outside immunology, with approximately 40 adult allergists and a similar number of paediatric allergists, working in a small number of allergy centres.

In 2004, the House of Commons’ Health Committee called for greater investment in the allergy workforce, stating:

“We endorse the proposal of the Royal College of Physicians that a minimum of one specialist allergy centre should be established in areas equivalent to each of the former NHS regions, serving populations of five to seven million, to offer at least some local expertise for allergy sufferers. More provision may well be needed in less densely populated areas. We also endorse their recommendations for staffing levels both for adult and paediatric care, that is to say that each centre should have as a minimum two adult allergy consultants, two paediatric allergy consultants supported by paediatric nurse specialists, two full-time nurse specialists, one half-time adult paediatrician and one half-time paediatric dietician. This is our key recommendation and the one on which all other elements to develop a national allergy service within the NHS will depend.”

Eighteen years later, however, it is clear that minimal change has occurred.

4. Training

Allergy still remains a rare specialism. As a result, allergy is poorly managed across the NHS with most GPs receiving little or no training in allergy, and a subsequent lack of consultant posts with this specialism exists.

Whilst we welcome the Royal College of General Practitioners’ (RCGP) recent introduction of allergy into the new GP curriculum, this will take time to adequately embed, and existing GPs will still need to acquire the right knowledge through independent learning and courses.

In addition to expanding the training of allergy-to-allergy qualified GPs, Allergy UK recommends appointing a health visitor and/or a practice nurse with sufficient training to be responsible for allergy in each practice.

Addressing this training gap at primary care is especially important to ensure that allergies are identified swiftly to prevent unnecessary and expensive referrals and ultimately improve the lives of patients with allergies.

5. Creation of specific posts

Allergy UK is calling for the establishment of a National Clinical Director or National Speciality Advisor or equivalent for Allergy, alongside an immunology lead, to act as a patient and clinical champion and improve pathways for allergy treatment and care.  

6. Recommendations

Allergy UK recommends:

• An expansion in the specialist allergy workforce as a priority. Ensure that training programmes prioritise allergy so that specialists of the future are appropriately trained and can safely deliver care.
• The creation of a national clinical lead for allergy, alongside an immunology lead, within the NHS to act as a champion for patient care and improve patient pathways for allergy.
• Enhancing health care training to ensure that all GPs and health care professionals in primary care have knowledge of allergic disease.
• Ensuring that allergy is included in the GP curriculum (RCGP have recently added allergy for new GP exams) and exit examination and improve allergy education for the already qualified GPs.
• The appointment of a health visitor and/or a practice nurse with sufficient training to be responsible for allergy in each practice

Apr 2022