Allergy in Hong Kong: an unmet need in service provision and training

Abstract

Many children in Hong Kong have allergic diseases and epidemiological data support a rising trend. Only a minority of children will grow out of their allergic diseases, so the heavy clinical burden will persist into adulthood. In an otherwise high-quality health care landscape in Hong Kong, allergy services and training are a seriously unmet need. There is one allergy specialist for 1.5 million people, which is low not only compared with international figures, but also compared with most other specialties in Hong Kong. The ratio of paediatric and adult allergists per person is around 1:460 000 and 1:2.8 million, respectively, so there is a severe lack of adult allergists, while the paediatric allergists only spend a fraction of their time working with allergy. There are no allergists and no dedicated allergy services in adult medicine in public hospitals. Laboratory support for allergy and immunology is not comprehensive and there is only one laboratory in the public sector supervised by accredited immunologists. These findings clearly have profound implications for the profession and the community of Hong Kong and should be remedied without delay. Key recommendations are proposed that could help bridge the gaps, including the creation of two new pilot allergy centres in a hub-and-spoke model in the public sector. This could require recruitment of specialists from overseas to develop the process if there are no accredited allergy specialists in Hong Kong who could fulfil this role.

Can Hong Kong take advantage of recent advances in allergy prevention?

“…It is recommended again that centres of excellence in allergy be established to drive patient care and teaching of under-and postgraduate students, and to conduct world-leading research in the discipline. 15 Each of the two medical schools with their partner hospitals in Hong Kong has the core of an allergy and immunology service already. It would not require large resources to transform them into centres of excellence.…”

“…In 2014, it was estimated that Hong Kong had only one allergy specialist for 1.5 million people, 15 and there had been no local trainees in immunology and allergy in adult medicine for nearly two decades. The current ratio of registered adult allergists per head of population in Hong Kong remains approximately one per 2.8 million, one of the lowest in the world.…”

“…The current ratio of registered adult allergists per head of population in Hong Kong remains approximately one per 2.8 million, one of the lowest in the world. 15 There are 2.4 full-time equivalent specialists in paediatric allergy, about one paediatric allergist per 540 000 paediatric population. This is less than the previous estimate 3 years ago of 1:460 000.…”

“…This is less than the previous estimate 3 years ago of 1:460 000. 15 The situation should improve by the end of 2017 when two trainees complete their training in Paediatric Immunology and Infectious Diseases (PIID). Nonetheless these graduates will only work parttime in allergy because of the manpower constraints in the public hospital system.…”

“…16,17 Another way to create more allergy services in public hospitals is by realigning resources. 15 Two public hospitals have adopted this strategy and now each offers a new penicillin allergy testing service. The new services are operated by a respiratory medicine specialist and a trainee allergist under supervision.…”