Management of allergic problems in primary care: time for a rethink?

Abstract

SummaryAllergic diseases affect 20-30% of the UK population and when severe are associated with considerable morbidity and occasional mortality. Initiatives to improve allergy services in the UK have been led by consultant allergists and have focussed on increasing the number of hospital training posts to improve access to specialist services. A high profile campaign to raise awareness of the lack of allergy services has so far failed to generate further training numbers for allergy as a single specialty. Although the campaign to improve tertiary allergy services continues, most mild or moderate allergy symptoms (e.g. hayfever, allergic asthma, urticaria and some food allergy problems), can be managed successfully in primary care with appropriate interest and training. Despite the high and increasing numbers of patients with allergy and the ease with which the majority of symptoms can be controlled, many doctors in primary care are reluctant to take a more proactive approach to managing allergic conditions. This appears to be due to concerns about overburdening an already busy service, but may also be due to recommendations from allergy specialists which have implied that high quality allergy care is not possible without identification of specific allergic triggers using skin prick tests or blood tests. In reality, symptoms can usually be controlled using pharmacotherapy, although a working knowledge of the appropriate guidelines is helpful. In this paper,we propose minimum levels of knowledge for all practitioners in order to raise the standards of primary care allergy management, and provide recommendations for * Corresponding author. training for those wishing to manage successfully more difficult allergy cases and allergy diagnosis.

Results of an allergy educational needs questionnaire for primary care

“…Developing a cohort of GPs with a special interest (GPSIs) particularly in countries where there is a deficit of allergists may also offer a solution as might developing shared care protocols for continuation of therapy commenced by specialists in general practice .…”

“…In a variety of aspects of allergy, there are repeated calls for improved education to improve outcomes with deficits being recognized across healthcare systems, concerns shared with paediatricians, who are often the first port of call for children in many countries . Work has also been undertaken to describe the core competencies required by GPs to provide allergy care and those which might be needed to provide a specialized level in primary care (general practitioner with a special interest, GPSI) . GPSIs are generally GPs who work part‐time in a defined clinical role, for example they see about 7% of allergy referrals in the UK .…”

Challenges in the implementation of the EAACI AIT guidelines: A situational analysis of current provision of allergen immunotherapy

“…53 A further option to be considered, particularly where specialists are scarce, is the development of a network of GPs with specialist interests (GPwSIs) whose remit would include service provision and local educational initiatives working in close collaboration with specialist mentors. 54,55 This would also present an opportunity to develop a network of care to establish clear communication and shared decision-making.…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…55 Guidelines provide evidence-based recommendations to inform the management of allergic rhinitis under the headings 'allergen avoidance', 'pharmacological treatment', and 'specific immunotherapy'. 55,[109][110][111] Allergen avoidance can be effective for reducing the symptoms of allergic rhinitis, [112][113][114][115] though single interventions may be insufficient to control symptoms. 116 Non pharmacological measures with some efficacy include saline douches, 55,117-120 rhinophototherapy, 121 nasal filters, 122 pollen-blocker creams, 123 or cellulose powder.…”