Survey of clinical allergy services provided by clinical immunologists in the UK

Abstract

Background: The UK National Health Service is failing to meet the need for diagnosis and treatment of allergic disorders, which are common and increasing in prevalence. The House of Commons select committee report on allergy services highlighted the inequalities and urgent need for investment. Aim: To survey the allergy workload provided by clinical immunologists to inform service planning and resource allocation. Results: The immunology centres surveyed serve 32 million people and offer almost the complete repertoire of a specialised allergy service. There were large variations in clinic capacity, new referrals, appointment duration, and service configuration. Services were largely consultant delivered, but availability of joint clinics with paediatricians and anaesthetists was locally variable. Novel service delivery models utilising nurses and clinical assistants have been developed and merit further investigation. Conclusion: Consultant immunologists and trainees currently make a major contribution to the development and provision of specialised allergy services. Consultant immunologists will probably remain key providers of tertiary level allergy care in the UK in the long term (in line with other countries) and will be pivotal in supporting and developing the provision of equitable national access to specialist allergy services in a timely manner. Rapid progress in developing the new specialty of allergy and securing better access to services for patients in the short term will be best served by strengthening the collaborative relationship between allergists and clinical immunologists.

Clinical Immunology Review Series: An approach to the use of the immunology laboratory in the diagnosis of clinical allergy

“…Testing for allergen‐specific IgE is carried out currently in approximately 100 UK laboratories, whose workload varies from 5000 to 50 000 tests/year [9]. Each laboratory can choose from a repertoire of about 800 allergen preparations available as panels or individual allergens (depending upon the manufacturer) falling into the following major subgroups: (a) spores and pollens, (b) foods, (c) insects and mites, (d) venoms, (e) animal proteins, (f) drugs and (g) occupational allergens.…”

Results of an allergy educational needs questionnaire for primary care

“…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 . It is of note that one of the consequences of this skill and knowledge deficit is many unnecessary referrals to specialist clinics and recourse to complementary and alternative medicine .…”

Systematic review of pathways for the delivery of allergy services

“…45 A study carried out in the UK has shown that immunologists, who have formal training in allergy, provide allergy care to 32 million individuals in the UK. 46 Some authors have pointed out that immunologists are indeed the sole providers of allergy services in parts of the UK. 44 46 Other specialists such as those with primary qualifications in ENT, respiratory medicine or dermatology also contribute to the delivery of allergy services in many countries 3 including about 10% of the total secondary care for allergy in the UK.…”