Children's allergy provision

Frances Dale gets an upbeat update on paediatric allergy services in the UK.

Three years after the new paediatric allergy unit opened at St Thomas' Hospital in London (Children's Allergy Service - on the NHS - 2007) Dr Adam Fox, one of the allergy team which runs the service headed up by Professor Gideon Lack, is encouragingly optimistic both about about the awareness of allergy within the NHS and about the improvement in paediatric allergy provision.

Five years ago awareness of allergy, not only in primary care, but amongst paediatricians, was low. Even when the Children's Allergy Service first opened three years ago, in every clinic, Dr Fox says, there would be at least one mother who burst into tears with relief as this was the first time that anyone had recognised or accepted that her child had an allergy. However, this is no longer the case. Although in depth understanding of allergy is uncommon among paediatricians (and even more uncommon among GPs), both now have a far greater awareness of allergy and although neither will necessarily wish to treat a complex allergic child, they will certainly recognise the need for more specialist care and refer it on. Rarely, these days, do Dr Fox's clinics see mothers sobbing with relief.

Although many in the allergy world have complained long and bitterly about the mounting pile of reports each cataloguing the failure of the NHS to recognise or provide for allergy, things have been happening behind the scenes. The most important, in Adam Fox's view, is the imminent (by the end of this year) publication of NICE guidelines on assessment and diagnosis: 'Short clinical Guidelines on assessment and diagnosis of food allergy in children in Primary Care', to be followed by further guidelines dealing with anaphylaxis.

(If you are a stakeholder or have a specific interest in this area the guidelines are now available for comment - please click here to access them.)

As he says, NICE guidelines are taken extremely seriously by the medical fraternity, so NICE's recognition of allergy will be a huge boost to awareness, especially in primary care. This awareness should be given a further fillip by the publication (also before the end of 2010) of six 'National Care Pathways' which have been commissioned by the Department of Health from the Royal College of Pediatricians and which will map out an 'optimal care pathway' for six different aspects of allergy – respiratory, skin and food. Clear guidelines as to what treatment/referral an allergic child should get and how this should be accessed.

Of course none of this addresses the dearth of knowledge within the medical profession about allergy – a dearth which can really only be addressed by the inclusion of allergy as a significant subject in medical schools. But, much though Adam Fox would love to see modules in allergy as a required element in the average GP's education, he has to admit that the pressure on medical students' time is enormous with their actual learning time reduced to five years and subjects (absolutely necessary subjects) such as communication skills and medical ethics having already been added to the existing curriculum.

Realistically, the only doctors who are likely to become expert in allergy are those who, post graduation, choose to specialise in the subject – and they are then likely to become consultants. Welcome though an increase in allergy specialists/consultants is, what is really needed is a greater knowledge of allergy at the GP level.

However, much progress has been made and in a relatively short time – although of course we are here only talking about paediatric and not adult allergy. However, this would not be the first time that children's services have led and adult services have followed, so let us hope that NICE guidelines for the diagnosis of allergy in children will be followed by guidelines for treatment and then, in due course, guidelines for diagnosis and treatment of adult allergy.

For more information on the Children’s Allergy Services call 020 7188 3300
or click here for the Paediatric Allergy Unit at Guys and St Thomas hospital

First published in 2010


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