Consultant physicians working with patients - Royal College of ...

2 Specialties AllergyAllergyDr Pamela Ewan Consultant allergistDr Shuaib Nasser Consultant allergist1 Description of the specialtyAllergy is a non-organ-based specialty, with its owntraining programme and Certificate of Completion ofTraining (CCT). The allergist provides expertise indiagnosis and management of allergy that is different,and complementary to, services of other specialties.Allergic disorders are common and increasing inprevalence. They cause significant impairment ofquality of life and considerable direct cost to theNHS. 1,2 The need is to identify or exclude allergy as acause of disease, eg an acute allergic reaction, or in achronic disorder such as asthma, rhinitis, eczema orurticaria; and to provide management. Allergydiagnosis and avoidance can prevent further episodesor reduce disease. This results in substantial healthcareimpact, reducing healthcare costs and improvingquality of life for the patient.There has been a documented rise in allergic diseaseover the lasts three decades in numbers, severity andcomplexity, eg admissions for anaphylaxis have risensevenfold in 10 years, 1,2 and nut allergy, previously rare,now occurs in 2% of children and persists to adulthood.Food and drug allergy and angioedema are common.New allergies are also appearing. The allergy epidemichas created a new and substantial demand for consultantallergists, not previously addressed by the NHS.There are a small number of specialist allergy servicesrun by academic or NHS consultant allergists. Inresponse to demand, some organ-based specialists,immunologists and paediatricians provide part-time orlimited allergy services in addition to their main service,which is only a partial response to patient need. Formany patients, however, there is an unmet need. Thereis inadequate access to care, suboptimal healthcaredelivery and, consequently, unnecessary cost to the NHSin avoidable disease. 3,4A Royal College of Physicians (RCP) report proposed arational approach to improve patient care in response tocurrent inequalities and the developing allergyepidemic. 3 Key to services is development of at least onemajor allergy centre in each region, staffed by adult andpaediatric allergists. This requires increased numbers ofallergy consultants and allergy trainees. Such aninvestment would provide the infrastructure andexpertise for the development of services throughoutthe region and support education in primary andsecondary care. A House of Commons HealthCommittee inquiry into allergy services endorsed theRCP report, recommending the development ofnational allergy services and commissioning of allergycentres. 4 In England, a Department of Health (DH)review recognised the need for allergy services. 5 Pivotalto service development and patient care is the need totrain more allergists.Who are the patients?NumbersAllergic disease is one of the most common diseases anda major public health problem. About 20 million peopleintheUKhaveadiseasewhereallergymaybeinvolved.Around 3.5–7 million require the care of a specialistallergist. 5DisordersDisorders commonly coexist. Some may beimmunoglobulin E (IgE)- or non-IgE-mediated: asthma rhinitis, conjunctivitis, rhino–sinusitis, nasal polyps eczema anaphylaxis urticaria angioedema glottal oedema food allergy, eosinophilic enteropathies food intolerance drug allergy latex allergy venom allergy mast-cell disorders occupational allergy.C○ Royal College of Physicians 2013 27