No Allergy Tsar in sight

Those of you who read my post earlier in the month and signed Tanya Ednan-Laperouse’s petition will no doubt also have received a government response this morning. In it they outline the position as they see it and what they are doing to help:

• They note that there has been a 38% rise in anaphylactic episodes in the last ten years, although these include not just anaphylactic reactions to food but to serums, drugs and idiopathic episodes where the cause is unknown. They also do point out that this number could include several admissions if a patient was peculiarly sensitive.
• They highlight the introduction of Natasha’s law in October which will certainly improve the situation as far as foods pre-packed for direct sale is concerned. Foods sold in outlets such a Pret a Manger will have to carry full ingredient labelling which will hopefully avoid tragedies such as Tanya’s own daughter Natasha’s death.
• They also point out that the MHRA is developing a communications campaign to raise awareness and understanding of allergy among patients, carers and healthcare professionals. Worthy but, with a few notable exceptions, most government health campaigns have only limited impact.
• They note that over the last 5 years they have funded two research projects into allergy (comparing treatments for cow’s milk allergy in babies and on peanut desenstisitation) to the tune of just over £2 million – a figure that is all but laughable when compared with the billions that has been poured into every aspect of COVID research. Moreover, this research is into management protocols and treatment. What we really need is core research into why the incidence of allergy has escalated so dramatically over the last 25 years.
• And finally they pass off the issue of allergy training as being outside their remit but the responsibility of the royal colleges – Royal College of Physicians and the Joint Royal Colleges of Physicians Training Board.  More details on recruitment on the NHS Physician ST3 Recruitment pages.

Lack of career pathways

What the government response totally fails to address is the shocking dearth of both specialist and primary allergy care within the wider NHS.

Consultants

Although there has been an increase in the numbers of consultant allergists, there are still only six specialist allergy centres around the country. Moreover the shortage of allergy posts available within the NHS is a significant disincentive to ambitious trainee doctors looking for a challenging area in which to specialise.  (An interesting subsection, Job Market and Vacancies, on the NHS Allergy site notes that there is a shortage of allergy posts and that ‘less than whole-time working is common in this speciality’.) So it is not that the training is unavailable. It is that, once trained, a budding allergist may have diffculty in finding a post in which he/she can concentrate on his or her chosen  speciality. As a result a patient with what could be a potentially fatal allergy could wait six months or longer to get an appointment.

Primary care training

Meanwhile, awareness of allergy within primary care remains patchy and often extremely poor. While prescriptions for adrenaline injectors are now readily handed out, all too often they come with no instructions, training, back up or follow up. The death of Shante Turay, highlighted in my earlier post, is all too glaring an example of how primary care can and does fail allergy sufferers.

A medical curriculum is already extremely tightly packed. But given the increase in the incidence of allergy, would it not seem reasonable to include basic training in managing allergy in the standard curriculum if you wanted to go into general practice rather than leaving it as an optional speciality? In exactly the same way as it would seem sensible to include a few core allergen control principles in basic hygeine training courses for anyone working in the food service industry.

However, as the government would point out, this would be down to the royal colleges and not to them.