Baroness Ilora Finlay
House of Lords
This piece is taken from Baroness Finlay’s foreword to the new World Allergy Organization White Book on Allergy. The Baroness chaired a study of allergy services in 2006 for the UK House of Lords Committee on Science Technology created to look at “trends of allergy prevalence, the social and economic burdens that allergic disorders cause, current allergy treatments and research strategies, and policies which impact upon allergy patients such as housing standards, food labeling and the work and school environments.” The House of Lords report closely tracks the WAO recommendations. The contented is unedited except for addition of American spelling.
These were the recommendations:
* There is a need for Allergy centers where specialist, high quality diagnostic and treatment services that are accessible to the public. Once a diagnosis is obtained and a treatment plan developed at the allergy center, the patient’s disease can often be managed back in primary or general secondary care. However, patients with severe or complex allergic conditions may need long-term followup from specialists in the allergy center.
Allergen immunotherapy by injection should always be carried out by specialists within the allergy center because of the risk of anaphylaxis. Collaboration between clinicians in primary, secondary and tertiary care is key to improving the diagnosis and management of people with allergic conditions. Once established, the allergy center in each geographical region should encourage and coordinate the training of local GPs and other healthcare workers in allergy. In a “hub and spokes” model, the allergy center, or “hub,” would act as a central point of expertise with outreach clinical services, education and training provided to doctors and nurses in primary and secondary care, the “spokes.” In this way, knowledge regarding the diagnosis and management of allergic conditions would be disseminated throughout the region.
The allergy center should also act as a lead in providing public information and advice. Specialists at the center should work in collaboration with allergy charities, schools and local businesses to provide education and training courses for allergy patients? their families? school staff and employers? in how to prevent and treat allergic conditions.
* Because of the lack of knowledge of health professionals in the diagnosis and treatment of allergic diseases, we recommended that those responsible for medical training strengthen the input of clinical allergy to the undergraduate and postgraduate training of internists and primary care physicians as well of those of nurses.
* Although high quality research into cellular and molecular mechanisms of allergy is advancing, the factors contributing to allergy development and the “allergy epidemic,” are poorly understood. It is imperative that further research should focus on the environmental factors, such as early allergen exposure, which may contribute to the inception, prevention or exacerbation of allergic disorders. We were concerned that the knowledge gained from cellular and molecular research in allergy was not being translated into clinical practice and was identified as an area of unmet need that required greater priority.
Immunotherapy is a valuable resource in the prophylactic treatment of patients with life-threatening allergies, or whose allergic disease does not respond to other medication.
Although initially expensive, immunotherapy can prevent a symptomatic allergic response for many years, and may prevent the development of additional allergic conditions, so its wider use could result could potentially result in significant long-term savings for health services. Full cost-benefit analyses of the potential health, social and economic value of immunotherapy treatment needs to be conducted so the case for its use and funding can be strengthened.
* We recognized the appreciable impact that allergic rhinitis has on student performance in schools and examinations. Indeed, we wished to encourage health professionals to interface more closely with schools to ensure children with allergic disease receive optimal care. We support the use of individual care plans for children with medical needs. However, we were concerned that many teachers and support staff within schools are not appropriately educated in how to deal with allergic emergencies and should take urgent remedial action to improve this training where required. We were especially concerned about the lack of clear guidance regarding the use of autoinjectors of adrenaline on children with anaphylactic shock in the school environment.
* We considered that controlled trials should be conducted involving multiple interventions to examine the effect of ventilation, humidity and mitereduction strategies on allergy development and control. As climate change and air pollution may significantly impact on allergic disease, we supported greater effort to take account of the interlinkages between air quality, climate change and human health.
* Vague defensive warnings on food product labels for consumers with food allergy can lead to dangerous confusion and an unnecessary restriction of choice. We recommend that the responsible government agencies should ensure the needs of foodallergic consumers are clearly recognized during any review of food labeling legislation. Many teenagers and young adults with food allergies sometimes take dangerously high risks when buying food. We considered that the relevant government agencies, charities and other stakeholders should explore novel ways to educate young people about allergy and the prevention of anaphylaxis.
* As sensitivities to various allergens vary widely, the setting of standardized threshold levels for package labeling is potentially dangerous for consumers with allergies. Instead, we considered that food labels should clearly specify the amount of each allergen, and if it is contained within the products, we wish to discourage vague defensive warnings. The phrases “hypoallergenic” and “dermatologically tested” are almost meaningless, as they only demonstrate a low potential for the products to be a topical irritant. Such products should warn whose with a tendency to allergy that they may still get a marked reaction to such products.
* In various parts of the world, traditional and complementary medical interventions for treating allergic disease are available and frequently accessed by the public, but the evidence base for this is poor. We recommend that robust research into the use of complementary diagnostic tests and treatments or allergy should examine the holistic needs of the patient, assessing not only the clinical improvement of allergy symptoms, but also analyzing the impact of these methods upon patient wellbeing. Such trials should have clear hypotheses, validated outcome measures, and risk benefit and cost-effectiveness comparisons made with conventional treatments.
* We were also concerned that the results of allergy self-testing kits available to the public are being interpreted without the advice of appropriately trained healthcare personnel, and that the IgG food antibody test is being used to diagnose food. We recommend that further research into the relevance of IgG antibodies in food intolerance together with and the necessary controlled clinical trials should be conducted.