Anyone who works in early years care and education will be all too familiar with the rise of food allergies and the strict policies and procedures that need to be in place to protect young children.
Peanut allergy, which ten years ago was considered to be rare, is now the most common food allergy to cause fatal or near-fatal reactions in children. It affects one in 70 children, and nuts are just one of the items on the list of foods that are now banned from the menu in many nurseries and schools.
Now the extent of the allergy epidemic and the overwhelming failure of the NHS to meet patient needs have been highlighted in a Royal College of Physicians (RCP) report, called Allergy: the Unmet Need - a blueprint for better patient care.
According to the RCP, the current cost of allergic disease to the NHS is Pounds 900m a year. Yet, the report claims that while the incidence of allergic disease in the UK has trebled over the past 20 years to epidemic proportions, with a staggering 12 million people every year seeking treatment for their allergies, 'the health service is failing to meet even the most minimal standards of care - far less of clinical governance'.
Despite the fact that one in three of us is now expected to develop an allergy at some point in our lives, NHS services have failed to respond to this increase in demand.
In short supply
There are only six specialist centres in the UK offering a full-time service with experts on hand to deal with all forms of allergy, and there is a geographical inequality of provision; most specialists are based in London and the south-east. Nine other centres staffed by allergy specialists only offer a part-time service.
There are allergy clinics run by part-time consultants in other medical specialities, but they do not have the facilities to cope with the high number of referrals and patients suffering from 'multi-system disease' - that is, people suffering from several allergies affecting different organs. This shortage of specialists means that patients are often treated by their GPs, who in most cases have received no specialist allergy training.
The report refers to a recent study of a sample of 500 GPs - although only half responded - which found that 80 per cent of them thought NHS allergy services were of poor quality, reflecting deficiencies in primary and secondary care.
The facts clearly demonstrate this failure. More than half of the patients referred to an allergy clinic by their GP had to wait more than three months to see a specialist.
According to a recent study by the British Society for Allergy and Clinical Immunology, 6 per cent of visits to GPs are for allergic disease, while another survey found that as many as 7 per cent of children admitted to St Mary's Hospital accident and emergency department in London as emergencies were diagnosed with an allergy disorder.
The RCP notes that, like GPs, few paediatricians are trained in allergy. A child suffering from eczema often has a food allergy with life-threatening reactions, asthma and/or rhinitis. But, says the report, 'Referral to a series of organ-based specialists or a general paediatrician is inappropriate and the allergic aetiology is not usually addressed'.
Seeking help
The report says that inadequate allergy services have led to people seeking advice from organisations such as Allergy UK (formerly the British Allergy Foundation), which each year receives 45,000 enquiries about a wide range of allergies and intolerances and sends out 250,000 fact sheets.
The Anaphylaxis Campaign receives around 20,000 enquiries a year, mainly about food allergies and sends out 140,000 fact sheets a year to schools, education authorities, colleges, hospitals, doctors' surgeries and exhibitions.
Both organisations run helplines to put people in touch with appropriate specialists and their demand reflects the difficulty people have in getting advice.
Although these charities clearly have a role to play, the RCP voices concern that the public has been forced to look outside the NHS for answers. 'This has led to the proliferation of dubious allergy practice in the field of complementary and alternative medicine, where unproven techniques for diagnosis and treatment are used,' it says.
Professor Pamela Ewan, deputy chair of the working party which produced the report, says, 'In large parts of the country, patients with allergy receive a poor service, and have great difficulty in seeing an allergy specialist.
Proper diagnosis means the cause of allergic reactions can be avoided, with improvement in symptoms. In the long term this benefits the patient and saves the NHS money.'
Complex causes
But just what is causing this dramatic rise in allergy? The report sums up, 'Although genetic susceptibility is an important risk factor for allergic sensitisation and its expression as disease in different organs, the current allergy "epidemic" is a consequence of our changing environment.
Increased exposure to allergens and air pollutants, overuse of antibiotics and other drugs, reduced fruit and vegetable intake, reduced early life exposure to bacterial products and an alteration in bacterial colonisation of the gut have all been blamed.'
The Food Standards Agency lists what it calls 'the big eight', which are the foods responsible for triggering 90 per cent of allergic reactions.
These are milk, eggs, peanuts (groundnuts), nuts from trees, (including brazil nuts, hazelnuts, almonds and walnuts), fish, shellfish (including mussels, crab and shrimps), soya and wheat.
Adults are most likely to have allergies to peanuts, nuts, fish, shellfish, citrus fruit and wheat. Apart from peanuts, most allergic reactions in children are to milk, nuts from trees, eggs, soya and wheat.
Symptoms typically appear within a few minutes of the food being eaten.
These include a rash, swelling in the mouth, throat and upper airway and difficulty with breathing. This is known as 'true food allergy' and occurs in around 3 per cent of the UK population.
But studies have shown that there is some room for optimism. Children can grow out of certain allergies, for example those to eggs and milk, which resolve naturally in 90 per cent of cases by the age of five. And there is new evidence from researchers in the US to suggest that this is also a factor with peanut allergy (see box, above).
But clearly, what all these studies demonstrate and what the RCP report in particular seeks to highlight, is that the dramatic rise in allergy, both in children and adults, is a serious issue that isn't just going to go away and one that needs to be addressed with some urgency by the NHS.
As RCP president Professor Carol Black says, 'The increased incidence of allergic disease, including some of the most harmful forms, is just one example of a change in the pattern of illness and disease that we could not have foreseen.'
FURTHER INFORMATION
* Allergy: the Unmet Need - a blueprint for better patient care, report published by the Royal College of Physicians, www.rcplondon.ac.uk
* Food Standards Agency www.foodstandards.gov.uk
* Allergy UK www.allergy foundation.com, helpline 020 8303 8583
* The Anaphylaxis Campaign www.anaphylaxis.org.uk, helpline 01252 542 029
ALLERGIES WORLDWIDE
* An estimated 1.5 million Americans are allergic to peanuts.
* Rice allergy is common in Japan and other countries in eastern Asia, but rare in the UK.
* Sesame allergy is on the increase in Australia and Israel, but UK numbers are not known.
* Kiwi allergy is known in New Zealand and on the increase in the UK.
* Allergy to fruit is thought to be linked to latex allergy.
* 'The UK is way behind in its capacity to provide adequate allergy services when compared to most countries in Europe, the US and Australasia,' said Professor Stephen Holgate, chair of the RCP report's working party.
PEANUT ALLERGY - A LIFELONG SENTENCE?
Recent research in the US suggests that some children may grow out of peanut allergy and recommends that they be tested regularly every one or two years.
* Doctors at Johns Hopkins Children's Centre in Baltimore and Arkansas Children's Hospital studied 80 children aged four to 14 with a history of peanut allergy. Follow-up testing on these children found that more than half of them had lost their sensitivity and were able to eat peanuts without any allergic reaction.
* Researchers at the Mount Sinai School of Medicine in New York have developed a vaccine for peanut allergy based on genetically modified peanut proteins. Already tested successfully in mice, the researchers say human trials could start within a year. Both findings are published in the July 2003 issue of the Journal of Allergy and Clinical Immunology.
* A way to create 'safer' peanuts has been discovered by food researchers at the US Department of Agriculture's Southern Regional Research Center in New Orleans. Scientists have found that by altering the food processes involved in roasting peanuts they can reduce their allergen content and minimise the chances of triggering an allergic reaction.