John Scott tries to put the advice in our Deadly Drugs article into practice - with limited success...

I heard recently, for the first time, of the existence of 'specials' - medicines manufactured on an individual basis to specific requirements, such as the omission of specified allergens (see Deadly Drugs).

Overjoyed to discover that there is the option to obtain 'free-from' versions of medicines, I tried to find out more about this from the people who should know - pharmacists - but the responses of pharmacists I contacted locally were not encouraging.

Comments ranged from the unequivocal ‘The option does not exist...your doctor needs to find an alternative drug’ through ‘Can't really say...I'd need to enquire’, to the irrational ‘It would depend on what the (allergic) reaction is’ and even the astonishing opinion that the production of an allergen-free medicine is ‘simply a matter of grinding up a tablet and mixing it with water!’

According to the only pharmacist I could find who did know, in detail, about 'specials' (and she was a locum who just happened to be on duty when I called), the procedure should be straightforward. All that is required is for a GP to write out a normal NHS prescription, stating the drug required and clearly specifying the allergen(s) to be omitted during preparation. The prescription is then presented to any high street pharmacy, which will place an order with a 'specials' manufacturer.

Judging from my straw poll of local pharmacies, the patient may need to inject a little encouragement and even guidance at this point, but my contact is adamant that all pharmacists should know of 'specials' manufacturers.

Provided that the drug is available in its pure form, a preparation will be made up containing this, but omitting the specified allergen(s). As it is not practical to prepare tablets in very small quantities, such 'specials' are likely to be dispensed in liquid form, so may contain such additional items as sugar, unless these are also specified for exclusion.

My contact says that allergy specialists should obviously be aware of the allergen-free option and that their patients may be able to have their special medicines made up by the hospital pharmacy, if this has a manufacturing unit. Even sterile 'specials', such as injectables, can be prepared in some larger hospital pharmacies if they have the requisite licence. The hospital's Drug Information Unit (a valuable source of information on all things medicinal) should be able to confirm whether this is the case.

The 'specials' option appears, therefore, to be an existing path, within the NHS, which has become overgrown from lack of use. It is in need of the efforts of a few intrepid trekkers to reclaim it by putting it into regular service, then flagging up its existence for the benefit of others. I'm sure there will be resistance, especially on the grounds of cost, something to which several of the pharmacists I contacted were quick to draw my attention, but this is a route which we desperately need to reopen and place firmly on the map.

Ed. If your doctor or pharmacist is struggling, refer them to this website where they will find our article on ‘specials’ and from which they will get a link direct to the relevant page of the MCA site and the details of the Association of Pharmaceutical Specials Manufacturers.

First published in 2006

• If this article was of interest you will find many other articles on unlikely allergies and allergy connections here – and links to many relevant research studies here.

• For more on the more 'mainstream' allergies check in to our 'allergy and intolerance home page' – and for ideas on alternative foods go here.

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