Doctors talk about allergy
At the recent Anaphylaxis Campaign Healthcare Professionals Conference Dr Matt Doyle talked about the increased awareness of allergy in primary care and Dr Paul Turner talked about anaphylaxis to food, and its management.
As all too many readers will know to their cost, the average GP is no allergy expert. Indeed, all too often in the past, the patient has been far better informed about allergy than their healthcare professional. However, Dr Matt Doyle believes that things are improving.
Traditionally GPs have had very little, if any, training in allergy and what training they have had has been via specific diseases or conditions – asthma/respiratory allergy; eczema/skin allergy etc. So what they have learnt they have learnt 'on the hoof'. Moreover, although they have 'permission' to prescribe management drugs (Salbutimol, autoinjectors, steroid injections, hydrolysed formulae etc) they have been given no training on what/how much to prescribe or how the medications should be used.
Ten years ago a GP's training did cover, briefly, hay fever and eczema, but there was no mention of allergy. Now, ten years later, the relevant 343 pages include 12 mentions of allergy, 24 of asthma, 8 of eczema and one of anaphylaxis (how to recognise it) – although still nothing on food allergy.
However, for those practitioners who wish to learn more, there is now, relatively speaking, a wealth of material for them to study.
NICE have produced a range of guidelines for the diagnosis and management of:
Meanwhile the following now all offer allergy courses:
Within Primary Care a new system to alert GPs if they are over prescribing is also forcing GPs to think about what they are prescribing in terms of allergy medication, especially autoinjectors. None the less, it remains extremely difficult to get both GPs and patients to actually use trainer pens. This is especially important if pens are changed as both the users and the medical professionals need to be retrained, but they rarely get that training. There can be further confusion as regards pharmacies and both pharmacies and doctor will assume that the other will train – and then neither does!
So there is still a long way to go, but, it is a much more encouraging picture than it was ten years ago.
Dr Paul Turner who is currently investigating mechanisms of food-triggered anaphylaxis at Imperial College made a number of interesting points with reference to anaphylaxis to food.
* The LEAP study did suggest that the early introduction of potential allergens could reduce the incidence of allergy, but despite the early introduction1.9% of the children remained allergic. So although we may be able to reduce the incidence, we cannot, at this stage anyhow, get rid of food allergy.
* The impact of food allergy is significant:
Published data on 12-20 year olds suggests that one in ten may report an allergic reaction but only one in every ten of those will actually have suffered anaphylaxis.
* Failure to treat anaphylaxis appropriately
* Sensitivity versus allergy
'Sensitisation is a poor marker of clinical sensitivity.' Only around 50% of those who are sensitive to a food are actually allergic to it.
For more articles on the management and treatment of food allergy and intolerance, see here.
For more reports an Anaphylaxis Campaign conferences see here.