Effective Allergy Practice

A report written by a sub-committee of the Society

This is the first report of the BSEM, written by a subcommittee of the Society because of concerns that many allergy patients were not receiving the help they needed. In particular that: although allergy patients with symptoms caused by the special immunoglobulin, (IgE), were being treated by allergists, most patients with chronic symptoms which would respond toallergy management were not.

Since the Department of Health had applied restrictions to the use of the standard desensitising method in 1988, incremental immunotherapy (IIT), patients with IgE-mediated allergies whose IIT had run out were mostly having to rely on the less effective alternative, medication, and not being offered either of the low-dose desensitising methods, unaffected by the restrictions.

Most of the patients suffering from chronic symptoms provoked by food or chemical pollutants were not being recognised, some actually being told that they were not reacting to food, or to chemicals, even when they had found that their symptoms could be prevented by avoidance.

The report aimed to summarise the evidence that adverse reactions to environmental factors and foods play a much larger role in the provocation of chronic illnesses thanis generally recognised, and that beneficial results were attained in most cases if they were managed as if they were allergies. It advised doctors about effective management methods, and Government about the implication of these findings.

Contents

Introduction

Historical background

The position of allergy practice in the UK

Areas of medicine to which allergists contribute

Investigative methods used by allergists

• History
• Skinprick testing
• Intradermal skin testing
• Patch testing
• Challenge testing with inhalant allergens
• Challenge testing with chemicals
• Challenge testing with foods

Laboratory tests

Management methods

Avoidance

Specific prophylaxis

• Incremental immunotherapy
• Enzyme potentiated desensitisation
• Neutralisation

Medication

Special facilities

Individual conditions to which allergists make a contribution

Traditional allergies

• Allergic rhinitis
• Asthma
• Skin disorders with allergic aspects
• Anaphylaxis
• Allergic reactions to insect stings and bites
• Allergic reactions to drugs and other chemical
• Food allergy

Syndromes which may be induced or exacerbated by reactions to food or environmental factors

• Irritable bowel syndrome and Crohn's disease
• Migraine
• Arthritis
• Cerebral symptoms
• Unexplained fatigue
• Abacterial cystitis and bladder pain
• Multi-system polysymptomatic illness

Other Physiological/pathological disorders

Estimating the need for allergists

The ethics of allergy practice