Why we are failing people with allergies in the UK

The lack of clinical expertise and awareness of allergies is a major issue in the UK

For me, like thousands of others, summer months bring the familiar misery of hayfever. For me, its not so serious that I risk developing, for example, a severe asthma attack. Nonetheless its not fun and definitely affects my quality of life. However, for some people, allergies can be incredibly serious and even life threatening - triggering severe asthma attacks or, in some cases, anaphylaxis as happened in the recent and tragic death of 12 year old Hannah Jacobs.

What is an allergy?

An allergy is what happens when your immune response starts reacting to things it should ignore like pollen or certain food types. There are two phases to developing an allergy- the first is when you get triggered to make certain types of antibodies-immunoglobulin E (IgE) - to a particular substance like grass pollen- we call this the allergen. This stage is known as sensitisation. These antibodies can stick to a type of immune cell called a mast cell. We have lots of mast cells in tissues like the nose, lungs, gut and skin. They are quite big cells with lots of granules (the dark blobs in the picture below).

If you never see the allergen again you won’t have symptoms but if you do you can react quite quickly as your mast cells are armed and ready! The allergen causes a change in the mast cell which triggers activation of the mast cell which then rapidly releases the chemical contents of those granules (see picture above). The release can happen in minutes after the allergen has been encountered.

There is a huge variety of chemicals in those granules including one chemical called histamine (which is why a lot of us use anti-histamines to prevent our symptoms). They cause physiological changes in our body including making more mucus (snot), muscle contractions and inflammation. If this is in your nose you will get snotty, your nose will get blocked up, you may struggle to breathe through your nose and the muscle contractions will make you sneeze.

The type of allergen and whether you breathe it in or eat will also affect where, in your body, you get the symptoms. In some cases, the immune response can cause a systemic effect and that is when anaphylaxis occurs. With anaphylaxis there is a massive drop in blood pressure, narrowing of airways and oedema (swelling) of tissues. Anaphylaxis MUST be dealt with very promptly and this requires good awareness of the risks, proper diagnosis and access to the right treatment. But are we, in the UK, able to do this as things currently stand?

Allergies are one of the most reported conditions in the UK.

Firstly we need to consider the scale of the problem. I am not alone with my allergy misery; allergies occur in around 1 in 3 people with over 21 million people affected in the UK. The UK ranks in the top three globally for the highest incidence of allergies and sadly incidence across the world has been increasing. In 2022, allergy emerged as the most reported chronic health condition in the UK.

The most common allergies are to things like pollen and dust which can trigger hayfever (rhinitis) and asthma attacks. Food allergies are much rarer. There can, however, be some confusion as to what constitutes a food allergy. For example, a report by the food standards agency found that although over 30% of adults reported some types of adverse reaction to foods only 6% were confirmed to have a true food allergy (using clinical criteria such as presence of IgE).

Food allergies can be confused with food intolerances or sensitivities. Whilst undeniably unpleasant, these do not involve immune mediated mechanisms- they are triggered by for example lacking key enzymes to digest certain foods or the microbiome struggling to process some foods. Some people may have coeliac disease- a serious condition which involves triggering of an immune response to gluten. Eating gluten affects the lining of the gut and ability to take in nutrients. The mechanism causing it, however, is quite different to a classical allergy and coeliac disease is considered an autoimmune condition. As such, neither food intolerance or coeliac disease are likely to carry a risk of developing anaphylaxis.

Clearly diagnosing accurately what condition you have is VITAL so you know how best to manage your risk. And that is where we, in the UK, have a major issue.

Allergy Care is under-resourced

There is a big issue about specialist allergy care and diagnosis which hinders the UK to manage allergies effectively. For several years now organisations such as the British Society for Immunology and Allergy UK have been campaigning to raise issues about the lack of clinical trained specialists that can properly diagnose allergies and support people to manage their condition. Unfortunately, several organisations have taken advantage of this gap in capacity to peddle fake diagnostics and “cures.”

As well as a lack of clinical immunology experts, the majority of services for people with allergies are commissioned through Integrated Care Boards (ICBs). An open letter from Allergy UK and the BSI reported that less than 10% of ICBs had accurate data on allergy diagnoses of their patients. This in turn impacts the NHS ability to plan and allocate resources appropriately. We need greater provision of clinical immunologists, consultant allergists, diagnostics to diagnose allergies and nurses and dieticians to support people to live safely with allergies.

We also clearly need to enhance awareness of the risks of allergies more widely. Natasha’s Law helped bring about changes to the food industry whereby common food allergens must be listed and reported. However, gaps in the training and implementation of that law were revealed in the inquest for Hannah Jacobs.

It is vital we enhance awareness and education of the risks of allergies. We must ensure people understand the measures that are needed especially in food services so that we can better support people with allergies. We can and must do better.