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Allergy testing – does pharmacy have a role?

With a lack of allergy testing in the UK, Emily Knight-Kristoffersen and Philip Crilly ask whether pharmacy screening is the answer

Allergy cases in Britain are the highest in Europe – and the problem is worsening. Hospital admissions for anaphylaxis are 700 per cent higher than in 1990 and in the same time period there has been a 500 per cent increase in reported food allergies and a six-fold increase in the number of adrenaline injectors prescribed.

This is happening at a time when NHS allergy clinics are scarce. For example, Liverpool has only two NHS allergy testing clinics to serve a population of more than 440,000.

It seems that there has never been a more appropriate time for pharmacies to offer allergy screening, and more than 100 pharmacies are now signed up to the NPA and Allergy UK testing service. But not everyone is happy to see pharmacists getting involved.

Pharmacy services are a "quick fix" that cannot replace allergy testing by GPs, says British Society of Allergy and Clinical Immunology (BSACI) secretary Glenis Scadding.

"Pharmacists can and do identify simple hayfever," Ms Scadding explains, "[but] we are not convinced that they are competent enough to diagnose allergy using consultation and tests… we remain fundamentally opposed to the concept of allergy diagnosis by pharmacists."

The problem is education, Ms Scadding says. "Pharmacy training involves education about medicines, not about clinical disease, patient history-taking or psychology. This means that pharmacists do not know what the diagnosis possibilities are in patients who present with, say, a blocked nose."

Former NPA director of pharmacy Nanette Kerr disagrees, emphasising the NPA and Allergy UK service is a "robust, accredited programme".

"All partners in this endeavour view it as an opportunity to meet a clearly unmet need by delivering an accessible and responsible allergy service," she says. "There is no need to choose between quality and access – you can get both in pharmacies."

"This screening service allows the clinical skills of pharmacists to be put to best use," agrees Catherine Duggan, director of professional development at the RPS. "Pharmacists will act in the best interests of patients."

Fears that pharmacists lack clinical skills seem to be unfounded. Marion Harvey, whose Fulham Pharmacy has been offering the allergy screening service for more than two years, says there is often a "lack of satisfaction" among people who come in for allergy screening because they believe the service has a "focus on testing".

The pharmacy service places great importance on the initial consultation, which includes taking a detailed clinical history and then discussing how best to reduce the symptoms of a person's allergy. Only after this consultation, and if it is required or requested, does an IgE test for sensitivity to common allergens take place.

In fact, far from acting as a ‘quick fix', pharmacy allergy screening offers an accessible first point of contact for people concerned about allergies.

In its guidance on allergy testing last year, Nice warned that many parents are bypassing GP and pharmacy services to use home testing kits to diagnose allergies, resulting in "restrictive and potentially dangerous diets".

There are other problems associated with testing kits. The latest evidence suggests they can have a very high false-positive rate, at about 50 per cent for IgE tests to inhalants and even higher for peanut extract. This could lead to people being advised to take costly and unnecessary allergy avoidance measures.

The BSACI fears that false-negative results could also put people at risk, citing the example of some individuals who are known to be anaphylactic to brazil nuts but can produce a negative specific IgE test.

However, the pharmacy service emphasises referral advice to GPs where appropriate, the NPA says, "with possible onward referral again if appropriate to secondary or tertiary care".

Ms Harvey acknowledges "the tests are not reliable". However, she stresses that pharmacists recognise the limitations of kit diagnosis, and would never confirm beyond doubt if a patient had an allergy based on a kit alone.

While in the ideal world everyone would have access to a specialist clinician and molecular allergy testing, it is simply not feasible at a time when the NHS is looking to cut costs.

Pharmacy screening offers an accessible first point of contact for patients concerned about allergies. As long as pharmacists are up front with patients about the limitations of test kits, the sector can become a vital and accessible port of call for allergy screening.

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