In recent decades, we’ve witnessed an increase in allergies, particularly severe and life-threatening forms such as anaphylaxis. The West of Scotland Anaphylaxis service, based in Glasgow, was established by Dr Eve Kirkwood in the 1980s and has been led by Dr Malcolm Shepherd since the mid-2000s and Dr Peter Kewin more recently.
The service is available to patients in the west of Scotland, covering nearly 50% of the country’s population, and offers severe allergy management to those who need it. They are one of the UK’s oldest and largest adult allergy services.
The service has never been more important, with allergies on the rise and several stigmas surrounding severe forms. “Allergies have increased dramatically over the past 40 years, with an eight-fold increase in admissions with anaphylaxis since 1992,” said Malcolm. “The epidemic of allergy noticed in children in the 1980s now means that most people suffering from life-threatening and severe debilitating allergies are adults.
“New allergies causing anaphylaxis are emerging with changes in sensitisers such as plant pollens and insect bites, driven in part by climate change. At the same time, many people labelled with anaphylaxis and anxious about risk are, in fact, safe and have been mislabelled.
“It takes expertise to manage severe life-threatening allergies, but also to de-label and reassure patients.”
Talking more about the service, Peter explains: “We assess and manage patients from teens upwards who have had anaphylaxis or may be at risk of it in the future.
“We gather as much information as we can from the patient or family/carer, their clinical record, previous blood results and drug prescriptions and try and decide whether they might have an allergy or not, and if so, how severe. We can then use tests (blood and skin prick tests) to narrow down what may be triggering their allergies.
“We can give them accurate avoidance and lifestyle advice to keep them safe but retain an acceptable quality of life. We can also advise on difficulties encountered at school, work, or travelling. We educate people in self-management after accidental exposure, including the use of adrenaline auto-injectors.
“Overall, we aim to put the patient and carers at the centre of their care, empowering them to look after themselves with common-sense approaches.
“We can also identify people who don’t have an allergy and delabel them, thus reducing anxiety about perceived risk that is not real. We make a range of alternate diagnoses and investigate and manage them, or refer on accordingly.”
With no cure for allergies, the service has a huge role in supporting people to live normal and healthy lives. However, they offer desensitisation treatment to patients with bee and wasp venom allergy to reduce their risk of anaphylaxis.
Peter added: “In the near future, we would aim to provide cutting edge, life-changing treatments in reducing the risk of food causing anaphylaxis, particularly to peanut, once those treatments are approved in Scotland and we have the resources to do so.”
The fear and stigma around severe allergies are also on the rise, which the service is trying to fight. “There are several stigmas around severe allergy,” said Malcolm. “The first is public suspicion that it is not as big a problem as it appears to be. For retail outlets, restaurants and members of the public, someone with an allergy is an inconvenience, and the remarkable rise in the prevalence, which is real, feels extraordinary, meaning that they are often not believed.
“Then there is the over-awareness of risk that attends anaphylaxis. People are denied access to workplace canteens, staff rooms or areas of work deemed unsafe due to the risk of an accident. Staff are often scrutinised at work as employers try to mitigate an imagined risk without the information needed to truly risk assess.
“The impact of antibiotic allergy mislabelling is enormous and can lead to inappropriate avoidance of good and safe antibiotics, but conversely can result in a failure to recognise true risk and the prescribing of antibiotics inappropriately.
“All these stigmas can be countered by improved education of patients, health care workers and the general public.”
Malcolm said about his pride in the service: “I am proud to have been able to lead and grow this service, and I am extremely proud of the team we have built. The commitment, quality of care and enthusiasm for the speciality this team shows is inspiring. We look after and improve the lives of over a thousand patients per year who live in fear of severe allergy and anaphylaxis.
“We also act as a springboard for the careers of team members who have gone to lead academic dietetic faculties and advanced nursing careers built on the skills and experience they have gained in the service.
“Across Scotland, however, there is a growing need for more services to be established, and I aspire to at least one adult physician offering care to allergy sufferers in each health board. This is an achievable goal that the West of Scotland service would support through governance with education and training.”
Patients cannot self-refer to the service, but they accept direct referrals from primary care and other specialities, such as dermatology, anaesthetics, and emergency departments.
