MEDICAL MATTERS Paul CarsonThe health service is in crisis (when was it not?). Demand outstrips supply: there aren't enough hospital beds for patients and there aren't enough doctors and nurses to treat them even when patients do get a bed.
Waiting lists for elective surgery or OPD appointments seem to stretch beyond reasonable limits. A&E departments are swamped and a corridor trolley is now almost as good as an in-patient bed. One wonders when open-heart surgery will be performed in the car park.
On the other hand, the influenza pandemic threatened for the past few years has not yet surfaced. Still, billions of euros have been promised to curb bird flu.
So maybe this is not a good time to be talking about another healthcare predicament. Yet ignoring it won't make it go away so here goes: there is a crisis in the management of allergy. In Britain this was formally acknowledged when a House of Commons Health Committee published its findings on an inquiry into allergy services. The committee found a serious epidemic of allergy and the Department of Health agreed. Allergy care in the NHS was totally inadequate at all levels with a postcode lottery of premium care. In Ireland we don't even have a postcode lottery of care.
Working from UK statistics the following figures probably apply here:
Up to 28 per cent of the population suffer some type of allergy.
Some 15 per cent need to see a specialist because of the complexity of the conditions.
Children are particularly affected. One in 50 children have a life-threatening nut allergy, apart from other food allergies.
Allergy has become more complex and severe. At least 10 per cent of children and young adults have more than one allergic disorder.
In the UK (population: 60 million) there are six full-time specialist allergy centres - and less than 30 consultant allergy doctors. Many of these doctors are employed in research and so their time for clinical work is restricted.
Some parts of the State have no allergists and GPs in these areas have no one to turn to for practical advice. The situation in Ireland is worse with alternative practitioners offering bogus tests and usually dangerous advice because there are so few experienced doctors available.
Consider the typical run around of a child with allergy and let's use atopic eczema (an intensely itchy and irritating dry skin condition) as an example of more than one condition in the same patient. The child's main problem is his skin and that's what motivates his parents to seek specialist attention. While they are with the dermatologist they might mention that the boy is "chesty". "That's not my area," they're told, "you must bring him to a chest doctor." At the chest doctor they wonder out loud about the boy's constant blocked nose and repeated head colds.
"That's not my problem," trumpets the chest doctor, "you must bring him to an ears, nose and throat [ ENT] doctor." At the ENT division they mention the boy rubs at his eyes a lot. "Take him to an eye doctor," they are advised.
ENT doctors don't look at the eyes and chest doctors refuse to inspect the nose. Eye doctors ignore the skin and skin doctors shun chests, noses and eyes and anything else thrown at them (mind you, they are very overworked and understaffed.)
However, this inter-department referral is distressing for children and parents. It suggests a lack of understanding of the background problem. Could this child really have so many and completely different conditions or is he suffering an allergic challenge to the various systems: eyes, nose, chest, etc?
You don't have to be a genius to make the connection yet it is often denied. It seems easier to ignore and keep referring than to look at the bigger picture and decide a logical management strategy.
Many dermatologists refuse to accept an allergic link in atopic eczema. Many paediatricians refuse to do allergy tests, even where there is an overwhelming allergic link to presenting symptoms. ("Lift the carpets . . . get rid of the dog . . . try stopping milk" - these are some of the many speculative snippets of advice offered. Much money is spent on anti dust-mite manoeuvres where there is no allergy at all.)
Expensive and inappropriate anti-asthma drugs are prescribed without any reference to background allergic cause. The link between nose/sinus allergy and asthma is barely acknowledged in many treatment plans.
Occasionally anti-allergy antagonism can swamp common sense and judgment. The parents of a child with a severe allergic reaction to peanuts asked should they carry adrenaline in case of inadvertent exposure? "That's an American fad," the treating specialist chided, "and totally over the top." Presumably this man believes in angina but not heart attacks.
It's far from an American fad and far from being over the top. Ask David Reading, director of the Anaphylaxis Campaign in Britain. In October 1993, David's 17-year-old daughter Sarah died from anaphylactic shock after eating a lemon meringue pie served to her in the restaurant of a well-known department store. The dessert contained peanut - to which Sarah was fatally allergic. Do patients have to die before the severity of their allergic state is accepted?
Perhaps the most baffling aspect is the indifference shown at all levels of the health system. With statistics suggesting so many have some type of allergy there are more resources devoted to cardiovascular and osteoporosis screening (to give but two examples) than to providing even a minimal allergy service.
The allergy epidemic is here already yet money and resources are pouring into a possible bird flu threat. Strange, don't you think?
Paul Carson is a doctor and novelist
(www.slievemore-clinic.com and www.paulcarson.net)