Allergies and the NHS: Allergy prevalence, treatment options and potential improvements to NHS allergy care

Approximate read time: 10 minutes

On 12 December 2024 the House of Lords will consider the following question for short debate:

Baroness Ramsey of Wall Heath (Labour) to ask His Majesty’s Government what steps they will take to ensure that patients with allergies receive timely and comprehensive care from the NHS.

1. Allergy symptoms and impacts

An allergy is the body having a negative reaction to something that is harmless to most people, like pollen, dust, pets or a particular food.^[1] Symptoms of allergic reactions vary, but can affect sinuses, skin, airways or digestive systems. In some cases, reactions can be life-threatening.

As well as physical symptoms, the charity Anaphylaxis UK has highlighted that people with severe allergies and the parents and carers of children with severe allergies report stress and anxiety related to the risk of a serious reaction.^[2]

2. Allergy prevalence in the UK

An estimated 21 million people are living with allergies in the UK, according to patient charity Allergy UK.^[3] This is just under one third of the UK population.

In the UK between 1998 and 2018, 101,891 people were admitted to hospital for anaphylaxis: a life-threatening allergic reaction.^[4] Food allergy was identified as the likely trigger of 152 anaphylaxis deaths over the same period. While the number of hospital admissions has increased in recent years, the number of deaths has decreased.

Food Standards Agency research has found that 6% of UK adults (around 2.4 million people) had a food allergy confirmed by a medical diagnosis.^[5]

In addition to allergies, some people live with illnesses or intolerances which cause reactions to certain foods. Food Standards Agency research has found that more than 30% of the population experienced symptoms from eating particular foods. Also, around 600,000 people experience a serious physiological reaction to gluten due to living with coeliac disease.^[6]

3. How does the NHS manage allergies?

Allergy services in England are generally commissioned locally by integrated care systems.^[7] NHS England also commissions specialised services that cover immunology and allergies. Patients usually see GPs or other primary care providers in the first instance, and in some cases are then tested for allergies.

If an allergy is confirmed, treatment can include:^[8]

• avoiding or reducing exposure to allergens
• taking medicines like antihistamines or steroids
• carrying emergency adrenaline injectors (such as EpiPens) to treat anaphylaxis
• desensitisation therapy, where an allergen is reintroduced under medical supervision to retrain the immune system to tolerate it

4. What could the NHS do differently for people with allergies?

Ahead of the July 2024 election, Allergy UK advocated for three key policies to improve NHS services for people with allergies:^[9]

• An allergy nurse and dietitian at primary care level for each UK health region to ensure those living with allergies could access care from a specialist clinician. The charity cited a current “postcode lottery” for specialist allergy services.
• A national register to consolidate patient data across the country and track allergy diagnoses. This, the charity said, would inform which services needed to be commissioned and ensure the safeguarding of people with allergies.
• The removal of prescription costs for those living with allergies “to address the additional costs people face when managing their allergies”. The charity has estimated that living with a food allergy incurs costs of around £3,000 per year.

Allergy UK has also noted that broader issues with NHS capacity and waiting times have been affecting access to care for people with allergies.^[10]

A number of reports since 2000 have called for action to improve NHS provision for people with allergies, including:

• Royal College of Physicians, ‘Allergy the unmet need’, 2003
• House of Commons Health Committee, ‘The provision of allergy services’, 12 October 2004, HC 696–I of session 2003–04; and Government response, January 2005, Cm 6433
• Department of Health, ‘A review of services for allergy’, July 2006
• House of Lords Science and Technology Committee, ‘Allergy’, 26 September 2007, HL Paper 166–I of session 2006–07; and Government response, November 2007, Cm 7255
• Royal College of Physicians and Royal College of Pathologists, ‘Allergy Services: Still not meeting the unmet need’, June 2010

Among other recommendations, the reports agreed the NHS needed more specialist expertise and services and better allergy awareness and training in primary care.^[11] A 2021 report by the National Allergy Strategy Group and the All-Party Parliamentary Group on Allergy said some advances in guidelines and care pathways had been made, but there was “not enough progress”.^[12] The report repeated earlier recommendations for an expansion of specialist staff as well as improved training for primary care. It also advocated for the creation of a ‘national plan for allergy’ overseen by a national clinical director with responsibility for delivering improvements.

A study published in the Lancet in September 2024 found rates of food allergies had increased over the past decade.^[13] It said most patients with food allergies were managed in primary care settings (like GP surgeries rather than hospitals). The authors emphasised “a need to better support those working in primary care to ensure optimal management of patients with food allergy”. They also highlighted low rates of adrenaline autoinjector prescription, even in those with previous anaphylaxis. The authors assessed that people from lower-income areas were least likely to be prescribed auto-injectors.

5. What has the government said about NHS services for people with allergies?

An Expert Advisory Group for Allergy (EAGA) was established in 2023 by the National Allergy Strategy Group and the Department of Health and Social Care (DHSC) to “bring together stakeholders, including clinical organisations, with the aim of improving the quality of life of people with allergies”.^[14] The new Labour government has confirmed that the EAGA will continue to identify priority areas for DHSC, NHS England, and other relevant government departments and agencies, and advise on how to achieve improved outcomes. As a part of this work, the National Allergy Strategy Group is developing a national allergy strategy for 2025–35.^[15]

Answering a written question on 8 October 2024, the government said it “recognises the challenges in allergy care and the need to address the rapid and continuing rise of allergies”.^[16] It added:

The department’s officials continue to discuss with NHS England and other government departments and agencies, as well as patient groups, how best to improve care and support for people with allergies, including their health outcomes and quality of life. We will be considering calls for the government to appoint a national allergy lead this autumn.

Allergy UK has welcomed the government’s broader announcements for NHS reform.^[17] It said the government’s three ‘key shifts’ towards digital transformation, care in communities and prevention “have the ability to align well with the needs of the allergic community” and the government should “consider the specific needs of the allergic community in their plans”.

6. Read more

• Sheena Cruickshank, ‘What’s behind the large rise in food allergies among children in the UK?’, University of Manchester, 2 September 2024
• Katie Tarrant and Ben Spencer, ‘Allergy deaths: 50 young lives lost in a decade’, Times (£), 18 August 2024
• House of Commons Library, ‘Debate on e-petitions relating to food labelling and support for people with allergies’, 12 May 2023; and Petitions Committee, ‘Why are MPs debating food labelling and support for people with allergies?’, 10 May 2023

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