Health: Allergy (Science and Technology Committee Report)

My Lords, many speeches today have stressed the seriousness of what can be described justly as an epidemic of allergy. We learned in committee that, among six and seven year-olds, one in five of suffers from asthma. Some 5 million people suffer to some extent from allergy to grass pollen. There is some suggestion that the number of people affected by allergies is levelling out. However, there is no doubt that millions of people—possibly an increasing number—suffer severe impairment to their quality of life because of some form of allergy. It was therefore deeply depressing to discover how backward we are in the United Kingdom. No doubt there are centres of excellence, but the overall picture was described by the World Allergy Organisation Specialty and Training Council, which is quoted on page 89 of our report. It highlighted the paradox that in the United Kingdom, a country with an outstanding record in allergy research, there is a remarkably poor clinical service for allergy sufferers. I was disappointed that when the Committee pointed out how backward we were, the Government reaction seemed to lack the appropriate urgency—they seemed relaxed about our deficiencies. Yet, as our chairman stated, we are considered the laughing stock of Europe in this field. By the way, I add my tribute to the noble Baroness, Lady Finlay, for her chairmanship. In a previous committee on which we served—on physician-assisted dying—I found myself in profound opposition to her views. However, after learning more about her activities and, in particular, after experiencing her chairmanship of this committee, I have become an admirer and feel that she is one of the most valuable Members of this House. There are at least three respects in which we are backward compared with many of our European partners. The first is in training and education. The diagnosis and treatment of allergies is not part of the basic training of medical students—an astonishing situation. Nor are there adequate general clinical postgraduate courses in allergies for nurses and doctors, which is most important in the case of GPs. Most GPs are not properly equipped to diagnose allergies or recommend appropriate treatment. A second result of this inadequate training and education is that we have an appalling shortage of specialists. As the noble Baroness, Lady Finlay, pointed out, we have 26.5 specialists—I am not sure who is the half. Spain, with a much smaller population, has 1,300 specialists—50 times as many. Equally unfavourable comparisons can be made with Denmark, Germany, Sweden and many other European countries. One of the most damning comparisons concerns the very limited facilities we offer for immunotherapy. I quote figures given to committee members who visited Germany. They appear in the appendix to the committee’s report, on page 128. Germany prescribes about 700,000 courses in specific immunotherapy, France about 500,000 and the UK about 5,000, yet the evidence that we received was quite clear. Immunotherapy is a standard and effective way of managing allergies in other European countries. It allows patients to lead much more normal lives, especially in the case of hay fever, asthma and allergies to wasp and bee stings, and it has a more lasting effect than treatment with drugs such as antihistamines or steroids. Immunotherapy can be administered either subcutaneously by injection, involving a lengthy and expensive form of treatment, or more cheaply and conveniently sublingually, by oral tablets. Sublingual treatment is very common in France but is almost unavailable in the United Kingdom. However, even the more expensive form of subcutaneous treatment saves costs in the end because it is much longer lasting and much more effective than drugs. Why do we neglect desensitisation or immunotherapy? We do so because the MHRA has created the strictest regulation in Europe. Its attitude seems to be determined by safety concerns based on 27 deaths from anaphylactic shock between 1956 and 1982—over a quarter of a century ago. A Danish company gave evidence that it had product licences for subcutaneous immunotherapy in many European countries but had given up seeking licences in Britain because of the attitude of the MHRA. We were also told that NICE has no plans to appraise immunotherapy products. However, the evidence that we received was clear. If administered by specialists in a proper environment, the treatment is safe. If there is a severe reaction, it can be promptly recognised and dealt with. The MHRA has simply not kept up with the evidence and it has apparently not looked at the experience of the rest of Europe. There is no justification for that defensive attitude. We seem to be unique in our view of the safety of the treatment. Not only other European countries but also the WHO regard immunotherapy as the most effective treatment—the only one that can influence the natural course of allergic disease. Its views are found at page 131. Therefore, I return to the question of why we are so backward and why we refuse to learn from the experience of other European countries. I fear that it is part of a wider disease—a certain insularity and a refusal to accept, because of insular attitudes, that in many ways other European countries are more civilised than we are. That is certainly the case in their approach to crime and penal policy but it is also the case in many aspects of health policy. Our National Health Service has many virtues and is often unfairly criticised, but our public attitude towards the scourge of allergy is, frankly, a national disgrace.