Health: Allergy (Science and Technology Committee Report)

My Lords, as always it was a great privilege to serve on your Lordships’ Science and Technology Committee. We were extremely lucky to have such a cheerful and energetic chair. She has already paid tribute to our specialist adviser, but I should like to pay special tribute to our clerk, Sarah Jones, who came through her initiation as a committee clerk with flying colours. I also thank our hosts on external visits, who went out of their way to make us feel welcome and arranged fascinating and informative programmes. I am not an allergist or an immunologist but, as a general practitioner without special training in allergies, I saw many patients with allergy problems. The great majority of these could be helped by simple measures to mitigate the symptons. Inhaled, topical and, occasionally, systemic steroids were extremely useful, as were antihistamines and cromoglycate. I usually referred more severe or intractable problems, mostly asthma or severe skin allergy, to the appropriate chest or skin specialist. It was difficult to get an early NHS appointment to see our one allergist in the catchment area, who always had a long waiting list. I was fortunate never to have to deal personally with a severe anaphylactic reaction, though one of my patients died as a result of a wasp sting while on holiday in Greece. I have suffered a moderately severe reaction myself as a result of a wasp sting, dealt with competently and effectively by the A&E department at the Royal Sussex Hospital in Brighton. Subsequently, I received a long drawn-out but effective course of desensitisation at Professor Stephen Durham's unit at the Royal Brompton. I know that it was effective because, a year or so later, I was stung eight times at once after treading on a wasp nest in the dark—an experience not to be recommended. Thanks to my desensitisation, it was not a fatal experience—as it might have been, because I had left my EpiPen at home. In my practice, it would have been extremely useful if one of our practice nurses had received training in the use of patch testing and other allergy diagnostic procedures. As it was, we had only empirical knowledge of the allergens that triggered allergic responses in patients. In many cases, no single factor seemed to be responsible and control of the symptoms—whether a skin rash, wheezing attack or rhinitis—was the doctor’s sole aim, rather than finding out exactly what was causing it. The main recommendation of the report—to establish a network of specialist allergy centres similar to the one that the committee visited in Cambridge—would make that much more possible. Not only could patients with troublesome allergies be referred there, but GPs and practice nurses could be trained in allergy procedures, as the noble Lord, Lord Crickhowell, suggested. Already, at the Cambridge centre, GPs have improved their allergy skills through their correspondence through referrals. My noble friend will know of the new allergy centre proposed for Manchester, which the noble Baroness, Lady Finlay, mentioned, which consultants want to set up and requires only modest funding. I understand that my noble friend’s colleague, Ann Keen, has agreed that the Manchester Centre should be supported, but so far, no funding has been agreed. Can my noble friend give us good news here? The rise in allergic disease in the past few decades—which all our witnesses mentioned and which is well understood to be real and not simply due to changes in clinical awareness or diagnostic criteria—has occurred in all modern industrialised countries, not merely in Britain, although we have perhaps had the highest rise. It has not occurred among the populations of developing countries living a traditional lifestyle but, interestingly, it has increased to some extent among the better-off members of those societies, whose standard of living is similar to ours. As we have heard, that phenomenon has been labelled the hygiene hypothesis: those at greater likelihood of exposure to more infections, infestation, environmental pollution or certain foods very early in life—possibly even in utero—are less likely to develop allergies as older children or adults. The clean, the hygienic, thus has a downside. That is perhaps another way of saying, ““A bit of dirt never harmed anyone””—and may even do some good. An example of research carried out in Berlin and Munich on whether the hygiene hypothesis applied was described to us; it has already been alluded to. Before the unification of Germany, the incidence of allergic disease was lower in poor children in the east, where there were higher levels of atmospheric pollution than in the west. After unification, which led to less pollution and higher living standards in the east, levels of allergy gradually rose, so that there is now no difference between east and west. In rural Germany, children brought up on farms, exposed to animals and drinking unpasteurised milk, had lower levels of asthma and other respiratory problems than children in the same area not living on farms. Research that has been described to us, as noble Lords will have heard, by Professor Gideon Lack at the Evelina Children’s Hospital demonstrated that the prevalence of peanut allergy in Jewish children living in Israel was much lower than in genetically similar children living in the UK. As my noble friend has described, the Israeli children had been weaned on to a food based on peanuts. I will not describe the study known as LEAP—Learning Early About Peanut Allergy—which Professor Lack is conducting because it has already been well described. As its name suggests, the hygiene hypothesis is a hypothesis rather than a full explanation, as there are many exceptions to the rule. It is not much help being allergy free if, as a result of living in an unhygienic environment, a young child were to get seriously ill and fail to survive to enjoy its allergy-free status. However, the hygiene hypothesis may be helpful in understanding the origins of allergy. The mechanism of the immune response to certain bacilli—possibly in the gut flora—in early life appears to enable an individual to deal more efficiently with potentially allergenic challenges later. Research to identify and understand the processes involved in the acquisition of tolerance early in life has far-reaching potential, and hopefully it will be possible to identify and isolate at a molecular level the factors in the ““unhygienic”” environment initiating this process. Thus ““clean dirt”” could be given to vulnerable individuals, enabling tolerance to develop without the long process involved in a desensitisation course. Here, however, I am speculating beyond the evidence that we received. The purpose of my remarks is to underline the importance of stable or increasing government funding to enable the high-quality basic and epidemiological research in this country to continue. The noble Earl, Lord Selborne, and the noble Lord, Lord May, described this very well. Food allergy is an increasing problem. Although many who think they may be allergic to certain products—according to some estimates about a quarter of the population at some time in their life—may in fact be suffering from food intolerance or ascribe a variety of symptoms to certain foods, encouraged by some complementary practitioners and the media, rather than having a true allergy mediated by IgE or T helper cells. Five to seven per cent of infants are thought to have some manifestation of true food allergy, but the figure is not precise due to diagnostic difficulties. This prevalence reduces to about 1 to 2 per cent of adults, according to the Institute of Food Science and Technology. As has been said, peanut allergy has increased in prevalence so that about 25,000 people may now be affected. New food allergies are being described, such as to kiwi fruit and certain other fruits, tree nuts as well as ground-nuts, chickpeas, sesame, mustard and soya. Dr Clare Mills of the Institute of Food Science and Technology ranges potentially allergenic food products in a hierarchy of severity, with peanuts and hazelnuts at the top of the list and carrots, tomatoes and melon at the bottom. To conclude, the European Union is reviewing its food-labelling legislation. This should provide an opportunity to rationalise what is at present a confusing set of regulations that cover only 12 known allergens added to food. The list is constantly changing. The review should provide the Food Standards Agency with an opportunity to influence the rationalisation of EU food labelling legislation. Our report recommends that food labels should specify the amount of each allergen listed if it is contained in the product, and we support the FSA in discouraging vague, defensive warnings which can severely restrict the choice of those with possible allergic tendencies, especially if they are of a cautious disposition.