All specialists in relevant specialties should have a working knowledge of allergic mechanisms and their role in causing and triggering disease. This applies particularly to ear, nose and throat (ENT), respiratory medicine, gastroenterology, dermatology and emergency medicine. Where specialist clinical allergy services exist, these will typically form networks with the relevant specialists.
Specialist allergy services are unevenly distributed across the country, but most areas have referral pathways to local secondary teams and regional tertiary services. Where local services are inadequate, secondary allergy care may be delivered out of area by a regional service. Some allergy services will be delivered by doctors trained specifically in allergy; others will be delivered by clinical immunologists or by organ-based specialists with specific training in clinical allergy (chest physicians, ENT etc). They are all considered clinical allergists in the sense that they see patients with suspected allergic problems.
Standard referral pathways may vary from place to place. Most patients will be referred by their GPs and seen as outpatients. Some will be referred by organ-based specialists as tertiary referrals. Regional services often see displaced secondary care patients (direct referrals from GPs outside the usual catchment area). Patients with allergic emergencies will mainly have been seen in A&E departments and will be referred on by the A&E team or the patient’s GP. Some patients with drug allergies may come from anaesthetic departments. Individual clinics are responsible for informing local and regional healthcare purchasers about the services available for their clients.