Introduction

Asthma and allergies are public health problems which are increasingly prevalent in industrialised countries. They are community-based diseases with medical as well as social and psychological consequences.

It has been estimated that half of all Europeans will suffer from some sort of allergy by 2015 if this new epidemic goes unchecked. Allergies among children are an increasing concern and are mainly responsible for the growing numbers suffering from asthma. Thirty years ago, approximately one third of asthma cases were said to be caused by allergy. Today it stands at 80 per cent.

Asthma is the main reason for lost days at school. Ireland is now second only to the UK in the European league table for childhood asthma.
Unfortunately, the response of the Government to this growing problem has been less than adequate. We have insufficient numbers of medical experts in the country to serve the needs of the growing number patients and we have no dedicated allergy and asthma clinics.

In Ireland there are only three public clinical immunologists and one paediatric allergist to serve a population of 4.6 million.
In Australia there are a 130 immunologists and, in one state alone with a population equivalent to Ireland, there are 50 immunologists. In Sweden 96 trained paediatric allergy specialists serve a population of 1.5 million children.
This lack of service provision is placing an unfair cost burden on individual patients and is exposing them to further medical complications:

• In the absence of a full public allergy services, many patients are forced to seek out advice in the unregulated allergy testing sector.
• Patients are being referred to private organ-based specialists with an interest in allergy. This is a problem for patients, as these specialists have no specific training in full spectrum allergy management. It would be preferable for referrals to be made to clinical immunologists who are formally trained in the diagnosis and integrated management of allergic disease.
• Patients are being prescribed with repeat antibiotics or long-term cortisone medication to treat persistent problems, instead of being treated within an immunology setting. Further medical problems arise as patients develop resistance to drugs or serious side-effects to long-term medication.
• Without asthma and allergy nurse specialists, and without on-going education and support to GPs and their patients, many sufferers are under-managing their conditions and are being exposed to potentially fatal health risks.
• Without developing guidance and protocols on allergy management and the use of adrenaline in schools, in the ambulance service and within the primary care setting, sufferers are left to their own devices to seek advice from the Asthma Society and the Anaphylaxis Society.

Better services for sufferers

This Green Party discussion document puts forward a number of concrete proposals that will, if implemented, improve allergy and asthma medical service provision in Ireland.
The measures proposed are targeted to ensure that all medical services can provide the same level of information and guidance on the issue of asthma and allergy management to all sufferers. This will curtail the need for hospital admissions, as patients will manage their conditions more effectively. The Green Party proposals recommend:

• Establishment of a regional allergy and asthma centre to provide clinical, laboratory, research, and community medical outreach services across the country;
• Schools support;
• Guidelines on the use of adrenaline for serious anaphylactic reaction in ambulances, restaurants and schools;
• Further education of GPs;
• Outreach services for GPs and other primary health service providers.

Asthma and Allergies

An allergy is a hypersensitive reaction to an otherwise harmless substance in the environment. The allergic individual may react adversely to a food, grass pollen, animal dander, house dust mite, bee and wasp venoms or contact with latex rubber. The number of potential candidates is endless. Allergy is a multi-system disorder that manifests itself in wide spectrum of medical conditions including asthma, rhinitis (chronic nasal symptoms), eczema, urticaria (severe raised skin blotches).

Food allergies are a more recent, yet increasingly common phenomenon, with patients being allergic to a wide range of foods including milk, fruit (kiwi, apple, strawberry, orange), sesame, and tree nuts. In 1990 peanut allergy, for example, was rare. By 1996 in the UK its prevalence amongst children was one in 200. In 2004 it was reported in the UK as affecting as many as one in 50 .

Asthma is a common chronic inflammatory disorder of the airways that affects children and adults of all ages. Its causes are not fully understood but environmental, hygiene, modern living and house design are increasingly linked with the growth in allergies. As hygiene standards increase our resistance to common allergens weakens. The EU is looking seriously at the issue of environmental influences on the growth in allergies and asthma in Europe. It funded the €26 million 'Global Allergy and Asthma European Network' (GALEN) under the Sixth Framework Programme (2004-2006) and brought together 25 universities and research institutes to work on nine issues that scientists believe hold the key to allergies. A key focus of the research is to examine the hypothesis that allergies are directly linked to the way we live, in bacteria-free homes. Children exposed to more infections in early life are less prone to allergies and children raised on farms are less likely than others to get hay fever, asthma and eczema.
The most recent studies on the prevalence of asthma show that Ireland is second only to the UK in rate of asthma per head of population (ISSAC (1998) and WHO (1996)). In Ireland the ISAAC study (1998) showed that 23% of children and adolescents experienced asthma-related wheeze over the course of a year.