GP Matters has a Doctor with qualifications and experience in the management of allergy.
Dr McAlister completed an Allergy Degree Module
through the National Respiratory Training Centre at the University of Warwick in 2003 and has worked part time as an Allergy Specialist at Glasgow Yorkhill Hospital.
"The basis for making a diagnosis of allergy is the consultation."
The first step in the diagnosis of any allergy is taking a thorough medical history. The key is that exposure to an agent results in symptoms suggestive of allergy which are redness, itch and swelling and that this occurs within minutes or up to one hour after contact. This usually presents as itching and burning in the mouth followed by swelling of the lips and a feeling of being unable to breathe. It can also present as sneezing, a blocked nose, a runny nose, a post nasal drip or itchy streaming eyes.
We were the first private clinic in Scotland to provide a skin prick allergy test. The results of this testing are read after 15 minutes therefore you would have the results before you leave the clinic.
Skin prick testing introduces a small amount of liquid containing the proteins of the common airborne allergens or food allergens into the skin. A positive test results in a red itchy weal at the injection site. Skin prick testing is safe and not particularly uncomfortable.
Make sure you do not take antihistamines before the test, as they make the results meaningless.
To ensure the results are accurate, there should have been no antihistamine taken for three days prior to the testing. Also please include any medication you take on the registration form you complete on arrival at the clinic.
Please follow the link for a list of Available Allergens for Skin Prick Testing
Like the skin prick allergy test, this method provides quality, reliable results, they just take a little longer to process – approximately 5-10 working days.
Tests are available for over 500 substances ranging from wheat to blomia tropicalis (a tropical mite). Please follow the link for a list of Available allergens for blood testing.
In addition to the wide range of individual tests, we also provide tests for groups of the more common allergens.
Food profile: Nuts, fruits, fish, egg white, cow's milk,
Inhalant profile: Trees, weeds, moulds, dust mite, grasses, animals
Food and Inhalant combined
Children's profile Egg white, cow's milk, cod, wheat, peanut, timothy grass, dust mite, kiwi fruit, strawberry
Shell fish profile: Clam, crab, crayfish, lobster, octopus, prawn/shrimp, scallops, squid
Fin fish profile: Cod, herring, mackerel, plaice, sardine, salmon, swordfish, tuna, sole
Cereal profile: Wheat, oats, maize (corn), sesame seed, buckwheat, rye, barley, rice
Antibiotics profile: Penicillin G and V, Ampicillin, Amoxicillin, Cefaclor
Nuts and seeds profile: Peanut, hazel nut, brazil, almond, coconut, pecan, cashew, pistachio, walnut, pumpkin, poppy, macadamia
Insect venoms profile: Honey bee, bumble bee, common wasp, European hornet, yellow hornet, white faced hornet
Most people with mild allergies find that taking antihistamine tablets when exposed to allergens will help to some extent, but they are not the mainstay of treatment. More useful are steroid nasal sprays or a combination of intranasal steroids and intranasal antihistamines. Although it is more expensive, a more effective way to manage allergic rhinitis due to grass or tree pollen, or cat or dust mite allergy is immunotherapy. We do not offer immunotherapy for food allergy. The best advice is avoidance of the food.
Immunotherapy is a type of treatment for allergies that works by suppressing a specific immune response. It is a way of changing the body’s immune system to help it to recognise harmless substances and learn not to respond negatively to them. This is known more specifically as suppression immunotherapy. It is the only available treatment for allergy that actually deals with the allergy itself rather than treating the symptoms using antihistamine or steroids.
Immunotherapy works by exposing the body to the allergen a miniscule amount at a time, allowing the body to slowly adjust and become less sensitive to it. This process is known as desensitisation. The treatment is administered by a course of injections or drops under the tongue over a period of one to three years by a doctor or allergist and is normally only used in cases where the person's quality of life is seriously affected by their allergy or if the patient is at risk of anaphylactic shock.
Immunotherapy does not work for everyone, and in some people will only improve symptoms rather than cure the allergy completely. It is most effective when started as early as possible, in children or as soon as the allergy has been diagnosed. We start the administration of this aged 6.
The products we use for immunotherapy (IT) are:
Pollinex Quattro injections for grass or tree pollen
Oralvac sublingual drops for cat or house dust mite allergies.
The guide price per year for the immunotherapy treatment itself is around £1500 per year for three years.
The use of adrenaline as an emergency allergy treatment is well understood by doctors and has saved many lives. It is used to treat anaphylactic shock where the sudden, high levels of histamine and other substances released during an allergic reaction cause the patient to have difficulty breathing due to swelling of the tissues in their airway, and can also cause loss of consciousness.
Anaphylactic shock can occur immediately after contact with an allergen, and/or there can be a delayed reaction a few hours later. Adrenaline is a hormone produced by the body that decreases swelling associated with an allergic reaction, relieves asthma symptoms, eases breathing, tightens blood vessels and stimulates the heart. This is obviously the medication given as an injection in an emergency situation.
Research has shown that the sooner adrenaline is given once an anaphylactic reaction has started, the better the health outcome for the patient. This makes rapid treatment of anaphylaxis possible, rather than having to wait for the emergency services carrying the medication to arrive.
For this reason, people who are at risk of anaphylaxis are often prescribed adrenaline auto injector devices for use by themselves or others in an emergency. The first step would be to take an antihistamine and if this does not stop the allergic reaction, the patient should use the epipen/anapen (adrenalin injection). These should also be carried by the person particularly to restaurants or activities where they might be exposed to their allergen trigger eg peanuts in an asian restaurant.
Adrenaline auto-injectors look like pens and are prescribed according to the weight of the patient. Most children will be given a junior injector, but larger children and teenagers will be prescribed the adult version. Whichever style or type of device is prescribed, the doctor prescribing it should be able to demonstrate how to use it. If the doctor does not offer this, ask for it.
Once a dose of adrenaline has been given, an ambulance needs to be called and the patient should go to hospital so that any further reaction can be treated. It may be that another dose of adrenaline is needed before they can get to the hospital, and allergy sufferers who are at risk of anaphylaxis should carry two injectors for this reason. By the time they reach hospital, the patient may have a late phase reaction/delayed reaction, for which the hospital can provide further treatment.
• Steroids: We do NOT offer Kenalog or any other type of steroid injections. There is a long list of possible serious complications from a steroid injection including acute vascular necrosis of the hip.
• Cromoglycate - works by blocking the responses of the cells that release histamine during an allergic reaction, and can be a useful alternative to an anti-histamine in preventing allergic reactions. However, this treatment only works if taken before contact with the allergen, and it can take a number of weeks for the effects of the treatment to be seen. Cromoglycate is mostly used in eye drops as anti-histamines do not always offer much relief from allergic eye symptoms.
• Anti-Leukotrienes - Leukotrienes are chemicals released by the immune system that cause swelling and secretion, and can cause allergy symptoms to persist. Anti-leukotrienes reduce inflammation and mucus production and work in a similar way to steroids, but with fewer side effects. These drugs have often been used as add-on treatments alongside treatments for asthma and allergic rhinitis. However, they are now being used more often as a first line choice in treating asthma, especially in children. Montelukast or singulair is a useful medication in this group.
The science behind allergies is in some ways little understood. One of the current theories to explain the increase number of children with allergies we are seeing is "the hygiene hypothesis". The child's immune system does not adapt normally to the environment outside the womb as "we are too clean", meaning that the immune system is not challenged or trigerred in the way it should be.
It is true to say that allergies can be cured or significantly improved in many cases, but it is not entirely clear to scientists how the process works. However, there are plenty of treatments available and new discoveries in allergy research are being made all the time. The mainstay of treatment remains avoidance of any identified allergen trigger.
There are many different kinds of food allergies. It is possible to be allergic to almost any kind of food. A food allergy is caused by your body mistakenly identifying the proteins in a certain food as a threat. One food allergy in particular that is very common is peanut allergy, but allergies to soya, eggs, milk and wheat are also prevalent.
Symptoms of a food allergy: Symptoms of a food allergy will differ greatly depending on the severity of the allergy. If the allergy is mild, you may notice a slight burning or itching sensation in your throat when eating certain foods. A food allergy would usually present with itch, burning or a tingling feeling in the mouth which results in swelling of the tissues in the throat making it difficult to breathe. This would happen very soon after the ingestion of the allergen such as a nut. Adrenaline administered by a device such as an epipen would counteract these symptoms.
Treatments for food allergies: Avoidance of the suspect food trigger is essential.
Allergic rhinitis is where an allergy to something like pollen, dust or mould irritates your nose and causes cold-like symptoms.
Allergic rhinitis is usually seasonal (grass or tree pollen) or persistent (cat or house dust mite).
Symptoms of hay fever: Most people will be able to recognise the most common symptoms of hay fever (grass pollen allergy). These would be feelings of tiredness and lethargy, coupled with an irritated nose and throat symptoms, dry and itchy eyes and itchy skin are the most common. Other symptoms include feeling sick, finding it hard to breathe normally, loss of sense of smell, pain in the face caused by blocked sinuses, headaches and earache. Hay fever can also make the symptoms of asthma worse and vice versa.
Treatments for hay fever:
You can ease symptoms of allergic rhinitis with antihistamines and rinsing your nose with salt water. The GP can prescribe a steroid nasal spray.
It is not definitively known what causes asthma, but it is likely to be a combination of factors. There is some evidence to suggest that asthma is a genetic condition, with children whose parents suffer from asthma being more likely to develop asthma themselves. Exposure to irritants such as cigarette smoke and air pollution are likely to contribute to asthma and are certainly irritants, though there is little evidence to suggest that they are the cause. The hygiene hypothesis as previously mentioned, the suggestion that being in a very clean environment growing up can lead to the immune system not being appropriately challenged and therefore not developing normally, may be a factor in causing asthma and allergies.
Symptoms of asthma: Asthma is a potentially serious condition, though many people only experience mild symptoms. The most common symptoms include wheezing (a ‘whistling’ sound when you breathe), a feeling of tightness in the chest, shortness of breath and coughing. These symptoms are often worse at night and early in the morning, in the cold, or when exercising. Sometimes asthma can be triggered by exposure to an allergen, such as pollen. Another presentation might be an asthma attack, or ‘acute exacerbation of asthma.’ This is when asthma symptoms become unmanageable and the patient experiences shortness of breath, fast breathing and a fast heartbeat, and being unable to eat, drink or sleep. This would be a medical emergency and would require urgent medical help.
Treatments for asthma: The most common treatment for asthma is the use of inhalers, devices that deliver drugs directly to the lungs. The type of inhaler prescribed depends on the frequency of symptoms.
The two main types of inhaler are preventer inhalers administered daily to prevent symptoms, and reliever inhalers that are taken when the patient is feeling wheezy or short of breath. These can also be taken prior to exercise if that is a known trigger.
Other types of treatment for asthma include theophyllines, oral steroids and montelukast.
Urticaria is the swelling of the skin due to histamine or other chemicals released from under the skin’s surface causing a nettle-sting like rash. It often co-exists with a condition called angioedema, when the skin around the eyes and lips becomes puffy and swollen. Triggers can include food allergies (for example to peanuts or shellfish), pollen or other environmental allergens, infections, insect bites or stings and emotional stress. Other common triggers include stress, alcohol, caffeine, prolonged pressure on the skin (for example wearing tight clothing) medications and exposure to heat, cold or water. However it is often very difficult to get to the bottom of what is causing the rash and swelling. In many cases these are short-lived conditions lasting less than 6 weeks (acute urticaria and angiodema) or in some cases it can last for longer (chronic urticaria and angioedema). Any testing done would be based on obvious triggers to the rash and swelling and so keeping a diary of possible links to symptoms prior to coming to the clinic would be very helpful.
Symptoms of urticaria and angiodema: Urticaria is most obviously recognised by a red, raised and itchy rash like a nettle sting. These marks are usually raised and are also known as weals or hives. They are itchy. The marks can appear all across the body, or in just one area. They can last a few hours before they fade, but when they do the skin will return to normal.
Angioedema presents as facial swelling. The symptoms are normally temporary and will be most severe after 8 to 12 hours. But it will usually completely clear up within 24 hours.
The pattern of symptoms in those who suffer from chronic urticaria and angiodema can be unpredictable, with around half of people suffering with the conditions having outbreaks of symptoms lasting 6-12 weeks, followed by a period of remission where the symptoms improve or disappear completely.
Treatments for urticaria and angiodema: Urticaria and angiodema usually do not need any treatment, as symptoms are usually mild and will clear up after two or three days. However, some people will suffer with more persistent symptoms, and if you find that they are not clearing up by themselves then over the counter antihistamine medication can help. There are other useful treatents such as another type of histamine receptor blockers or montelukast.
Anaphylaxis is a severe and in some cases life-threatening allergic reaction that develops rapidly in response to an allergen. It is caused by an overreaction of the immune system. Any allergic reaction can lead to anaphylaxis, though it is not common. For this reason, it is important to seek medical attention both in the acute situation and for preventative measures such as immunotherapy to avoid a similar reaction in the future.
Symptoms of anaphylaxis: The most important and obvious symptom of anaphylactic shock is difficulty breathing. Anyone struggling to breathe will require medical attention and it is very important to seek this as quickly as possible. There are a number of other common symptoms that occur alongside or before difficulty breathing. These include a weak and rapid pulse, swelling of the throat, tongue and sometimes mouth, skin reactions including hives and flushed or pale skin, nausea, vomiting or diarrhoea, dizziness or fainting and loss of consciousness. Extreme coughing and sneezing can be other features of acute anaphylaxis.
Treatments for anaphylaxis: If you suspect that someone is suffering from anaphylactic shock, call an ambulance immediately and use an adrenaline injector or Epipen if one is available. The patient will need to go to hospital even if they receive adrenaline, as they may need oxygen and to be kept under observation to make sure the symptoms do not return.
Consultation + Skin Prick Testing: £140
Follow this link for Available allergens for Skin Prick Testing
Single IgE blood tests cost £40 each.
Follow this link for Available allergens for Blood Testing
Please note that all Blood test prices do not include the £80 consultation fee.
As with any other health checks, we are unable to do blood tests without any prior consultation.
Various allergen profiles are also available:
Food profile - £300
Peanut, Hazel Nut, Brazil Nut, Almond, Coconut, Cod, Shrimp, Blue Mussel, Tuna, Salmon, Egg White, Cow’s Milk, Wheat, Soya Bean, Apple, Pear, Peach, Banana
Inhalant profile - £300
House Dust mite, Cat dander, Horse dander, Cow dander, Dog dander, Box Elder, Silver birch, Hazel pollen, Oak, Sycamore/London plane, Cladosporium herbarum, Aspergillus fumigatus, Penicillium notatum, Alternaria tenius, Mugwort, Nettle, Timothy Grass
Food and Inhalant profile - £500
Peanut, Hazel Nut, Brazil Nut, Almond, Coconut, Cod, Shrimp, Blue Mussel, Tuna, Salmon, Egg White, Cow’s Milk, Wheat, Soya Bean, Apple, Pear, Peach, Banana, House Dust mite, Cat dander, Horse dander, Cow dander, Dog dander, Box Elder, Silver birch, Hazel Pollen, Oak, Sycamore/London Plane, Cladosporium herbarum, Aspergillus fumigatus, Penicillium notatum, Alternaria tenius, Mugwort, Nettle, Timothy Grass
Children's profile - £200
Egg white, cow's milk, cod, wheat, peanut, timothy grass, dust mite, kiwi fruit, strawberry
Shell fish profile - £200
Clam, crab, crayfish, lobster, octopus, prawn/shrimp, scallops, squid
Fin fish profile - £200
Cod, herring, mackerel, plaice, sardine, salmon, swordfish, tuna, sole
Cereal profile - £200
Wheat, oats, maize (corn), sesame seed, buckwheat, rye, barley, rice
Antibiotics profile - £100
Penicillin G and V, Ampicillin, Amoxicillin, Cefaclor
Nuts and seeds profile - £350
Peanut, hazel nut, brazil, almond, coconut, pecan, cashew, pistachio, walnut, pumpkin, poppy, macadamia
Insect venoms profile - £150
Honey bee, bumble bee, common wasp, European hornet, yellow hornet, white faced hornetv
Components profile - £600
Food Allergens: Egg, BSA, Cows Milk, Cod, Brazil Nut, Hazelnut, Peanut, Soybean, Wheat, Kiwi, Celery, Peach. Aero Allergens: Bermuda Grass, Timothy Grass, Birch, Cypress, Olive, Ragweed, Mugwort, Wall Pellitory, Saltwort, Dog, Cat, Alternaria, Aspergillus, House Dust Mite. Other: Honey Bee Venom, Paper Wasp Venom, Common Wasp Venom, Latex.
Pollinex Quattro injections for grass or tree pollen - 3 year treatment
Guide price per year: £1000 for the kit/medication plus 4 x £80 consultations for the administration of the Pollinex injections.
Oralvac sublingual drops for cat or house dust mite allergies - 3 year treatment
Guide price per year: £1500 for the medication plus 1 additional £80 consultation for the supervision of the initial dose.
In general, because of the lack of the maturity of the immune system, we do not recommend allergy testing to children under 12 months.
Dr McAlister will first take the full details of your symptoms and how they have affected you. Other background medical questions will help us to understand other factors that might be involved. From your description of your symptoms, and the answers to other questions, we will begin to understand what the causes might be.
We can provide all available allergy tests. These can be done on the day of your first appointment where they are indicated. However, not all patients who come to see us actually need an allergy test. Even if your symptoms are typical of allergy, tests are not always needed to make the diagnosis. In other cases no allergy testing is required as it is clear from the history that the symptoms are not allergy related. Guidance will be given. Sometimes tests other than allergy tests are performed, being based on the clinical history.
Please stop anti-histamines at least 3 days prior to your appointment, as they interfere with skin testing. If anti-histamines cannot be stopped, we will still be able to do IgE (blood) testing.
Please take time to think carefully about events surrounding your reaction / symptoms.
• Photos and digital images
• Referral letters
• List of foods / allergens that may have caused a reaction
• A list of your medication (or ideally the medication itself).
Allergies are usually a life long condition. They change with age and this is called the “Allergic March”. Children tend to get eczema, asthma and food allergies. Milk and egg allergies tend to be outgrown, while shellfish and nut allergies tend to persist. Teenagers get hay fever and generally the older you get, the less problematic your allergies become. Or so it used to be. However the pattern has changed over the past few years with more adults developing allergies, and children tending to take longer to out grow the milk and egg allergies of the early years.
Peanuts are legumes (bean family) and unlike the nuts grow on trees. They are different food families, but co-incidentally 50% of peanut allergic children also react to tree nuts and sesame seed. As peanuts are from the legume family, it would be important to ask/test for any reactions to other foods in this group such as peas, beans and lentils.
Skin Prick Testing results would be available by the end of the consultation.
We would have the allergy blood results from the lab within 2-3 days.
Allergy is an acute reaction with reddening, itching and swelling that involves the immune system and which can occasionally be life threatening (anaphylaxis). Intolerance is a non life-threatening reaction. The onset is usually slower in onset and does not involve the immune system. The presentation might be abdominal pain or a feeling of malaise. There are no specific tests that ca be done to test for intolerance. The best advice is elimination of a suspected food/agent for a period of time, then re-intoducing it to see if the symptoms reappear. Lactose intolerance is the inability to digest the cows milk sugar lactose.
Skin prick testing
• Lower cost, high sensitivity and rapid results
• May be affected by medication and skin condition.
• Potential to cause adverse reaction.
• Responsiveness depends on age.
• Inconvenient for patient.
• Not interfered with by skin condition or medication such as antihistamines
• Returns quantitative result for future monitoring
• No reaction triggered in patient.
• Reliable testing method.
• Minimal blood sample.
• Higher cost
• Results take a few days.
No. Ezcema is not an allergic condition. However, a consultation with our doctor would help in the manangement of the condition.