A pharmacist specialising in allergy testing tells Rachel Carter how to diagnose allergy in young patients
Hilltop Pharmacy in Warley, West Midlands, has been running an allergy screening service for 18 months. The tests for the UK’s top 20 allergies – covering both food intolerances and airborne allergies such as pet dander and pollen costs a patient £99.99.
The pharmacist, dispensers and healthcare assistants are all trained to use the service, but the pharmacist always runs the test and conducts the ﬁnal consultation with the patient. Hilltop’s independent contractor and pharmacist, Bhupinder Malhi, talks us through how he would use the service to determine which allergy of allergies a young patient is suffering from and what steps to take next.
Nine-year-old Lucy* comes into the pharmacy with her mother, who is concerned she has an allergy. Lucy is exhibiting typical hay fever symptoms and is continuously sneezing. Her mother has noticed the symptoms are particularly bad during the spring and summer months.
*This is an imaginary scenario and not based on a real patient
1. Undertake an initial consultation
The ﬁrst step would be a consultation with the patient. This lasts 30 minutes and involves collecting basic information, including their full name, date of birth and address, then an in-depth discussion about medical history, symptoms and any key triggers.
This discussion helps to determine whether there are any patterns in a patient’s symptoms — for example whether they are worse at certain times of the day, or when they are indoors or outdoors. I decide Lucy’s symptoms warrant an allergy test.
2. Complete the allergy screening test
The allergy test involves taking a small, ﬁnger-prick blood sample — enough to ﬁll a capillary tube. Bear in mind that the test will only be effective if the allergy is live in the blood system. For this to be the case, the patient must have been exposed to the allergen within the past two weeks.
I then arrange a follow-up appointment for discussing the results – either for the same day or the following day. The sample is run through a series of chemicals and the results are available within 30-40 minutes. This is also the point at which the patient pays – the initial consultation is free.
3. Write up a report on test results
Before the patient returns, I write a report on the test results. This is approximately four pages and includes how the test works, how accurate it is and the clinical studies and evidence that support it, as well as what speciﬁc allergies have been tested for and whether the patient’s result is high, moderate, medium or low.
Any allergies scoring as ‘high’ will be the main focus of further discussion. The report also contains a ‘frequently asked questions’ section. When talking patients through the results in the consultation room, it can be a lot for them to take in, so they need all the information in the report to take home and read.
The report is crucial, especially if the patient needs to share the information with their GP or a consultant.
4. Discuss results and treatment options
The ﬁnal step is to meet the patient to discuss their results, which I go through in considerable detail. This discussion is always done with the pharmacist because we feel this offers the patient the best value for money.
Depending on the allergy, this conversation can be straightforward - for example, the advice for a nut allergy would be to not eat that particular nut. But when the allergy is something that affects the patient’s lifestyle or family, we have to be more sensitive in answering those questions.
We also suggest possible treatments. We always present the patient with options, as we would with any other treatment, and allow the patient to decide what’s best for them. In Lucy’s case, the test detected that her allergy was to a particular type of tree pollen, so the recommended options were an antihistamine, sodium cromoglicate eyedrops and beclometasone nasal spray.
It’s also important to tell the patient to take the medication every day, even if they feel well. Some patients do not want the treatment but may come in at a later date having changed their mind. You always leave the door open, rather than closing it with a sale, because that’s not the important part. In the long term, the most important thing is that the patient understands what allergies they have and the options available to them going forward.
Rachel Carter is a freelance journalist