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Should you offer allergy testing in your pharmacy?

06 Apr 2018

Allergies are on the rise, creating opportunities for testing services in pharmacies. Here’s the essential information, says Saša Jankovic

Latest figures show rates of allergy are increasing throughout the world, affecting up to 30-35% of people at some stage in their lives, according to Allergy UK.

In the UK alone, it is estimated that up to 50% of children are diagnosed with an allergic condition, and that the pattern of allergy is also changing. Initially, the increase was in asthma and allergic rhinitis (hay fever) but recent studies confirm a significant rise in food allergies.

It is therefore no surprise that Allergy UK Nurse Adviser Holly Shaw says there is an increasing demand for allergy testing and not enough services available. But she warns that setting up an allergy testing service is not to be taken lightly.

‘We’ve seen a rise in calls to the Allergy UK helpline from parents with concerns about food allergies in their children and adults worried about respiratory allergies from things like pets, house dust mites and moulds,’ says Ms Shaw.

‘However,’ she adds, ‘the first thing we do is make it clear that they may not need an allergy test. Often people self-report an allergy – for example, to a certain food – when actually there may be another reason for the problem they are having.’

Determining demand

It is wise to work out if there is local demand for an allergy testing service before you look into setting one up.

Deborah Evans, managing director of consultancy company Pharmacy Complete, says the first step before making an investment in any new service (private or NHS) is to make sure you understand the opportunity in your local area.

‘From a business development perspective, you are considering introducing a new product (the service) to your existing customer market and while you know your customers, it is important not to make any assumptions,’ she advises.

‘Undertaking your market research will be critical to ensure there is a need for the service that your customers will pay for it and to understand how to position and promote the service to optimise take-up.’

You also need to know if there are any similar services locally or online that you may be competing against. With that in mind, Gavin Birchall, founder and managing director of pharmacy marketing company Dose Design and Marketing, suggests doing secondary research.

He says: ‘Look at the documents that relate to local health needs – eg the Pharmaceutical Needs Assessment (PNA) – and then connect with national and local organisations that relate to the conditions you are considering. You can gather a lot of information quickly that will most likely tell you whether you are heading in the right direction.’

Service requirements

Establishing whether there is a demand is one thing, but do you know what running an allergy testing service entails?

In short, an allergy screening service usually consists of a short consultation to find out what symptoms the patient is reporting, followed by a skin-prick or patch test or blood test, which will be sent away for analysis. If the results show an allergy or intolerance, you need to follow up about how to manage the symptoms and signpost to sources of specific guidance and support.

Pharmacist Anil Rokad has worked at The Maple Leaf Pharmacy in Twickenham, south-west London, for 24 years. He runs a weekly allergy testing clinic offering the IgG blood test – also known as the radioallergosorbent (RAST) test– for allergies and intolerances.

‘Saying you are allergic to something has become a bit of a fad,’ he said. ‘Also there is a preconceived idea that wheat or milk are common allergens so people avoid them and miss out on the nutrients,’ he says. ‘The point is to find out what the patient is really allergic to, and I believe testing is the best way to find out for sure.’

Before he carries out the blood test, Mr Rokad asks the customer to keep a food diary for a couple of weeks to narrow the symptoms down to a couple of possible allergens. ‘Once we have that, we do a blood test for those items,’ he explains, ‘and then after a few days we’ll have the result and will talk to the patient again to discuss changes to diet and lifestyle.’

Room for testing

The allergy testing service should take place in your pharmacy consultation room. Mr Birchall says environment is a ‘key consideration when designing a service’ and can have a ‘big impact on how a patient will view professionalism and effectiveness.’

Any extra facilities needed will depend on the type of test – for example, blood tests will require the appropriate disposal of sharps and clinical waste, in addition to risk assessment procedures and referral protocols.

Team training

The pharmacist will need to learn about allergies, how to carry out the tests and give recommendations to patients following the results, says Ms Evans. She adds that the pharmacy team should also be trained so that ‘they can support and promote the service, proactively engage with and recruit patients and potentially take on some of the administration. Referral pathways should also be understood for those who are confirmed positive to allergens.’

The British Society for Allergy and Clinical Immunology (BSACI) is a good place to start if you want to find out more about training in allergy advice and testing. Mr Rokad read up on symptoms and allergens for his own interest, but when he set up the service 15 years ago he went to The Doctors Laboratory (TDL) – where he sends his tests for analysis – to learn more about blood tests, and also undertook phlebotomy training.

Marketing the service 

Mike Holden, principal associate at Pharmacy Complete, says: ‘Historically, pharmacy has been quite poor in valuing and promoting what it does’. So how can you promote your allergy testing service, and how much should you charge?

Mr Rokad started by putting leaflets in prescription bags and in local surgeries, and then word of mouth took over. However, he says: ‘It still took a while to get off the ground but at the start it was just a side interest so I was prepared to wait and see.’

Now he runs a clinic every Wednesday afternoon and sees a couple of patients each time, spending about an hour per patient in total, he estimates.

As for pricing the service, Mr Holden says it is ‘a complex process and depends on a mix of value, real (not perceived) market assessment and costs including business overheads, materials, time and associated costs’. Mr Rokad agrees, adding: ‘It also depends on the area where you are offering the service and whether your customers want to – or can afford to – spend money looking after their health.’

Mr Rokad prices the test either per item (for example, wheat) or by food or allergy groups. ‘This works out from £35 per item,’ he says. ‘Or if we test for a group – such as a hay fever profile including grass, tree, animals or mould – it’s more economical at £18-£19 per item.’

Nonetheless, Mr Rokad says lots of pharmacies are put off offering an allergy testing service because the training and time involved don’t always make the monetary reward that appealing. His advice is: ‘Be patient. We’ve had lots of happy customers saying it’s really helped them and once you provide a good service,  then customers come back for other things.’

More information

•Allergy UK resources for healthcare professionals

•British Society for Allergy and Clinical Immunology (BSACI) meetings, events and short

•The Doctors Laboratory pathology services

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