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The nurse's role in allergy management in primary care

Sue Cross
RN BSc(Hons)
NPDip PGCE
International Project Manager
Respiratory Education Resource Centres
University Hospital Aintree, Liverpool
E:sue@respiratory erc.com

The nurse has a major (and now established) role in the routine care of patients with differing chronic diseases seen in general practice. The extent of the nurse's role depends on many factors, including skills, training and knowledge. The knowledge base and skills of the doctor and the circumstances of the practice will similarly have an impact.(2)

Diagnosis
Accurate allergy diagnosis may be limited by the availability of consultation time. Nonetheless, time taken early on in obtaining a full history may well save time later. Patients should be allowed to explain their symptoms in their own time. Ask the following questions:

  • Do symptoms occur at any particular time of the day or year, and how often?
  • Which part of your body is affected?
  • How severe are your symptoms?
  • What family history is there of similar complaints?
  • Which self-help remedies seem to help?
  • Is there anything in particular that makes your symptoms worse?
  • Do the symptoms appear to be linked to a particular place, such as home or work environment?

At the end of the consultation it is often helpful to ask the patient, "What is your main problem?"(3)

The way forward
Many primary care practices already benefit from clinics devoted to the management of asthma, one of the most common diseases associated with allergy. Taking an allergy history may enhance the effectiveness of asthma care. The recognition of the importance of rhinitis and the role of allergy in rhinitis and eczema will also enhance the management of atopic patients in general practice. Food allergy and occupational allergy should be considered; if such allergies are present, the patient should be referred to a specialist.
The logical person to deliver allergen avoidance advice is the nurse, supported by the primary care doctor and, where necessary, the local allergy service, whether provided by an NHS-based specialist allergist or an organ-based specialist with training in allergy. Studies are currently underway to define those patients who are most likely to respond to allergen avoidance measures. Specialist referral may be needed. The allergist may also effectively evaluate the role of allergy in patients presenting with nonspecific symptoms.

References

  1. Scadding GK. The co-existence of upper and lower airways disease. Respir Dis Practice 1994;9:1118-20.
  2. Durham S. Allergy in general practice. In: Durham S, editor. ABC of allergies. London: BMJ Publishing Group; 1998.
  3. Coombs RRA, Gell PGH. Classification of allergic reactions responsible for clinical hypersensitivity and disease. In: Gell PGH, Coombs RRA, Lachmann PJ, editors. Clinical aspects of immunology. 3rd ed. Oxford: Blackwell Scientific; 1997. p. 761.

Resources
British Society for Allergy and Clinical Immunology
T:020 8398 9240
Allergy UK
T:020 8303 8583
National Asthma Campaign
T:020 7226 2260
Anaphylaxis Campaign
T:01252 54202
Medic Alert Foundation
T:020 7833 3034
Respiratory Education and Training Centres
T:0151 529 2598