This site is intended for health professionals only

Undertrained nurses “uncomfortable” treating allergy

Three-quarters of primary care nurses have admitted to lacking even basic training in treating allergies, and more than half say they feel "uncomfortable" seeing patients with allergy-related conditions.

This is despite the fact that in the UK the incidence of common allergic diseases has trebled in the last 20 years, to become one of the highest in the world - one in three of the UK population will be affected by allergic disease at some time in their life.1

This is increasing the burden on primary care, where the majority of such patients first present and where most of those with more minor or moderate symptoms will remain for treatment.

However, in a survey of more than 1,100 primary care nurses by Nursing in Practice, only 25% had any kind of training in allergy, and 53% felt uncomfortable working with patients with allergy-related conditions.

"Without formal training I'm lacking in confidence," said one practice nurse from Scotland. "I don't feel I know enough about allergy to be able to advise on anything more than on a superficial level," commented a practice nurse from Sheffield.

"Training in 'general' allergy is difficult for nurses to access locally," says John Collard, Clinical Director of Allergy UK. "The few nurses who have had training have normally done this in relation to a particular condition relating to allergy, such as asthma or eczema."

In addition, 23% of nurses who responded to the survey described themselves as the main nurse in their practice dealing with allergy. Yet, surprisingly, only 29% of these had any form of accredited training in allergy.

According to Marilyn Eveleigh, Consultant Editor of Nursing in Practice: "It is frustrating that nurses won't/can't undertake training. A one-day intense session would make such a difference to nursing confidence and patient support. Training is available but prioritising, funding and capacity are often lacking in primary care."

Dr Samantha Walker, Director of Education and Research at Education for Health, is keen to point out the benefits of improving allergy services. "There is evidence that training given to health professionals improves quality of life in patients with rhinitis."2 She also points to the importance of treating problems like hayfever given its impact on exam performance in teenagers.3

"Allergy is a condition ideally suited to management in primary care by GPs, nurses and pharmacists," says Marilyn Eveleigh. "Practice-based commissioning groups would be well advised to consider this as a cost-effective service for patients."

1. Royal College of Physicians. Allergy: the unmet need. London: RCP; 2003.
2. Price D, et al. Clin Exp Allergy 2007; 37(1):90-9.
3. Walker S, Khan-Wasti S, Fletcher M, et al. J Allergy Clin Immunol 2007;120:381-7.

To read the full report click here

Do the results reflect your experiences? Do you have easy access to training? Have you noticed an increase in the number of allergy cases? Your comments: (Terms and conditions apply)

"Hopefully this survey will provoke substantial food for thought for Nursing in Practice readers. On reading the full report, four things occurred to me that I'd like to share with you.

  1. An RCT published last year showed that patients who were cared for by a health professional who had undertaken Education for Health's level 3 allergy course were significantly better in terms of their health outcomes and quality of life. This could really help health professionals wanting to undertake education make their case for funding and/or inspire them as to why they should as a result of reading the survey.
  2.  "How to make your case for education and training" is a toolkit launched by Education for Health in early May.
  3. Education for Health also offer the sort of short-term practical one-day training training "allergy and anaphylaxis" to which Marilyn alludes in the conclusion of the article.
  4.  I don't think it ever got published but Dr Samantha Walker ran a project a few years ago in Harrow PCT providing specialist allergy care in primary care. From what I remember an enormous amount of work went into engaging the GPs and practice staff about what they could and should refer and once up and running the clinic was enormously popular with general practice and it demonstrated cost savings for the PCT in terms of reduced referrals to secondary care. It was an interesting project" - Candy Perry, Head of Communications and External Affairs, Education for Health

Nursing in Practice Awards 2008 will reward best practice in a variety of clinical areas. If you know someone who is quietly making huge strides in their area, but are not getting the recognition they deserve, why not nominate them? Or maybe you were you involved in an innovative, or introduced a new strategy or protocol in your practice that improved service delivery? Tell us about it. For more information go to