A systematic review of pathways for the delivery of allergy services

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The incidence and prevalence of allergies worldwide has been increasing and allergy services globally are unable to keep up with this increase in demand. This systematic review aims to understand the delivery of allergy services worldwide, challenges faced and future directions for service delivery.
A systematic review of Ovid, EMBASE, HMIC, CINAHL, Cochrane, DARE, NHS EED, INAHTA databases was carried out using pre-defined inclusion and exclusion criteria. Data on the geographical region, study design, treatment pathways described were collected and the findings were narratively reported. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
183 publications were screened and 23 selected for review. Only three were prospective studies and none included a control group. There were no eligible publications identified from North America, Africa, Australia and most parts of Asia. Most of the publications relate to allergy services in the UK. In general, allergy services globally have not kept pace with the increasing demand. Primary care practitioners are not adequately trained in allergy. There is also a paucity of appropriately trained specialists, especially in paediatric allergy. There are considerable barriers to service improvement including lack of political will and reluctance to allocate funds from local budgets.
Demand for allergy services has significantly outpaced supply. Primary and Secondary care pathways in allergy are currently inadequate leading to poor referral practices, delays in patient management and consequently poor outcomes. Improvement of services requires strong public and political engagement. There is a need for well planned, prospective studies in this area and a few are currently underway. There is no evidence to suggest that any given pathway of service provision is better than another although data from a few long term, prospective studies look very promising.
Original languageEnglish
Article numbere012647
Number of pages29
JournalBMJ open
Publication statusPublished - 1 Feb 2017


  • Allergy
  • Eczema,
  • Allergy services
  • Allergy service delivery
  • Primary Care Practitioners
  • Primary care
  • Secondary care
  • Specialists
  • Unmet need
  • systematic review


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