Allergy trends: How pharmacists can lead in the new era of allergy care

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Allergy continues to be one of the most common chronic conditions encountered in community care, and pharmacists are often on the frontline when patients seek relief or advice. In this article Professor Adam Fox OBE, founding director at Allergy Centre of Excellence reflects on the evolving landscape of allergy in the UK, with a focus on what community pharmacists need to know and how they can help deliver better outcomes for patients.

When patients with allergies walk into a community pharmacy, they most often fall into two key categories. The first is respiratory allergy, typified by hay fever or allergic rhinitis. These patients frequently request antihistamines, nasal corticosteroid sprays and eye drops. The second major category is food allergy and risk of anaphylaxis. Pharmacists will often interact with these patients when they collect epinephrine auto-injectors such as EpiPen or Jext and occasionally attend to queries about adrenaline use.

Shifting prevalence and severity

Over the last decade, food allergies in children have doubled, and episodes of anaphylaxis have tripled over the past 20 years. High-profile allergy-related deaths have also heightened public awareness and anxiety. In contrast, respiratory allergies such as hay fever appear to have plateaued in prevalence, though the burden remains large: around 20% of UK adults are affected by hay fever. The difference now is in severity, duration and impact on quality of life, not necessarily in higher numbers of new cases.

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We do not yet fully understand why food allergies are rising so sharply. With hay fever, climate change is playing a clear role: pollen seasons are longer, pollen peaks are higher and the geographic distribution of pollen is wider. Poor air quality compounds the effect. Even though the overall number of hay fever cases may not be increasing rapidly, the impact per patient often feels more intense.

Evidence-based treatments that pharmacists should know

This is a particularly exciting period in allergy care. In the realm of anaphylaxis, the upcoming launch of EURNeffy, a needle-free intranasal adrenaline device, offers a potential alternative to traditional auto-injectors. Fear or hesitation about injections remains a major barrier to prompt adrenaline use, and a less invasive device may encourage faster treatment of severe reactions.

In food allergy care, oral immunotherapy is developing rapidly. Palforzia is now available for peanut allergy, and oral immunotherapy protocols for milk, egg, tree nuts, legumes and sesame are helping transform the lives of patients with these allergies. Biologics, such as Omalizumab, now licenced in the US for food allergy, are starting to impact clinical practice. For respiratory allergies, the recent NICE approval of sublingual immunotherapy for pollen and dust mite allergies provides a new option for patients whose symptoms persist despite antihistamines and nasal corticosteroids.

Common misconceptions pharmacists can help correct

Allergy is riddled with myths. One is the belief that each allergic reaction must worsen over time, which causes unnecessary anxiety in patients with a history of anaphylaxis. Another major issue is antibiotic allergy overdiagnosis. In fact, around 90% of people labelled as allergic to penicillin or other antibiotics are not truly allergic. Many rashes are caused by infections rather than the drug itself. Allergists are increasingly working to ‘delabel’ patients, which can reduce anxiety, healthcare costs and inappropriate antibiotic use.

For food allergies, we cannot stratify patients by presumed severity. Someone with a mild past reaction may have a severe reaction in the future, which makes prediction impossible. For respiratory allergies, pharmacists can judge if symptoms are mild or moderate based on response to over-the-counter antihistamines. If antihistamines alone are ineffective, adding a nasal steroid spray is appropriate. If symptoms remain troublesome even on combination treatment, immunotherapy should be considered and referral made.

Red flags that require referral

Any patient whose symptoms do not respond to standard therapy should be referred for further evaluation. In the case of suspected anaphylaxis or repeated moderate to severe reactions, a specialist review is always warranted.

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Pharmacists are well placed to offer non-pharmacological guidance. For respiratory allergy patients, advice on environmental control such as dust mite prevention, saline nasal rinses, pollen balms, washing hair before bed, avoiding drying clothes outside and using pollen filters in cars can make a real difference.

For food allergy, signposting patients to reputable resources such as Allergy UK or Anaphylaxis UK helps build confidence and awareness. Few patients are aware of immunotherapy options for either respiratory or food allergies and consequently miss out on the opportunity to explore these important treatment options.

The expanding role of pharmacists

In a health system under pressure, pharmacists are uniquely positioned to support allergy patients. Ensuring that patients understand how and when to use inhalers, nasal sprays, eye drops and adrenaline devices remains critical. Beyond this, pharmacists should also be aware of emerging treatment options such as immunotherapy and biologics, and feel confident in signposting patients when standard care is not enough.

We live in a transformative era for allergy treatment. Biologics are being studied for new indications, and new approaches such as epicutaneous and sublingual immunotherapy are expanding patient options. Even those with multiple, severe food allergies are finding new pathways for therapy. The landscape is evolving rapidly, and pharmacists will continue to play a vital role in guiding patients safely through this new era of allergy care.

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The Allergy Centre of Excellence is a specialist clinical service based in London, dedicated to the diagnosis, treatment and research of allergic diseases. Led by Professor Adam Fox OBE, and colleagues Prof Gideon Lack and Prof George du Toit, the Centre brings together world-leading experts to improve patient care, raise awareness and advance innovation in allergy management.