The marked increase in the prevalence of allergic disease over the past few decades has left the NHS ill prepared. In response to the Health Select Committee's damning report in 2004 on allergy services,1 the Department of Health and the Scottish Executive are currently reviewing all aspects of provision of allergy care. Their separate reports will be published shortly. A key question is whether it would be more effective for the NHS to emulate the model used in other parts of Europe and North America and invest in expanding specialist services for allergy or—more controversially—to concentrate efforts on developing primary care services. This choice will have substantial and lasting implications for people with allergies in the United Kingdom and will probably affect the thinking of policy makers in other parts of the world who are grappling with similar rapid increases in the prevalence of allergic disease.

Around one in three of the UK population have allergic symptoms at some point in their lives.2 Localised …