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Research into allergy prevention and the introduction of new treatments is bringing hope to allergy patients. But how is independent pharmacy’s role developing, asks Victoria Goldman?

According to Allergy UK, eight per cent of GP appointments relate to allergic conditions such as hayfever, house dust mite allergy and food allergies.

While allergies can be fairly mild for some people, up to 20 percent of allergies can cause severe symptoms, including the risk of an asthma attack or anaphylactic shock.

Allergy prevention

In August 2024, researchers at Imperial College London revealed that the number of people living with food allergies in the England has more than doubled since 2008.

The analysis, published in the Lancet Public Health journal, found that up to four percent of preschool-aged children have a food allergy, while rates in adults were around one percent.

The researchers highlighted that newly diagnosed cases of food allergy may be levelling off in some age groups. This may be partly due to changes in baby feeding guidelines, which no longer recommend delaying the introduction of potentially allergens such as peanut.

The early introduction of egg and peanut are now standard recommendations for children at higher risk of food allergies (such as babies with eczema).

Peanut allergy affects more than one in 50 children in the UK and usually begins in early life. In May 2024, The LEAP-Trio study at King’s College London suggested that introducing peanuts to children under five can reduce the risk of developing peanut allergies by 71 percent.

Several other oral immunotherapy clinical trials are currently taking place across the UK. Children with food allergies (as young as two years) are taking part in research funded by The Natasha Allergy Research Foundation.

The Natasha Trial, at nine NHS hospitals, uses everyday foods to desensitise the children to their allergies. Early evidence shows children on the trial are tolerating cow’s milk and peanuts to which they were previously severely allergic. Trial results are expected in 2027.

Allergies versus intolerance

Around half of food allergies develop for the first time in later adulthood. Confusion between food allergies and food intolerances can delay the diagnosis, which is something that pharmacy teams could help to address when speaking to customers.

In May 2024, the Food Standards Agency’s “Patterns and Prevalence of Adult Food Allergy (PAFA)” report revealed that over 30 percent of UK adults report some types of adverse reactions when eating food but only around 6 percent of UK adults, around 2.4 million people, have clinically confirmed food allergies.

“There will continue to be a lot of confusion about the difference between food allergies and food intolerances until people understand the different symptoms that set them apart,” says Dr José Costa, senior allergy consultant at the Children’s Allergy Clinic in Warwickshire.

“Allergy symptoms are immediate, whereas intolerance symptoms are delayed and often affect the bowel. This confusion will inevitably lead to a lack of awareness about the potential severity of food allergies and the risk of anaphylaxis.”

Oral immunotherapy

Oral immunotherapy is a well-established treatment for some severe allergies.

Unlike other allergy treatments that simply manage the symptoms (such as steroid nasal sprays and antihistamines), immunotherapy effectively reduces or eliminates the body’s allergic response to specific allergens (such as peanuts or grass pollen).

Some forms of oral immunotherapy involve giving patients small but increasing doses of specific foods, while others use sublingual tablets (containing the allergen) that are held under the tongue rather than swallowed.

However, many oral immunotherapy treatments are only available privately, which limits their availability.

“All sublingual immunotherapies are life-changing, says Dr Costa, “but the earlier they are used, the more effective they are, and the more they can prevent the development of other conditions, namely asthma.”

In January 2025, the National Institute for Health and Care Excellence (NICE) issued optimised final draft guidance recommending a new daily sublingual tablet called Acarizax as a treatment option on the NHS for persistent moderate to severe allergic rhinitis in people aged 12 to 65.

Allergic rhinitis affects around 26 percent of adults in the UK, with around half of cases caused by house dust mite allergy. Acarizax (which is already available privately) involves giving a regular fixed amount of house dust mite allergy extract every day for three years.

“Many endure years of misery – of nasal congestion, loss of smell and sneezing – impacting their sleep and daily living with little respite from symptoms,” says Amena Warner, head of clinical services at Allergy UK.

“This can also affect mental wellbeing. With this treatment, there is now hope for people who fit the criteria to be able to access this through the NHS.”

Anaphylaxis awareness

The Imperial College London research in August 2024 found that 97 percent of allergy patients were seen only by their GP rather than in a hospital allergy clinic.

According to the researchers, more than one-third of patients at risk of severe allergic reactions weren’t being prescribed potentially lifesaving rescue adrenaline autoinjectors, such as EpiPens. Prescriptions were less common for people living in more deprived areas of the country.

Anaphylaxis can recur at any time, often long after the original allergic reaction.

In July 2024, the updated NICE Quality Standard on anaphylaxis stressed that people experiencing (or at risk of) anaphylaxis must be retrained on how to use their adrenaline autoinjector safely and effectively each time it’s prescribed.

Community pharmacists play an important role, as most adrenaline autoinjectors are obtained through repeat prescriptions. The new NICE Quality Standard also stressed that that patients should be reminded to check the expiry dates on their adrenaline autoinjectors when collecting their prescription.

“As well as providing the medication,” says Dr Costa, “it’s important that pharmacies provide support by asking if the patients have an action plan to carry along with their medication and if they are aware that it should be kept at a steady temperature.

“The best way is to carry it in an insulated bag, such as those from allerpack.co.uk.”

Rapid treatment is essential to manage anaphylaxis. However, research shows that some people delay using autoinjectors due to fear or uncertainty about using needles.

In February 2025, a new needle-free adrenaline nasal spray (Neffy) was approved for use in the USA and EU. ARS Pharmaceuticals has now filed for the approval of Neffy in the UK. The nasal spray would provide a more accessible option for managing severe allergic reactions.