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<<   作成日時 : 2010/12/17 23:58   >>

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 英国は世界でも有数のアレルギー疾患の有病率である。子供の多くは喘息、湿疹、花粉症、食物アレルギーにより苦しんでいる。高率にもかかわらず、NHSのアレルギー治療対応は不十分である。
 こうした状況は公的に明らかになっているが、英国のアレルギー専門医数は先進国の中で最低である。専門医不足のため医学生の教育は不十分であり、そのままの状態で資格が与えられている。
 幼児の8%が食物アレルギーを持ち、親の1/3は子どもが食物アレルギーを持っていると疑っている。必然的にインターネットなどから誤った・矛盾する情報を得てしまうことになる。
 子どもに多い食物アレルギーの1つは牛乳アレルギーであるが、これはまた同じように両親と医師への混乱の原因となる。湿疹、逆流、腹痛、下痢、便秘などが潜在的な牛乳アレルギーによって起こされる。しかしやっかいなことに、こうした症状が免疫系が全く関係しない乳糖不耐症による場合もある。
 問題を深刻に受け止め、時間と資源を当てる必要がある。家庭医GPは早期にアレルギー疾患を認識して診断・管理したり、いつ紹介すべきかを知る方法を与えられる必要がある。
 最新のNICE食物アレルギーガイダンスは最初の良いステップだが、医学生への適切な教育がされるまでは患者は大変である。

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26 November 2010 Last updated at 08:46 GMT
Children with allergies 'being let down'
http://www.bbc.co.uk/news/health-11494534
VIEWPOINT By Dr Adam Fox Child allergy specialist

画像The UK leads the world when it comes to prevalence of allergic disease.
More of our children are suffering from asthma, eczema, hay fever and food allergy than ever before.
However, despite these worryingly high figures, provision of NHS services for allergy remains seriously lacking
This has been recognised and documented by both the relevant royal colleges as well as the government - yet still the number of allergy specialists in the UK pales in comparison to virtually every other country in the developed world.

We are letting our children down.
A lack of specialists means a lack of the basic resource required to educate doctors in training and as a result, the overwhelming majority of medical students qualify without ever having received any training about identifying or managing conditions such as food allergy and intolerance.
And this is worrying because of the numbers involved - food allergy affects around 8% of infants and over a third of parents suspect their child has a food allergy.
The impact is obvious - parents find their doctors and health visitors offering conflicting information as to the cause of their child's illness, often having their concerns about allergy dismissed.
When they inevitably turn to the internet they are faced with a minefield of conflicting information, littered with unproven diagnostic tests.
So business has never been better for a whole range of complimentary and alternative therapists, who are happy to fill the vacuum left by the lack of NHS provision.

Spotting signs
One of the most common food allergies seen in children is milk allergy, but this can also be a cause of confusion to parents and doctors alike.
For some infants, a milk allergy can't be missed - as soon as the baby has infant formula he develops hives and swelling, but for others the reaction is delayed and causes chronic symptoms.
Eczema, reflux, colic, diarrhoea and even constipation may be caused by an underlying milk allergy. With all of these symptoms common, it takes an educated and experienced eye to tease out which children need to change their diet to help them feel better, rather than being subject to increasing medication and investigations coupled with significant parental anxiety.
To complicate things further, reactions to milk may not involve the immune system at all and simply be an intolerance; most commonly to lactose, the main sugar found in milk.
We need to take the problem seriously and commit the time and resources to it.
GPs need to be given the tools to recognise allergic disease early and know how to diagnose and manage it or at least know when to refer on.
The recent NICE guidance on food allergy is a good first step but until medical students are properly taught about allergies, patients will get a raw deal.

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Diagnosis and assessment of food allergy in children and young people in primary care and community settings
Full guideline
November 2010
http://www.nice.org.uk/nicemedia/live/12164/51821/51821.pdf

This guideline was developed following the NICE short clinical guideline process. This document includes all the recommendations, details of how they were developed and summaries of the evidence they were based on.

Food Allergy in Children NICE guideline DRAFT (November 2010)


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