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. 2025 Jun;55(6):458-468.
doi: 10.1111/cea.70034. Epub 2025 Apr 1.

Inequalities in Access to Specialist Allergy Services in the United Kingdom: A Report From the BSACI Registry for Immunotherapy (BRIT)

Mich Erlewyn-Lajeunesse  1 , Luciano Perfetti Villa  2 , Shifa Shaikh  3 , Maria Smith  3 , Vasiliki Balodima  4 , Sarah Baker  5 , Tom Dawson  6 , Pamela Ewan  7 , Sujoy Khan  8 , Deborah Marriage  9 , Louise Michaelis  10 , Leyla Pur Ozygit  11 , Anna Thursby-Pelham  12 , Amena Warner  13 , Olga Maslovskaya  2 ; BRIT Practitioners Group
Collaborators, Affiliations

Inequalities in Access to Specialist Allergy Services in the United Kingdom: A Report From the BSACI Registry for Immunotherapy (BRIT)

Mich Erlewyn-Lajeunesse et al. Clin Exp Allergy. 2025 Jun.

Abstract

Background: There is an unmet need for specialist allergy treatment in the United Kingdom. Allergen immunotherapy and treatment with omalizumab for chronic spontaneous urticaria (CSU) are key markers for these services. The British Society for Allergy and Clinical Immunology (BSACI) Registry for Immunotherapy (BRIT) is a national project to record the real-world effectiveness, safety and access to treatment for aero-allergen, venom and peanut immunotherapy as well as omalizumab for CSU.

Methods: We described participant demographics, the index of multiple deprivation (IMD) and access to treatment from the registry launch. Data for 1835 participants were available for analysis from 63 centres enrolled between 1st October 2018 and 24th August 2023.

Results: 96.5% (1771/1835) were living in England, with only 3.5% (64) being from the devolved nations. 14.4% (251/1748) were in the most affluent IMD decile compared to 4.5% (78/1748) in the most deprived IMD decile. White participants were 1.74 times more likely to be referred directly from primary care compared to people of Asian, black, mixed or other minority ethnic groups. Instead, these groups were referred more frequently from secondary or tertiary hospital services. The median distance travelled from home to the treatment centre was 15.2 miles, with evidence of clustering around specialist centres.

Conclusions: We have described disparities and unwarranted variation in the provision of treatment around the UK. The data suggest that there is limited access to immunotherapy in the devolved nations. Access is also reduced by socioeconomic deprivation. White participants were more likely to receive a direct referral from primary care than those from other ethnic groups whose referral pathways were more complex. Registry data are limited by participant enrolment and may have selection bias. Nevertheless, BRIT has highlighted inequity in access to specialist allergy services in the UK.

Keywords: allergen; allergy; basic immunology; biologics; clinical immunology; food allergy; immunotherapy; immunotherapy and tolerance induction; venom and insect allergy.

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Conflict of interest statement

M.E.‐L. has received advisory board honoraria and speaker fees from Allergy Therapeutics and DBV Technologies. He is supported by Southampton NIHR Biomedical Research Centre. T.D. reports ALK Albelo provided travel and conference registration fees to members of his department (2023). L.M. has previous (2020) speaker fees, Advisory Boards and Commercial Clinical Trial Research Grants from Danone Nutricia and Regeneron unrelated to this work and submission. Other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Participants stratified by index of multiple deprivation (IMD). The bar chart shows registry participants in England and Wales according to the IMD decile rank of their home postcode. The first decile is the most deprived (shaded bars) the tenth decile is the least.
FIGURE 2
FIGURE 2
Index of multiple deprivation (IMD) by treatment domain. Where decile 1 is the most deprived and decile 10 is the most affluent.
FIGURE 3
FIGURE 3
Bar chart showing referral patterns to specialist allergy services by ethnicity.
FIGURE 4
FIGURE 4
Charts showing the distance travelled to access services. The panels show box and whisker plots of the distance travelled between home postcode and specialist hospital in Miles. The uppermost panel shows distances according to ethnicity, followed by Country of residence, type of immunotherapy received, with the full registry distance travelled in the lowermost chart.
See this image and copyright information in PMC

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