DOI: 10.12809/hkmj175069
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
COMMENTARY
Can Hong Kong take advantage of recent advances in
allergy prevention?
TH Lee, ScD, FRCP1; HK Ho, MD, FRCPCH2;
TF Leung, MD, FRCPCH3
1 Allergy Centre, Hong Kong Sanatorium
& Hospital, Happy Valley, Hong Kong
2 Department of Paediatrics and
Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong,
Pokfulam, Hong Kong
3 Department of Paediatrics, Prince of
Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
Corresponding author: Dr TH Lee (takhong.lee@hksh.com)
Introduction
Major opportunities have been identified recently
to prevent allergic disorders including the early introduction of
allergenic foods to infants1 2 3 4 5 6 7 8 9 and
immunotherapy.10 11 Breast feeding is still strongly encouraged, but new
evidence suggests that the avoidance of allergenic foods in infancy to
delay the onset of allergic diseases may have sustained rather than
prevented food allergies and eczema. International guidelines on infant
feeding are being revised.12 13 14 It is a
moot point whether Hong Kong has the infrastructure required to exploit
these transformative opportunities to improve public health in allergy.
Can Hong Kong take advantage of the recent advances in
allergy prevention?
In 2014, it was estimated that Hong Kong had only
one allergy specialist for 1.5 million people,15
and there had been no local trainees in immunology and allergy in adult
medicine for nearly two decades. The current ratio of registered adult
allergists per head of population in Hong Kong remains approximately one
per 2.8 million, one of the lowest in the world.15
There are 2.4 full-time equivalent specialists in paediatric allergy,
about one paediatric allergist per 540 000 paediatric population. This is
less than the previous estimate 3 years ago of 1:460 000.15 The situation should improve by the end of 2017 when
two trainees complete their training in Paediatric Immunology and
Infectious Diseases (PIID). Nonetheless these graduates will only work
part-time in allergy because of the manpower constraints in the public
hospital system. Hong Kong also has two clinical immunologists who work
part-time. Therefore, by the end of 2017 it is estimated that Hong Kong
will have one allergist per 1.17 million population, a slight improvement
on the 1:1.5 million figure estimated for 2014 although the ratio is still
very low.
One way to grow a discipline is to recruit
specialists from overseas.1 In
2016, a public hospital recruited a paediatrician who had already
completed his medical, paediatric, and allergy/immunology training in the
United States. Nonetheless he is now required to spend a further 4 to 5
more years fulfilling the requirements of the Medical Registration
Ordinance and specialty registration before he is recognised as a PIID
specialist in Hong Kong. Whether it is desirable to have a more
expeditious mechanism to assimilate doctors trained overseas, especially
those with expertise that can fulfil an unmet need, into the local health
care system is a subject of intense current debate.16 17
Another way to create more allergy services in
public hospitals is by realigning resources.15
Two public hospitals have adopted this strategy and now each offers a new
penicillin allergy testing service. The new services are operated by a
respiratory medicine specialist and a trainee allergist under supervision.
Both clinicians gained experience in testing for drug allergies at an
allergy centre in a local private hospital under the supervision of a
specialist who is included in the ‘Immunology and Allergy’ Registry (S34)
of the Medical Council of Hong Kong (MCHK). This example of collaboration
between the private and public sectors could provide a template for future
progress.
Training
A robust throughput of trainees is essential to
grow a specialty. In a long overdue development, Hong Kong now has its
first trainee in adult allergy (MCHK Specialist Registration S34) in 20
years. This trainee, however, has to spend time training overseas as there
is no locally available adult allergy trainer. Allergy specialists in
private practice are not recognised by the Hong Kong College of Physicians
(HKCP) as official trainers because they do not work in a HKCP-recognised
training centre. There are undoubted benefits of gaining experience
overseas but consideration could be given to improving the training
environment in Hong Kong. A structured pathway could be developed to
maximise the local opportunities to train future specialists.
There has been a successful training programme for
paediatric allergists for several years. The subspecialty board of PIID
(S56) under the Hong Kong College of Paediatricians has recently applied
to change its name to ‘Paediatric Immunology, Allergy and Infectious
Diseases’ (PIAID). This is a major step forward for the future of
paediatric allergy as a discipline in Hong Kong and may attract additional
trainees.
Professional societies and patient organisations
The community is well-supported by allergy-related
professional societies and patient organisations. These include the Hong
Kong Institute of Allergy (HKIA), Hong Kong Society of Paediatric
Respirology and Allergy, Hong Kong Society for Paediatric Immunology and
Infectious Diseases, The Hong Kong Allergy Association (HKAA), and The
Hong Kong Asthma Society (HKAS). To a certain extent they all host allergy
conventions, symposia, and courses. Scientific papers18 19 20 and clinical allergy practice guidelines1 are published. Some of them have social media platforms
to engage the public, have their own websites, and publish regular
newsletters. The HKIA also offers educational scholarships and research
grants. The two patient organisations, namely HKAA and HKAS, are committed
to making a difference to patient experience through peer-group support,
patient and public education, advocacy, and organisation of social
activities.
Conclusions
Patients with allergic diseases in Hong Kong are
well-served by professional societies and patient organisations but there
remains inadequate clinical support to take full advantage of recent major
public health advances in allergy. It is recommended again that centres of
excellence in allergy be established to drive patient care and teaching of
under- and postgraduate students, and to conduct world-leading research in
the discipline.15
Each of the two medical schools with their partner
hospitals in Hong Kong has the core of an allergy and immunology service
already. It would not require large resources to transform them into
centres of excellence. The imminent opening of the Hong Kong Children’s
Hospital also provides an opportunity to synergise various strands of
paediatric allergy and immunology expertise. If the vision for the
creation of allergy centres can be realised, Hong Kong can play its part
in stemming the global allergy epidemic for the benefit of its community.
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