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This website has been constructed to provide reliable and understandable information for the many millions of allergy sufferers in this country, where allergy specialists are now so rare that there is only one for three million people.
A unifying concept of allergic disease is proposed to explain how any part of the body can be affected by allergy, and how any medical speciality can become involved. This unifying concept , supported by case reports and clinical photographs from my files, should preferably be read before referring to the section in the contents which seems to relate best to your personal problems.
Specialised Facilities for Investigation and Treatment
I will see patients of all ages, especially children, even including infants with feeding problems. At my consulting rooms I have developed specialised facilities for the out-patient investigation of all sorts of allergies. These include a very wide range of skin tests, patch tests if necessary, electronic lung function testing, oximetry, and typmpanometry for investigating glue ears and Eustachian dysfunction, etc..
Microscopical examination of the cells in the sputum or nasal discharge, and of samples of house-dust when required, is carried out on the spot when relevant. Immunological blood tests are available when required. A completely unique investigation is making special extracts from samples of the patient's own house dust or pet hair to use as a skin test to establish the importance of the patient's own home environment. This innovative and logical method of investigation can pinpoint the source of allergy in the home, assess its importance, and indicate what action should be taken.
Allergy problems are often complicated and require much time and expertise to sort out, so I find it best to regard the sufferer as a partner in the investigation rather than as a patient. The objectives of an allergy consultation are to identify the cause of the problem, assess its severity and impact on the quality of life, ensure that treatment is using the most up-to-date treatments, and to establish rapport with the patient. Ideally, the patient should become sufficiently well-informed to be fully responsible for the effective management of their own treatment and life-style.
I routinely send a copy of my report to the patient as well to the family doctor, as this practice prevents misunderstandings, encourages compliance with my recommendations, reassures the patient, and provides a back-up against loss of medical records.
Fees
My fees are paid by every Medical Insurance Scheme except BUPA, which has an ageist policy and refuses to pay for any consultant over seventy years of age, regardless of professional eminence.. When making enquiries to your medical insurer before a consultation it should be stated that my entry in the Medical Register is "H M Brown, registration number 0102548".
It is difficult to estimate fees because they depend so much on the amount of time required to sort out the problem , plus any necessary tests . The first consultation will last for at least an hour, often more, and will cost a minimum of £150, plus any essential tests. Further visits if required will take less time and cost less. These fees are comparable with those charged by solicitors or chartered accountants.
Personal Medical Status
Today there are so few allergists that many dubious practitioners have attempted to satisfy this unmet need. For this reason it is essential to establish my medical professional status by a brief account of my career.I qualified as MB ChB at Edinburgh University in 1939, won the Sir John Fraser medal for Clinical Surgery as a student, then served in the Royal Army Medical Corps throughout the war, mainly in India, until 1946. Post-graduate studies led to the award of the degree of MD with Commendation in 1950 for my thesis on "Adaptation and Adaptive Dysfunction". In 1949 I became a Member of the Royal College of Physicians of Edinburgh , and was elected a Fellow in 1965.
After experience in the Professorial Unitin Dundee Medical School under Professor Sir Ian Hill, and in the Dundee Chest Clinic, I was appointed Consultant Chest Physician South Derbyshire In 1953, and later Allergist to the Derwent Hospital, Derby Chest Clinic, and the Derby Children's Hospital until I reached NHS retirement age. So many practitioners in the Derbyshire/Nottingham area who knew me well have retired that most family doctors in practice today are quite unaware of my international reputation as a Clinical Allergist, or that I am still in active consulting practice.
Whilst working at Derby Chest Clinic and Derwent Hospital during the following thirty years I carried out many research projects in allergy and aerobiology, and organised five International Symposia on Clinical Allergy held at Nottingham University.. I founded that Midlands Asthma and Allergy Research Association in 1968 to support allergy research in the Midlands. In 1993 I was awarded the Charles Blackley Lectureship by the British Society for Allergy and Clinical Immunology, the William Frankland Medal for services to Clinical Allergy in 1999, and in 2004 I received an Honorary Doctorate from Derby University.
I am a member of the British Society for Allergy and Clinical Immunology, the European Academy of Allergology and Clinical Immunology, the American College for Allergy Asthma & Clinical Immunology. I have frequently presented new research at annual meetings of all these learned societies.
In July 2006, I was elected as an International Fellow of the American Academy of Allergy Asthma and Immunology. I am only the tenth British doctor to have been honoured by the most prestigious Allergy Association in the world.
I continue in active practice not only because I enjoy seeing patients and solving their allergy problems, but also because there are so few allergy specialists available. It is a curious paradox that while Britain probably has the most inadequate allergy service in the developed world, we also have the highest incidence of allergic disease especially in children.
My objective has always been to find the cause rather than suppress the symptoms with drugs which may have side-effects and can never cure. For example antibiotics will cure an infection completely, but allergies are quite different because the treatment is only suppressing the symptoms of asthma, rhinitis, or eczema. I have always felt that to rely on drugs without attempting to find the cause is an inadequate approach to allergic problems, and a poor standard of Medicine.
I have also published books for patients which are now out of print, but I still have a few copies left which are available for £ 12.00 including postage.
Research Career - A Brief Outline of Major Events
My paper in which I had shown that if many eosinophil cells were found in sputum or in nasal discharges from patients with asthma they would be greatly helped by giving oral prednisolone tablets was published in the Lancet in 1958. The presence of these cells indicates that an allergic reaction is taking place in the bronchi, and steroids will be very effective treatment. When eosinophil cells were absent and many macrophage cells, which scavenge pollution and infection, were present instead patients did not improve when given prednisolone, so the correct diagnosis in these cases was was chronic bronchitis. This paper by only one researcher, not carried out under blinded conditions, and with only one table of results and no statistics, would never have had a hope of being accepted for publication today, but it has proved to be a seminal observation .
Nevertheless this observation, which enabled me to select the patients who would benefit from steroids from those who would not, is still used in important research to this very day. Mast cells are also found which liberate granules full of histamine and other noxious substances as part of an allergic reaction, but are not such a prominent feature of the sputum or nasal cytology..
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Mast Cell in nasal smear |
Macrophages in bronchitic sputum |
eosinophils stained red in sputum |
Following this development I soon had hundreds of very happy asthmatic patients taking oral steroids, but I was very concerned about their future because I knew that oral steroids have many long-term side-effects. In my opinion steroids should be regarded as a chemical crutch to control the allergy while a search is made for the cause. In my contribution to a Symposium on Airways Obstruction at the Royal Festival Hall in 1969 I stated "Steroids pave the primrose path of therapeutic dalliance, leading only to a mirage of apparent health and well-being". Perhaps this was an extreme view, but it is still appropriate in some instances to this very day.
Because the presence of many eosinophil cells usually indicates that an allergic reaction is taking place I wanted to find out why these allergy cells were present. As a result I became deeply involved in allergy research directed at finding the innumerable causes of the asthma, rather than relying entirely on indefinite suppression of symptoms with drugs. It seemed obvious that if the cause or causes of the asthma could be found and avoided there would some possibility of getting patients off steroid treatment, or at least controlling the asthma with a smaller dosage. If the cause was unavoidable. Desensitising injections could then be given until the patients no longer reacted to the allergen. The result could be that they could stop steroids altogether or reduce dosage considerably. Success with these methods, particularly asthma, encouraged my interest in finding the causes of other allergic diseases such as allergic rhinitis, hay fever, eczema, anaphylaxis, and food allergies. This was the situation from 1958 to 1970.
This eosinophil sputum test, which I still carry out on the spot in my consulting room, enabled me to select the patients most likely to respond to steroids, was probably the reason why I was given the opportunity to carry out a clinical trial of the very first inhaled steroid, Beclomethasone Dipropionate, (later named Becotide) beginning in July 1970. This clinical trial was really of crucial importance because trials in Edinburgh from 1968 onwards had failed to show any benefit, probably because cases of chronic bronchitis were selected. The makers, Allen & Hanburys, were just about to discard Becotide as a useless drug on the basis of these poor results from Edinburgh, but Dr Wilfred Simpson, their Medical Director, did not agree because he had heard me lecture on selecting responders to steroids by the results of sputum cytology. He wrote to me stating that his last act before taking up a new appointment with another company was to ask me to try the steroid aerosol because he was so sure that it would be effective. I then commenced a clinical trial selecting only patients who had eosinophils in their sputum. My results, monitored for the first time by giving peak flow meters to every single patient, were so impressive that after six months Allen & Hanburys wrote stating that they had decided "to give the steroid aerosol another chance",.
Thus the first steroid aerosol was rescued and a new era in the treatment of asthma had begun, and .I was the first in the world to publish reports on the remarkable effectiveness of inhaled steroids in both adults and children in the British Medical Journal in 1971 and 1972. This research would have been very difficult to carry out under the strictures which govern clinical trials today, and unacceptable for publication because this was not a double blind study where neither doctors nor patients know who is receiving active drug or placebo.
One of the most important findings was that many patients dependent on oral steroids for control of their asthma could stop taking steroids and be controlled by the inhaled steroid instead. This treatment was soon used all over the world because inhaled steroid aerosols act directly on the bronchial tubes and control asthma without causing side-effects, while oral steroids are absorbed from the stomach and circulated all over the body by the circulation, thus causing side-effects as well as remarkable benefit, depending on the dose.
Inhaled steroids have been acknowledged to be the most important development in the treatment of asthma in the last thirty years, and I am very proud that trials here in Derby were the first to show how effective they are. Today few asthmatics need oral steroids except in emergency, and total dependence on oral steroids is unusual. Many similar steroid drugs for inhalation have been developed over the years which are all effective, but recent improvements in the propellant gas have resulted in the aerosolised particles of the drug being so small that they penetrate to the very smallest bronchi, enabling the whole bronchial tree to be treated for the very first time. Unfortunately very few doctors in this country seem to have heard of this development, even though the QVar aerosol, which contains Becotide, the first inhaled steroid, as the active drug, has been prescribable on the NHS for four or five years and is not even expensive.
When tuberculosis was a major problem Chest Clinics looked after the whole family from cradle to grave, and patients were followed up from infancy onwards. After tuberculosis became controlled and allergy became my major interest, the old TB clinic organization gave me the opportunity to observe how allergy or intolerance to milk and other foods could affect two or even three generations. .
This unique personal experience would be impossible today because the development of organ specialties has created barriers to the comprehensive generalised approach which, in my opinion, is essential for the recognition of the diverse clinical problems caused by faulty adaptation to foods or environment Today I would not have been permitted to treat children because this would have been encroaching on the province of the Paediatricians.
During my time within the National Health Service I was fortunate to have a great deal of freedom to follow my research interests and develop a very active research unit. I am certain that this would have been quite impossible under the restrictive conditions and the bureaucracy which have been imposed since then.. However, the development of the World Wide Web gives me a wonderful opportunity to publish an account of my researches and experience for all to see.
I continue to publish new research, and last year was involved in a report in the Lancet where I personally diagnosed the first case of anaphylaxis in the UK to be caused by lupin flour. This is a hidden menace because the commonest dangerous food allergy is to peanuts, and many peanut allergics are also sensitive to lupin, which does not have to be declared on the label. This new finding was also published as a poster at the 2005 meeting of the British Society for Allergy and Clinical Immunology.
© Dr. Harry Morrow-Brown. All Rights Reserved