Hong Kong has a serious lack of allergy specialists: journal

PUBLISHED : Tuesday, 10 February, 2015, 3:02pm
UPDATED : Tuesday, 10 February, 2015, 4:55pm

When Julian Ngai was five years old, he sipped a teaspoon of milk and suddenly stopped breathing. His mother Sandra Lai Pui-ling was terrified as an unconscious Ngai had to be sent to the intensive care unit, where he was administered extra oxygen.

It had been part of a traumatic – but life-saving – allergy test he was given at the Queen Mary Hospital in Hong Kong, with doctors later concluding he had severe reactions to dairy, particularly eggs, as well as peanuts.

Since then, Ngai, now 10, only eats food his family has packed for him – even when they are going out to a restaurant. There are rare exceptions with restaurants where they know the food doesn’t contain anything he’ll react to, like the fries at McDonald’s. He has also undergone six months of treatment which helped him recover from his egg allergy.

He has even gotten to the point where he can eat one egg a day. “Once he’s tasted an egg, he always wants to eat them in front of other people to prove that he’s over the allergies,” says his mother, who is an accountant.

Ngai’s parents got him tested for allergies shortly after he was born in Canada. By then, they knew he had food allergies, but got him tested again at Queen Mary Hospital when he was older because some children will just get over their allergies at that age.

“Now he’s very happy because he can finally taste eggs. He says even raw eggs taste good,” says his father, Andrew Ngai, adding that Julian has not had an allergic episode in three years.

Hong Kong Allergy association chairman Marco Ho, a child immunology and infectious diseases specialist at Queen Mary, suggests Ngai is one of the lucky ones. The lack of allergy specialists in the city means that desensitisation treatments like Julian’s are not easy to come by.

An article published in the Hong Kong Medical Journal this month found that allergy services are a “seriously unmet need” in Hong Kong.

A desensitization treatment involves gradually injecting larger and larger doses of allergens (eggs, in Julian Ngai’s case) until the person no longer has a reaction. But it starts with another test like the one that sent Ngai to the ICU.

The Journal explains that only four public hospitals (including Queen Mary) have clinics for food and drug allergies, but they cater to child patients only. There are two full-time and four part-time staff members at Queen Mary’s allergy clinic.

The overall ratio is about one allergy specialist, or allergist, for every 1.46 million people in Hong Kong, according to the journal authors. Comparing that to numbers from the World Allergy Organisation, that puts Hong Kong well behind other developed countries like Japan and Australia.

Ho says that though there is a “definite demand” for proper allergy assessments and treatment, patients often have to wait for nine months to a year.

Sandra Lai says that after their family moved back to Hong Kong from Canada more than a year after their son was born, they spent three months looking for an allergy doctor.

She also says they had to go to the private Hong Kong Sanatorium & Hospital for the treatment, racking up HK$200,000 in bills. So far, the treatment worked. Ngai eats an egg every day. If he keeps it up for three years, then he’ll definitely be over his egg allergy.

“In Hong Kong, we barely have paediatric clinics and there are no facilities at all for adults. Quite often, [young patients who become] adults will come back to us for care and we have to tell them that we’re paediatricians and can’t treat adults,” said Marco Ho, the specialist.

He adds that in countries like Britain, there are different specialised allergy services for children and adults. He explains that some people only show symptoms of allergies as adults, so under Hong Kong’s current shortage of adult specialists, adult patients have trouble even getting diagnosed. He adds that allergies are chronic conditions, which means they don’t go away without treatment.

Adults must seek out specialists on their own, outside of dedicated clinics.

This is bad news for people like Ida Lam Shuk-yee, 48, who has been living with allergies all her life. One can see it in her hands – the lines and creases of her skin turning a shade of red, looking like open wounds that had recently healed.

There are also faint red spots on her skin – a condition called eczema, a skin allergy.

Adding to her health woes, Lam, who has asthma (asthma and allergies often occur together), is allergic to painkillers, seafood and chemicals like perfume, paint and cleaning products.

Lam says she has had difficulty finding a job because of her obvious condition.

“A lot of people might not hire you for fear that your physical appearance can affect their business. For example, restaurants and hospitals will want someone presentable,” Lam says. “But even on our best days, you can still tell we have skin allergies because we’ll never have smooth skin.

“Once, an employer said to me, ‘I can hire you, but you have to get a doctor to certify that you’re not infectious. And you have to wear white gloves if your skin gets red’,” she recalls.

 “I wondered, ‘Do you want me to wear gloves to protect me or because you don’t want other people to see something that they’ll find gross?’” she says.

The incident struck a nerve with her and to this day she can’t see white gloves without recoiling.

Lam worked for seven years as a clerk in an industrial building, but in 2011, her allergies got so severe that she could not even walk up the stairs.

She quit her job and for the past two years has been living off her savings. She also has to take care of her elderly parents, who are 88 and 80.

Lam still needs regular check-ups for eczema at a public hospital. “Worst-case scenario is I use up all my savings and I [get] public assistance,” Lam says. “Getting treatment is very expensive, beyond the reach of a lot of patients.”

Marco Ho, the specialist, says the eczema clinic at Queen Mary Hospital is treating around 700 cases, while the food allergy clinic has a similar caseload.

Immunology specialist Lee Tak-hong, one of authors of the Journal study, recommends that the government open two pilot allergy centres and recruit overseas allergy specialists to train more local doctors.

Lee, director of the allergy centre at the Hong Kong Sanatorium, as an example said all final-year medical students at the University of Hong Kong, numbering between 100 and 150, came to train with him for half-day shifts in the past two years, following him around the hospital and observing how he administers treatment.

Later, they’ll shadow him for two-day shifts, Lee says, but this is still not enough. 

“Without specialists, you won’t have any teachers, which means you won’t have any students. We’ll never make progress, unless we have more trainees and specialists to teach them,” he says.

Asked to comment on the problem, Hong Kong’s Hospital Authority said: “Please be reiterated that [the authority] has an established a mechanism to align service planning and resources allocation relating to service operation and manpower.”

Marco Ho, from Queen Mary Hospital, says unlike fields such as cardiology and surgery, there is no career track or training programme for becoming an allergy specialist in Hong Kong, so medical students do not see it as an option.

Ho says there will be a greater demand for allergy specialists in Hong Kong and other cities as well.

The Journal article notes that although there is a dearth of data about allergies among adults in Hong Kong, allergies are expected to become more common worldwide, partly due to climate change.

A 2010 review from the Journal of Investigational Allergology and Clinical Immunology concluded that cases of allergic respiratory diseases and bronchial asthma are increasing worldwide, with these conditions more common in urban areas.

It notes that climate change affects the distribution of air pollutants and prolongs the period when pollen stays in the atmosphere.

Ho says there are multiple factors that give people allergies – including weakened immune systems.

He says that as humans get exposed to less and less germs in their surroundings due to advances in hygiene practices, immune development is affected and people become more susceptible to allergies.