Allergy is common and the prevalence has increased substantially in the last 2-3 decades. There has been a particular increase in severe allergic disease, including anaphylaxis, food, drug and latex rubber allergy. Provision of allergy services in the NHS is extremely poor and there is a huge unmet need. Allergy is a full speciality, but there are few consultants and few trainees. Whilst other specialists have a role in the management of allergy, it is no longer adequate to devolve most of

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... gy care to them. Provision of allergy care must be lead by allergy specialists so that adequate standards of care can be achieved. The lack of care leads to morbidity, mortality and substantial cost to the NHS, much of which is avoidable. There is an urgent need for the creation of more consultant posts in allergy and this requires recognition by Trust Managers, Regional Commissioners and the Department of Health. Disorders dealt with by an allergist An allergist deals with a wide range of disorders crossing the organ-based disciplines within medicine (Table 1) . It is important to emphasise that the expertise of an allergist is unique and distinct from that of organ-based specialists and immunologists. However, in addition, allergists require detailed knowledge of certain areas within some of the organ-based specialities, but not the full breadth of knowledge that these other specialists have, e.g. in respiratory medicine, dermatology and ENT. One of the difficulties in the establishment of this speciality has been to define the need, particularly where there appears to be overlap with an organ-based specialist. Of the disorders an allergist will deal with ( Table 1) , some of these are clearly specific to allergy, such as drug allergy, food allergy, venom allergy, latex rubber allergy, (disorders categorised by aetiology) as well as some of the disorders defined by symptomatology -anaphylaxis and severe allergic reactions. There are others where there is overlap with the organ-based specialists in terms of appropriate referral. These are asthma, rhinitis, conjunctivitis, eczema, urticaria and angioedema. An allergy opinion may be of great value in these disorders. This is particularly true when they are severe, not readily controlled, part of multi-system allergic disease or where an allergic aetiology is (or should be) suspected. Correspondence to.