Changing the Narrative on Allergies: A Conversation with Dr. Costa
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- March 12, 2025
We sat down with Dr. José Costa, an expert in allergy treatment and a passionate advocate for changing the way we approach allergies. With years of experience in the field, Dr.Costa is dedicated to raising awareness about the growing prevalence of allergies, particularly in urban environments, and the potential of Sublingual Immunotherapy as a revolutionary treatment. During our discussion, he shed light on the hidden factors contributing to rising allergy rates and how better urban planning, along with innovative treatments, can make a difference.
Dr. José Costa is a leading allergy specialist dedicated to advancing research and improving medical guidance on Allergic Rhinitis (AR), allergic asthma, and associated conditions. With over 20 years of experience as a senior medic in both the NHS and private sector, he has led allergy services at University Hospitals Coventry & Warwickshire and Sherwood Forest Hospitals NHS Foundation Trust. Dr. Costa is also a member of the Royal College of Paediatrics and Child Health and has contributed to the National Allergy Guidelines for the British Association of Allergy and Clinical Immunology (BSACI).
Despite the increasing prevalence of allergies in the UK, the NHS has been slow to adopt advanced treatments, particularly Sublingual Immunotherapy (SLIT), which could significantly reduce suffering and NHS expenditure.
The Allergy Crisis in the UK
Allergic Rhinitis affects nearly 50% of the UK population, yet it is often dismissed as a minor condition. However, studies show that AR is linked to chronic health issues such as allergic asthma, food allergies, and even long-term respiratory diseases. The UK has the highest asthma death rate in Europe, and 40% of hay fever sufferers go on to develop asthma.
A study by Allergy UK found that nearly 30 million people in the UK suffer from airborne allergies. However, access to effective treatments remains a postcode lottery. While some NHS trusts in cities like Manchester, Sheffield, and Southampton offer SLIT, many areas provide no immunotherapy options at all.
The lack of uniform access is a significant concern. “The NHS focuses too much on immediate costs rather than long-term savings,” says Dr. Costa. “If we changed our approach, we could save billions.”
The Economic Impact of Allergies
Beyond the personal suffering of millions, allergies have a major economic impact. A UK study estimated that absenteeism due to AR costs businesses approximately £1.5 billion per year. However, presenteeism—where employees work despite suffering from allergy symptoms—causes even greater economic losses, affecting productivity and increasing workplace errors.
The NHS spends over £1 billion per year on allergy treatments and related health conditions, with 10% of primary care prescribing costs going toward managing allergic diseases. Over-the-counter antihistamines and nasal sprays only provide symptomatic relief, failing to address the underlying inflammation that can lead to chronic conditions like COPD and dementia.
“With the right approach, we could save between one and four billion pounds annually,” argues Dr. Costa. “Investing in effective treatments like SLIT could transform lives and dramatically reduce long-term healthcare costs.”
The Case for Sublingual Immunotherapy (SLIT)
SLIT is a scientifically proven treatment that builds long-term tolerance to allergens through controlled micro-doses administered under the tongue. Unlike traditional treatments that only manage symptoms, SLIT can effectively “reset” the immune system, preventing allergic reactions from occurring.
Key benefits of SLIT:
- Prevention of asthma and food allergies: Studies show that treating airborne allergies early reduces the risk of developing asthma by 80% and food allergies by 20%.
- Long-term efficacy: After three years of treatment, patients often remain symptom-free for decades.
- Cost-effectiveness: The average cost of SLIT is £4,500 per patient over three years. However, research indicates an 80% lifetime saving per patient compared to conventional treatments.
Dr. Costa shares the story of a police officer who nearly lost her job due to severe hay fever: “She started SLIT in November 2023. By summer 2024, she was back on active duty without symptoms. Her life changed dramatically.”
A 12-year-old boy, another patient, had previously missed three months of school per year due to allergies. “After starting SLIT, he only missed two days—not due to illness but because his mother was cautious about high pollen counts,” Dr. Costa recalls. “His quality of life and education improved significantly.”
Why Isn’t SLIT Widely Available on the NHS?
Despite its success, SLIT remains largely inaccessible on the NHS. In the UK, only around 4,000 patients are registered for SLIT treatment, while an estimated 15 million could benefit.
“Bureaucracy is the main barrier,” Dr. Costa explains. “Some NHS trusts refuse to invest in SLIT despite clear evidence of long-term cost savings. Even when I pushed for its approval in Coventry, progress was painfully slow.”
He points to a UK study showing that after three years of SLIT, NHS savings per patient exceed 80%. “In four years, the treatment pays for itself, and from year five onwards, the NHS saves money. Why isn’t this being implemented?”
The Urgent Need for Reform
The Urgent Need for Reform Allergy care in the UK has been neglected for decades. In 2003, a report titled Allergy: The Unmet Need was published and signed by Parliament in 2007, outlining a framework for improving allergy treatment. In 2010, another report Allergy Services: Still not meeting the unmet need was issued, showing how little progress has been made.
Dr. Costa is frustrated by the NHS’s failure to act. “Why spend money on unnecessary tests while failing to do the right ones? I have patients who have suffered anaphylaxis, yet when they arrive at A&E, the correct tests aren’t done in time, making future diagnosis difficult.”
He recalls a shocking case from Oxford: “A 12-year-old girl was given five adrenaline injections for anaphylaxis, yet the NHS told her she’d have to wait two years for an allergy specialist appointment. This delay could be fatal.”
What Can Parents Do?
For parents of children with allergies, Dr. Costa offers practical advice:
- Ensure correct medication use: Many allergy medications require prescription nasal sprays and antihistamines. Seasonal and perennial allergy sufferers need different approaches.
- Consider SLIT privately if necessary: While NHS access is limited, private treatment is an option for those who can afford it.
- Advocate for better care: Push local healthcare providers to offer immunotherapy and educate schools about managing allergies effectively.
The Future of Allergy Treatment
Sublingual immunotherapy has been available for over 30 years and widely adopted in Europe. Yet the UK lags behind, with outdated policies and limited access. “We’re sitting on a goldmine of potential savings and better patient outcomes,” Dr. Costa states. “It’s time for the NHS to wake up.”
As more patients demand access to SLIT and awareness grows, change is inevitable. The question remains: how many more people must suffer before the system evolves?
For those struggling with allergies, Dr. Costa’s message is clear: “Allergy treatment should not be a postcode lottery. It’s time for the NHS to recognise the value of immunotherapy and make it accessible to all who need it.”
DISCOVER: thechildrensallergy.co.uk
