Professor Douglas Robinson: Allergy specialist in London
Allergy specialist in London: Professor Douglas Robinson
Douglas Robinson graduated from Cambridge University with a First Class Honours in Medical Sciences and completed his training at St Thomas', St Mary's, the Royal Free and Brompton Hospitals in London. He completed his MD research with Professors Barry Kay and Stephen Durham at the National Heart and Lung Institute and was awarded the Ralph Noble prize for his MD in allergic asthma from Cambridge University.
He has combined allergy research with clinical medicine, publishing over 70 research papers including the most highly cited paper on asthma in the last 15 years. His experience as director of the St Mary's Allergy Clinic combined with leading the specialist difficult asthma service at the Royal Brompton Hospital has confirmed his recognition as an international authority in allergy and asthma.
Professor Robinson consults on allergic disease (asthma, rhinitis, food allergy, allergic skin disease including eczema and urticaria, anaphylaxis and drug allergy). He provides diagnostic skin prick testing to confirm allergic senstisation along with blood tests as indicated. Immunotherapy (sublingual or subcutaneous) is available for severe summer hay fever due to grass pollen allergy.
Allergen immunotherapy or desensitization involves treatment with increasing doses of an allergen extract either given by injection into the skin or by a tablet that dissolves under the tongue (sub-lingual immunotherapy).
Pets may act as pollen reservoirs as may washing hung outside to dry.
Injection Allergen Immunotherapy
Injection under the skin was the first route used to give immunotherapy and remains the most effective form of this treatment. It involves injections of gradually increasing doses of allergen extract (which contains a carefully controlled mix of the allergen proteins of say, grass pollen) over time. For example treatment of grass pollen hay-fever might involve a series of increasing weekly doses over 12-16 weeks followed by monthly maintenance “shots”.
How effective is injection immunotherapy?
In clinical trials one year of treatment resulted in up to 75% reduction in symptoms and medication requirement for severe hayfever: these were carefully selected patients. For bee and wasp venom there is a 90% or more reduction in the risk for anaphylaxis if stung.
Other forms of immunotherapy
Recently an oral/sub-lingual (under the tongue) form of immunotherapy for grass pollen allergy was licensed in the UK. This preparation termed Grazax (TM ALK Ltd) is a tablet taken under the tongue then swallowed and is used every day for at least three months before the grass season then throughout the pollen season.
It was very effective in clinical trials with 40-60% reductions in symptom scores and requirement for medication. Side effects were minor, with no reported severe reactions or anaphylaxis although it is recommended that the first dose be given in the clinic, it can be used at home thereafter. Side effects include oral itching and mild swelling. Other sub-lingual preparations are available but are not yet licensed in the UK.
Severe allergic reactions can occur to bee or wasp stings
Hayfever results from seasonal allergic symptoms due to grass pollen allergy. It is one form of allergic rhinitis which means allergic inflammation of the nasal lining. This has been classified in recent treatment guidelines by the World Health Organization.
Nasal symptoms: classically nasal allergy can cause itching, sneezing running or nasal blockage. It is frequently associated with asthma and/or allergic conjunctivitis (itchy, watery, inflamed eyes).
When symptoms occur may give a clue about the allergen responsible:
Spring symptoms (April-May in UK): tree pollen allergy
Summer symtoms (May-July in UK): grass pollen allergy
All year symptoms: house dust mite allergy
Severe rhinitis has considerable impact on quality of life: for example students with severe hayfever have been shown to drop a grade in summer time exams.
Are nasal steroids safe?
As for asthma inhalers, many patients worry about taking regular nasal steroids. However there is no evidence of long term effects either on other systems such as bones or in the nose.
Key Papers (of over 70 peer review publications):
Robinson D.S., Hamid Q., Sun Ying, Tsicopoulos A., Barkans J., Bentley A.M., Corrigan C.J., Durham S.R., and Kay A.B. “Evidence for a predominant "Th2-like" bronchoalveolar lavage T-lymphocyte population in atopic asthma”. N.Engl.J.Med. 326, (1992), 298-304: This paper defined the immunology of asthma and has informed research and development in the field. It is one of the most highly cited papers on asthma.
Robinson DS, Campbell DA, Durham SR, Pfeffer J, Barnes PJ, Chung KF; Asthma and Allergy Research Group of the National Heart and Lung Institute.Systematic assessment of difficult-to-treat asthma. Eur Respir J. 2003; 22:478-83
Ling EM, Smith TRF, Nguyen D, Pridgeon C, Dallman M, Arbery J, Carr VA, Robinson DS. CD4+CD25+ regulatory T cell suppression of allergen-driven T cell activation is related to atopic status and expression of allergic disease. Lancet 2004;363:608-15. This paper defined a possible immunological explanation for the development of allergies and provided a novel approach for therapy.
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