Young patient Charlie and her doctor Professor Adam Fo (Image: Suzi Arkley/Humphrey Nemar)
“Someone cries in every clinic”, says Professor Adam Fox as we tour the UK’s first specialist hospital dedicated to delivering groundbreaking food allergy treatments. “The difference is that it used to be crying in despair and now, broadly, it’s crying with happiness.” Around three million people live with food allergies in the UK. Until recently, treatment amounted to telling them what they were sensitive to and advising them to avoid it.
“In every clinic, someone sheds a tear,” remarks Professor Adam Fox as we explore the UK’s pioneering hospital dedicated to cutting-edge food allergy treatments. “The difference now is that those tears are more often of joy than despair.” Across the UK, approximately three million individuals grapple with food allergies. Historically, treatment options were limited to identifying allergens and advising strict avoidance.
Today, a new wave of therapies is transforming the lives of children and their families, liberating them from the ever-present fear of severe allergic reactions. A key advancement is oral immunotherapy (OIT), which involves administering gradually increasing amounts of an allergen under medical supervision to build tolerance. For young children, this process can shift the risk from being life-threatening upon exposure to hazelnuts, mustard, eggs, or other allergens, to safely tolerating small quantities. This breakthrough offers newfound peace for anxious parents and the possibility for teens to travel independently.
Charlie eating her chocolate pudding, and recovering from a bad reaction (Image: Suzi Arkley)
One eight-year-old boy was able to travel to China to meet his grandparents for the first time after being treated for a peanut allergy at the clinic. Prof Fox says: “The difference between now and six years ago is night and day. Most kids diagnosed in infancy, we can actually cure.
“Even being OK with a couple of peanuts means you can stop worrying that someone has used the wrong knife or not scrubbed the pan properly, because you’re not going to react to small exposures, which are what cause the overwhelming majority of accidents.”
Take, for instance, an eight-year-old boy who, after receiving treatment for a peanut allergy at the clinic, was able to visit his grandparents in China for the first time. Professor Fox highlights the revolutionary change, stating, “The contrast between now and six years ago is staggering. We can truly cure most cases when diagnosed early in childhood.”
“Even the ability to consume a couple of peanuts without incident means no longer fearing minor cross-contaminations, such as using a shared knife or an inadequately cleaned pan,” he adds. “These small exposures account for the majority of accidental reactions.”
Eleven-year-old Charlie Arkley experienced a significant transformation thanks to OIT. Initially diagnosed by Professor Fox with severe allergies to four types of nuts—peanuts, cashews, Brazils, and pistachios—after dealing with rashes as an infant, her options were once limited.
A decade ago, her family moved to New York, where Charlie endured a frightening allergic reaction during a Halloween outing. Dressed as pirates, Charlie and her younger sister Chloe, now seven, were trick-or-treating when Charlie accidentally consumed a candy containing peanuts. The situation escalated quickly, resulting in an emergency call and three doses of epinephrine to stabilize her.
Charlie joined the NHS waiting list for Palforzia, a drug that helps children build tolerance to peanuts. (It has since been discontinued by the manufacturer for operational reasons.)
Then she suffered another life-threatening reaction during a picnic, after eating a pastry emphatically labelled as nut-free. Suzi said: “After that, we decided we weren’t going to wait for the NHS. We were going to pay to do it privately.”
Over three years, Charlie completed six to eight months of OIT for each of the four nuts. “Now she eats a small dose of peanuts, Brazil nuts, cashews and pistachios every day,” Suzi says. “She mixes it with chocolate pudding. When she gets bored of chocolate pudding, she mixes it with hummus.”
The treatment means Charlie can enjoy the same freedoms as her peers, such as visiting her favourite matcha cafe with friends. She always informs staff about her allergy but now knows that if an error were made, it would not be lethal.
In February 2023, 13-year-old Hannah Jacobs died from a fatal anaphylactic reaction after taking a sip of a Costa Coffee hot chocolate mistakenly made with cow’s milk.
Charlie’s tolerance is “life changing, for her and for us”, Suzi says. “It’s been an incredible journey. I am absolutely in awe of how far this field of allergy medicine has evolved.
“My hope is that now there will be bigger things that Charlie will need to worry about as she embarks on her secondary school journey. This will always be there but it will be something she becomes comfortable living with, part of the muscle memory of how she goes about her day.”
The treatment cost tens of thousands of pounds. Suzi adds: “We had to make some sacrifices to afford it, but they were well worth making. I’m frustrated that more people cannot access it.”
NHS provision of OIT is a “patchy” postcode lottery, Prof Fox says. The paediatrician describes the situation as a “crisis”, particularly when research shows food allergies have doubled in the last 20 years.
He argues that such a huge gap between the burden of a disease and treatment provision would not be accepted in other specialties, such as cancer or heart care.
“The disparity between what we’re able to offer here and what you get offered in other developed healthcare economies is a disgrace,” Prof Fox adds. “The real frustration is that if we were able to instigate proper allergy prevention and put these disease-modifying treatments into place, it would save the NHS money.”
Prof Fox (right) and colleagues James, Prof Lack and Prof Du Toit at the clinic (Image: Humphrey Nemar)
Prof Fox worked full-time in the NHS for 25 years, including nine as clinical lead for allergy at Guy’s & St Thomas’ Hospital, during which time it was recognised as an international centre of excellence. He initiated the first patient outside of the US on Palforzia at Great Ormond Street Hospital in 2021.
However, as these new therapies arrived, he says it became clear that the NHS lacked the organisational will to roll them out at scale. He and some other leaders in the field began to feel that “if we’re going to do this, we have to be in the private sector”.
He adds: “I came to the point where I felt that the right thing for me to do, in terms of actually looking after patients and doing what I could do best, was in the private sector, which is really sad.”
This is why he has joined forces with two top consultants — Professor George Du Toit and Professor Gideon Lack — to launch the Allergy Centre of Excellence. Their specialist hospital in London’s Marylebone is thought to be the biggest centre for OIT in Europe.
The clinic, which was officially launched last month, will see around 20,000 patients a year, including 500 seeking desensitisation. Prices for a course of OIT start at £6,000.
There is a paediatric intensive care doctor on site during treatments and a high dependency unit equipped for emergencies. There are large, open waiting areas where children can play while being easily observed.
And an on-site pharmacy dispenses novel drugs such as Neffy, the needle-free spray that can replace adrenaline auto-injectors. “There’s more expertise around anaphylaxis in this building than you’ll get anywhere else in the country,” Prof Fox says.
Prof Fox has dedicated his career to improving NHS allergy care (Image: Humphrey Nemar)
He spends two days a week here and also continues to work at his own private practice and in the NHS. He hopes the centre will demonstrate the benefits of comprehensive allergy care, providing a new model that could be rolled out.
Prof Fox adds: “The future looks very bright and it’s great to be a part of it. At the moment, somebody has to die in order for anybody to pay any attention, and we really do need to get past that.
“There are families that can’t get anywhere close to somewhere like this and that’s fundamentally wrong. We can do it in pockets — in central London where people can afford it.
“But people should have access everywhere, particularly when they’re first diagnosed in early childhood because that’s when the treatments make the biggest difference.”
A Department of Health and Social Care spokesperson said: “We know allergies can impact sufferers’ lives significantly and we commend Professor Adam Fox’s career-long efforts to improve allergy treatment.
“We are committed to improving care for people with allergies and that is why we are working with a range of partners and experts to consider how allergy care and support could be improved, including considering the recommendations in the National Allergy Strategy.”
