Allergy in the military

The UK military has relatively strict requirements which ensure that recruits and serving personnel are medically fit to meet the diverse challenges involved in military service, including unpredictable and substantial physical and psychological stress often at short notice and away from easy access to medical care in an emergency. Consequently they are very careful in their assessment of people reporting certain medical conditions and there is a Joint Service Manual of Medical Fitness (JFP 950 6-7-7) to provide guidance in which conditions are acceptable, which are not, and which might be in certain circumstances.

Unsurprisingly many young people wishing to join the military report allergic disease, either currently or earlier in their life. Many of these may obviously be suitable or unsuitable for military service according to JFP 950 6-7-7 (https://data.parliament.uk/ DepositedPapers/Files/DEP2019-0604/Joint_ Service_Manual_of_Medical_Fitness.pdf), but some require specialist allergy assessment to confirm the diagnosis, establish whether it is ongoing or resolved, what treatments might be required (and what the consequences would be of treatment being unavailable), and some discussion of the risk of exacerbation might be and what factors would influence it.

A working group has been assembled to develop guidance to help standardise the approach to these individuals between allergy services around the country. A document is under development to provide some guidance for allergists. An important focus will be on what the military requires from an allergy assessment – we often think of straightforward factors such as the requirement for adrenaline autoinjectors, but in fact a more detailed discussion of risks is more helpful. There are also ethical considerations –should we perform oral food challenges in people with significant sensitisation but mild reactions previously? Ordinarily we might suggest avoidance but are occupational implications sufficient to justify a higher-risk challenge? Is this balance different between aspiring recruits and existing service personnel?

We hope the final document will facilitate standardisation of allergy assessment between allergists and centres to provide confidence to allergists and to provide the military with assurance that assessment from any allergist will be of equivalent value in making decisions regarding recruitment, retention, and deployment.

Finally we are very grateful to Tony Frew who began the discussion of these issues some years ago.

The BSACI webinar in March 2023 covered some of these issues in more detail, and it can be found at www.bsaci.org/education-and-events/ webinars/2023-webinars/