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Current practice and future directions in clinical immunology.

Clinical immunology services were originally reviewed in 1976 by a working party of the British Society for Immunology (BSI). The availability of specialist immunology facilities for patient care were detailed and guidelines produced both for the development of clinical and laboratory services and the training of medical, scientific and technical personnel1. Recent advances in therapy for immunological diseases have been some of the factors which demanded a current review of clinical and laboratory immunological services for patients in the UK. These indude the increasing use of intravenous immunoglobulin therapy for a range of autoimmune diseases as well as for immune deficiencies, the introduction of therapeutic cytokines and their inhibitors as well as monodonal antibodies. In addition, the enormous geographic variability in services for diagnosis and management of patients with primary immune deficiencies and those with dinical allergy needed to be ascertained, particularly in view of the National Health Service (NHS) reforms. The Clinical Immunology Advisory Group of the BSI initiated a new survey in 1992. Data were collected in order to report on the current provision of the NHS services in immunology throughout the UK. The basis of the survey was a detailed questionnaire which was distributed to 43 consultants and two senior scientists in England, Scotland and Wales, who were known to be professionally involved in hospital immunology services. There was a 90% response to the questionnaire. From this data it was possible to identify deficiencies in these services, to suggest possible solutions and to highlight manpower implications. The subsequent BSI report has been updated and forms the basis for this article.