Many years ago I was taught medicine in London when it was swinging and Carnaby Street sold rainbow clothes. Our teachers had qualified before the Second World War, well before most tests had been invented and cholesterol was "bad". We were taught to take a careful medical history, perform a physical examination and then, if necessary, do tests to confirm what we had already decided.

Tests were slowly devised and the emphasis drifted towards testing first and using them to direct the history and examination. Very much the cart before the horse and very prevalent in certain specific areas of complementary medicine where the opposite extreme has been reached with allergy testing in the absence of any of other input whatever.

Last week the House of Lords long awaited report on allergy services in the United Kingdom was published. It recommended that services be established at consultant level in each area and cast some stones at complementary medicine and the plethora of allergy testing available.

Doubtless it will find its way on to a dusty shelf with the Royal College of Physicians - 2003 and House of Commons Select Committee - 2004 reports on allergy services which came to similar conclusions that would cost the cash strapped NHS more money.

However hidden in its conclusions we find that there is concern that allergy self testing kits are available without any professional advice to back up their findings.

What advice could we give to a patient who thinks that they might have an allergy, has a GP untrained and unwilling to recognise allergy and in any case who lives 100 miles away from the nearest centre?

Firstly, the diagnosis of allergy consists of identifying the allergen and the treatment, by and large, of avoiding it if possible. That is often not easy but unless you are lucky enough to get access to the cutting edge treatments is all that is on offer.

The identification is a painstaking detective job based on a thorough diary with details of foods eaten, places visited, fumes or perfumes inhaled and so on. The popular (and expensive) tests are no substitutes for this. A diary will demonstrate any patterns. For example, an asthma attack only when you eat cod or smell lavender perfume will point towards a specific fish or perfume allergy. Those substances can then be avoided without any need for tests.

Using the same example, if the problem is less clear and it happens with a range of fish or perfumes then there is at least some indicator to point towards confirmatory tests. If the problem is a food allergy (and that can cause Asthma, Irritable Bowel Syndrome, Eczema or Psoriasis and other problems not obviously food related) then proper dietary advice is needed to avoid the offending allergen and, importantly, vitamin and other deficiencies.

If you have an allergy the advice would be diagnosis via a diary, avoidance with help from a dietician or allergist if you can find one, and then confirmatory tests only if necessary.

Some complementary therapies are suited to a support role after these steps have been taken.

Mike Matthews - Editor