Allergies

Around one or two people out of every 100 in the UK have a food allergy, but food intolerance is more common.

Genuine food allergy is rare. About 2% of the population and 8% of children under the age of three are affected. 

What is a food allergy?

A Food Allergy is a rapid and potentially serious response to a food by your immune system. It can trigger classic allergy symptoms such as a rash, wheezing and itching. 

The most common food allergies among adults are to fish, shellfish and nuts, including peanuts, walnuts, hazelnuts and brazil nuts. Children often have allergies to milk and eggs as well as to peanuts, other nuts and fish. 

What is a food intolerance?

Food intolerances are more common than food allergies. The symptoms of food intolerance tend to come on more slowly, often many hours after eating the problem food. Typical symptoms include bloating and stomach cramps. 

It's possible to be intolerant to several different foods. This can make it difficult to identify which foods are causing the problem. 

Food intolerances can also be difficult to tell apart from other digestive disorders that produce similar symptoms, such as inflammatory bowel disease, gastrointestinal obstructions or irritable bowel syndrome (IBS)

Lactose intolerance

Lactose intolerance, sometimes known as dairy intolerance, occurs when your body can't digest lactose. Lactose is in milk and dairy products such as yoghurts and soft cheeses. 

The main symptoms are diarrhoea and stomach pain. In most cases, your GP can diagnose lactose intolerance by looking at your symptoms and medical history.

Could it be another type of food intolerance or condition?

Sometimes it isn't clear which food is causing a problem. The only reliable way of identifying such a food intolerance is through an exclusion diet, where you cut out certain foods from your diet one at a time to see if there's an effect.

Coeliac disease is a common digestive condition where a person has an adverse reaction to gluten. However, coeliac disease is not an allergy or an intolerance to gluten. It is an autoimmune condition where the immune system mistakes substances found inside gluten as a threat to the body and attacks them. 

Gluten is a protein found in wheat, rye and barley that damages the intestine of people with coeliac disease. Symptoms include diarrhoea, bloating and weight loss. Coeliac disease can be accurately diagnosed with a blood test and biopsy.

About 1 in 100 people in the UK have coeliac disease, but it's estimated that around half a million aren't diagnosed. 

Treatments for food allergy and food intolerance

• In all cases, always read food labels carefully, and learn where your problem food may be used as an ingredient in other foods. 
• In the case of a food allergy, you'll have to avoid the food you're allergic to. You may be able to eat the cooked versions without any problems, as can be the case with fruit or vegetable allergies. 
• With lactose intolerance, you'll have to reduce the amount of dairy food that you eat. 
• With other forms of food intolerance, you'll have to stop eating the food for a while, or possibly for life. 

With the autoimmune condition coeliac disease, you must avoid gluten for life.

For more advice on your diet, ask your GP to refer you to an NHS dietitian.

Pet allergens from the hairs of cats and dogs can inflame allergies. Children with pet allergies can miss out on visits to friends, sleepovers and parties where there are animals present.

Commenting on the impact of allergens on her 14-year-old son's life, Sarah Chapman said: "I have four children who would all love to have a dog. Unfortunately, due to my son's allergy to dogs, it's just not possible. I had to limit his visits to my mum's house (she used to own two dogs) just to keep his allergic reactions under control."

Dr Hicks has this advice for pet owners to reduce the spread of allergens in the home:

• Don't allow pets in bedrooms, and keep them out of the living room if possible. 
• Wash your pets once or twice a week. 

Indoor allergy hotspots

As well as pet allergens from cat and dog hair, the most common indoor allergens in UK homes are house dust mites and moulds. 

House dust mite allergen is most associated with bedrooms, but it can settle on surfaces and spread around the house.

Allergens from outside such as pollen particles and pet hair can infiltrate the home through the air, especially during summer, and through open doors and windows. 

But they also make their way inside by sticking to clothes, skin and hair. Once inside the home, they circulate in the air and settle on soft furnishings and hard surfaces. They may cause problems for anyone with hay fever.

Reducing indoor allergens

So, how can you reduce the allergens in your home? Dr Hicks recommends thorough and frequent cleaning, especially of the areas of the house you spend the most time in. Here are his tips:

To reduce house dust mites

• Damp dust the hard surfaces in your home. Don't forget places that gather dust and tend to get neglected, such as the top of picture frames, the backs of sinks, and so on. 
• Vacuum carpets and hard floors daily if possible, and soft furnishings twice a week. Don't forget to vacuum under your bed (where the house dust mite allergen gathers). 
• Use a barrier mattress cover on beds. They're also available for pillows and duvets. 
• Vacuum your mattress and pillows and wash bedding and duvets above 55°C, or put bedding, duvets and soft toys into a plastic bag and put them in the freezer for 24 hours. 

To reduce indoor pollen

• Keep pollen out of your home by keeping windows closed. Be aware that you can bring pollen in from outside if it sticks to your hair and clothes. 
• Change your clothes the moment you get in, put them in a plastic bag until you can put them in the washing machine, have a shower and wash your hair. 
• Wipe down pets when they come in the house after playing outside. 

Get an eczema diagnosis

If you think your baby or child has eczema, see your GP to get a proper diagnosis and treatment. If necessary, your child may be referred to a dermatologist. 

Don't try to treat eczema by yourself. Each case can need different treatment, which usually involves a combination of moisturisers (emollients) and steroid creams or ointments 

If their skin becomes red and starts to seep liquid, it may be infected, in which case see your GP immediately for antibiotics 

Give your child a bedtime routine 

Children with eczema often find sleeping a problem, as their skin can get hotter and itchier at night. Keep their bedroom cool and use cotton sheets or a light, natural-fibre duvet. 

Apply moisturiser at least 20 minutes before bedtime to allow it to soak in. Keep pets out of the bedroom, as dogs and cats can make eczema worse. 

Avoid harsh soaps, shampoos and bath oils 

Soap and bubble bath can make eczema far worse, as can washing your child too often. 

Current advice says that you should wash a baby or young child once or twice a week (although the baby's face, hands and bottom should be cleaned daily). 

Bathe your baby in warm – not hot – water, and stick to fragrance-free soaps, shampoo and bath oil. Your pharmacist or GP can advise you on what products to buy. 

Use lots of moisturiser 

Dry skin is more likely to flare up or become infected with a bacteria or virus. Use creams on your child as directed by your GP to make sure the skin affected by eczema is kept as soft and moist as possible. Avoiding harsh soaps that dry out the skin will also help. 

Help your child to stop scratching 

One of the biggest problems with childhood eczema is the urge to scratch the itchy skin, which may then bleed or become infected. 

See if your child scratches at certain times of the day, for example while watching TV, and try to teach them to do something else instead, such as tightly holding their arm. 

Praise them for not scratching, or even use a star chart. Keep their nails short. Cotton clothes rather than wool may lessen the itching. 

Check your child's diet

Eczema usually starts when a baby is around six months old. In about 10% of cases it is triggered by foods, including milk, eggs, citrus fruit, chocolate, peanuts and colourings. 

If you suspect a food is causing your child's eczema, it's important to seek advice from your GP before you cut out the food to make sure your child still gets a balanced diet

        

Alternative or Complementary care for Cancer

 

The difference between complementary and alternative therapies

The phrases complementary therapy and alternative therapy are often used as if they mean the same thing. They may also be combined into one phrase – complementary and alternative therapies (CAMs). It is not always easy to decide whether something is a complementary or an alternative therapy. But there is an important difference. 

A complementary therapy means you can use it alongside your conventional medical treatment. It may help you to feel better and cope better with your cancer and treatment. It is important to discuss with your doctor any complementary therapy that you are thinking of using.

An alternative therapy is generally used instead of conventional medical treatment. All conventional cancer treatments have to go through rigorous testing by law in order to prove that they work. Most alternative therapies have not been through such testing and there is no scientific evidence that they work. Some types of alternative therapy may not be completely safe and could cause harmful side effects. 

If you are thinking of using CAMs

If you are considering using any complementary or alternative therapy it is very important to talk to your cancer doctor, GP, or specialist nurse for advice about the safety of the therapy. It is also very important to let your complementary or alternative therapist know about your conventional cancer treatment. Some treatments may interact.

 

What complementary therapies are

Complementary therapies are used alongside conventional medical treatments prescribed by your doctor. They can help people with cancer to feel better and may improve your quality of life. They may also help you to cope better with symptoms caused by the cancer or side effects caused by cancer treatment. 

A good complementary therapist won't claim that the therapy will cure your cancer. They would always encourage you to discuss any therapies with your cancer doctor or GP. Complementary therapies are available from many different types of people and organisations.

There are many different types of complementary therapy, including the following

• Aromatherapy
• Acupuncture
• Herbal medicine
• Massage therapy
• Visualisation
• Yoga

Many health professionals are very supportive of people with cancer using complementary therapies. They can see that the therapies help people to cope better with the cancer and its treatment. But some health professionals have been reluctant for their patients to use such therapies. This is because many therapies have not been scientifically tested in the same way as conventional treatments. 

Some research trials have been carried out to see how well complementary therapies work for people with cancer. Some trials are still in progress. But we need more studies to help us develop our knowledge about the best way to use complementary therapies.

 

What alternative therapies are

Unlike complementary therapies, alternative therapies are used instead of conventional medical treatment. People with cancer have various reasons for wanting to try alternative therapies. Some people may not start conventional treatment and may choose to use an alternative therapy instead. Some people might stop conventional cancer treatment and switch to an alternative therapy.

Some alternative therapists may claim to be able to cure your cancer with their treatments, even if conventional medical treatments haven’t been able to do so. Or a therapist may say that conventional cancer treatments are harmful. A trustworthy therapist with a good reputation won't claim this.

There is no scientific or medical evidence to show that alternative therapies can cure cancer. Some alternative therapies are unsafe and can cause harmful side effects or they may interact with your conventional medical treatment. This could increase the risk of harmful side effects or may stop the conventional treatment working so well. Giving up your conventional cancer treatment could reduce your chance of curing or controlling your cancer. 

Some alternative therapies are very cleverly promoted so that people reading about them think that they work very well. But the claims are not supported by scientific evidence and they may unfortunately give some people false hope

 

Other terms used to describe CAM therapies

There are several different terms commonly used to describe complementary or alternative therapies. If you are not familiar with them, it can be confusing. You may see therapies described as

• Unconventional or unorthodox therapies
• CAM (Complementary and Alternative Medicine)
• Integrated healthcare or medicine
• Traditional medicine

Unconventional therapies

This generally means treatments that aren’t normally used by doctors to treat cancer. In other words, any treatment that is not thought of as part of conventional medicine.

Health professionals working in cancer care are becoming more aware of the differences between complementary therapies and alternative therapies. And they know how important it is to make a distinction between the two terms. Now most doctors and nurses describe therapies as either complementary or alternative, rather than unconventional.

CAM (Complementary and Alternative Medicine)

CAM is a term which covers both complementary and alternative medical therapies.

Integrated healthcare or integrated healthcare

These terms are generally used to describe the use of conventional medicine and complementary therapies together. The terms are commonly used in the USA but are becoming more widely used in the UK. In cancer care, integrated medicine usually includes making sure that you have access to all of the following:

• Conventional medical treatments
• Different types of complementary therapies such as massage, reflexology, relaxation, herbal medicine and acupuncture
• Counselling services and support groups
• Up to date information about your cancer and its treatment

Traditional Medicine

Health professionals usually use the term traditional medicine to mean a therapy or health practice that has developed over centuries within a particular culture. It is usually formed around a particular belief system. 

This term can be confusing because in the western part of the world conventional medicine could be considered to be a traditional medicine. But we don't usually use the term traditional medicine in this way. We usually mean it to refer to therapies or treatments that developed in the eastern part of the world such as 

• Ayurvedic medicine
• Traditional Chinese Medicine 

 

What conventional medicine means

Conventional medicine is the sort of medicine and treatment your doctor would usually use to treat your cancer. You may also hear this called orthodox medical treatment. The most common treatments include

• Chemotherapy
• Radiotherapy
• Surgery
• Biological therapies
• Hormone therapy

The aim of conventional treatment is to kill or remove, and hopefully cure, the cancer. If the cancer is not curable the aim may be to control it for as long as possible. Your doctor will discuss with you how likely the treatment is to help in your particular situation. 

Nearly half of all conventional medicines or drugs are developed from plants or other natural substances. As conventional drugs, they are tested and used in a controlled way. 

All conventional cancer treatments are tested thoroughly in clinical trials to prove that they work for specific types of cancer. 

Living With A Food Allergy

Living with a food allergy  

The advice here is primarily written for parents of a child with a food allergy. However, most of it is also relevant if you are an adult with a food allergy.

Your child’s diet

There is no cure for food allergies, although many children will grow out of certain ones, such as allergies to milk and eggs. The most effective way you can prevent symptoms is to remove the offending food (known as an allergen) from their diet.

However, it's important to check with your GP or the doctor in charge of your child’s care first before eliminating certain foods.

Removing eggs or peanuts from a child's diet is not going to have much of an impact on their nutrition. Both types of these are a good source of protein, but can be replaced by other alternative sources.

A milk allergy can have more of an impact as milk is a good source of calcium, but there are many other ways you can include calcium in your child’s diet, including green leafy vegetables. 

Many foods and drinks are fortified with extra calcium.

If you are concerned that your child’s allergy is affecting their growth and development, see your GP.

labels

It's very important to check the label of any pre-packed food or drinks your child has, in case it contains ingredients they are allergic to.

Under EU law, any pre-packed food or drink sold in the UK must clearly state on the label if it contains the following ingredients:

• celery 
• cereals that contain gluten (including wheat, rye, barley and oats) 
• crustaceans (including prawns, crabs and lobsters) 
• eggs 
• fish 
• lupin (lupins are common garden plants, and the seeds from some varieties are sometimes used to make flour) 
• milk 
• molluscs (including mussels and oysters) 
• mustard 
• tree nuts – such as almonds, hazelnuts, walnuts, brazil nuts, cashews, pecans, pistachios and macadamia nuts 
• peanuts 
• sesame seeds 
• soybeans 
• sulphur dioxide and sulphites (preservatives that are used in some foods and drinks) at levels above 10mg per kg or per litre 

Some food manufacturers also choose to put allergy advice warning labels (for example, "contains nuts") on their pre-packed foods if they contain an ingredient that is known to commonly cause an allergic reaction, such as peanuts, eggs or milk. 

However, these are not compulsory. If there is no allergy advice box or "contains" statement on a product, it could still have any of the 14 specified allergens in it.

Look out for "may contain" labels, such as "may contain traces of peanut". Manufacturers sometimes put this label on their products to warn consumers that they may have become contaminated with another food product when being made.

food products contain allergy-causing food:

• Some soaps and shampoos contain soy, egg and tree nut oil. 
• Some pet foods contain milk and peanuts. 
• Some glues and adhesive labels used on envelopes and stamps contain traces of wheat. 

Again, read the labels of any non-food products that your child may come into close physical contact with.

Unpackaged food

Currently, unpackaged food doesn't need to be labelled in the same way as packaged food. This can make it more difficult to know what ingredients are in a particular dish.

Examples of unpackaged food include food sold from:

• bakeries (including in-store bakeries in supermarkets) 
• delis 
• salad bars 
• "ready-to-eat" sandwich shops 
• takeaways 
• restaurants 

If you or your child have a severe food allergy, you need to be careful when you eat out.

The following advice should help:

• Let the staff know. When booking a table at a restaurant, make sure the staff know about your child’s allergy. Ask for a firm guarantee that the food you or your child is allergic to won't be in any of the dishes served. The Food Standards Agency (FSA) offers chef cards that provide information about your child’s food allergy, which you can give to restaurant staff. As well as informing the chef and kitchen staff involved in cooking your food, let waiters and waitresses know so they understand the importance of avoiding cross-contamination when serving you. 
• Read the menu carefully and check for "hidden ingredients". Some food types contain other foods that can trigger allergies, which restaurant staff may have overlooked. Some desserts contain nuts (such as a cheesecake base) and some sauces contain wheat and peanuts. 
• Prepare for the worst. It's a good idea to prepare for any eventuality. Always take your child’s anti-allergy medication with you when eating out, particularly if they have been given an auto-injector of adrenalin (read more about treating food allergies with a auto-injector). 
• In older children, you can use what is known as a "taste-test". Before your child begins to eat, ask them to take a tiny portion of the food and rub it against their lips to see if they experience a tingling or burning sensation. If they do, it suggests that the food will cause them to have an allergic reaction. However, the "taste-test" doesn't work for all foods, so it shouldn't be used as a substitute for the above advice.

Can allergies be prevented

There is currently no evidence-based advice for prevention of food allergies.

It used to be believed that avoiding eating peanuts during pregnancy and when breastfeeding could help reduce the risk but this theory has now been questioned. 

It's important to follow the standard recommendations for pregnancy and breastfeeding, whether or not you have a family history of food allergies.

Tips for food allergen avoidance at home

Utensils, cookware, glassware, storage containers, and other food preparation equipment

• Thoroughly clean before preparing or serving safe meals.
• Prepare safe meal first to avoid inadvertent cross-contact
• Be aware of the potential for cross-contact with utensils. For example, a knife used to prepare peanut butter and jam by a non-allergic child could introduce peanut into an otherwise safe jar of jam and subsequently cause a reaction in a peanut-allergic sibling eating the jam.
• Designate specific containers for use by the allergic person only. For example, avoid sippy-cup mix-ups by using a specific cup for the allergic child or using an obvious label

Refrigerator/freezer and kitchen larder

• Keep food containers covered/sealed to prevent spill contamination
• Assign a specific shelf or cabinet for safe foods. Consider using colour codes or tags for easy identification

Good practices for the family

• Wash hands before and after meals but particularly before serving allergen-free meals and after ingestion of allergens
• Confine food consumption to specified dining areas or create allergen-free zones within the home
• Wipe down surfaces after preparation and ingestion of meals. Cleaning surfaces with standard cleaners has been shown to be sufficient for removal of allergens such as peanut.
• For young children, unsafe foods should be kept out of reach both at the dinner table and when storing foods

Tips for eating out

Before (prepare)

• Check the menu (is it online?) to determine if there are suitable meal options
• Call ahead to assess the restaurant’s ability and willingness to accommodate your needs
• Consider carrying a print out of our help sheets with information about allergens and warnings about cross-contact
• Take your emergency medications, especially any adrenaline auto-injector pens you have been prescribed

During (communicate)

• Communicate clearly and directly about food allergy. It is best to speak directly to the person making the food, but don’t forget to speak to other staff including the waiter and/or manager.
• Ask about ingredients and method of preparation. Do not trust ingredient lists on menus at face value

AVOID high-risk places for cross-contamination, such as:

• Buffets
• Ice cream parlors
• Bakeries
• Chinese and Asian restaurants (for peanut and tree nut allergies)
• Seafood restaurants (for fish and shellfish allergies)
• Deep fried foods, where the oil is reused for different foods and may therefore be contaminated by previously cooked foods
• Potlucks and parties where homemade dishes come from a variety of sources

Huntington's Disease

Living with Huntington's disease 

Help is available to assist people with Huntington's disease in their day-to-day living. This might include physiotherapy, occupational therapy and speech therapy.

Huntington's disease puts a great deal of strain on relationships, and is very stressful and upsetting for the family. It's distressing to see a family member's state of mind deteriorate so much that they may not be like their former self at all.

Daily routines such as getting dressed and eating meals can be frustrating and exhausting. The types of help outlined below aim to ease the strain of the condition by improving skills that may deteriorate.

Help with communication

Speech and language therapy can improve communication skills, memory and teach alternative ways of communicating. It can also help with swallowing problems.

Communication aidscan sometimes be helpful, as they allow communication without the need for talking. For example, you can point to symbols on a chart to indicate your mood or whether you're hungry. 

The family of someone with Huntington's disease will need to be patient and supportive. They can try alternative ways of communicating if speech is a problem.

Help with mealtimes

People with Huntington's disease need to have a high-calorie diet. A dietitian can help you work out an appropriate diet plan. 

To help with eating and drinking, food should be easy to chew, swallow and digest. It can be cut into small pieces or puréed to prevent choking. Feeding equipment is also available, such as special straws and non-slip mats. 

At some point, it may be necessary to use a feeding tube that goes directly into the stomach. If a person with Huntington's disease doesn't want to be artificially fed during the later stages of the condition, they should make their wishes known to their family and doctor. They may want to consider making an advance decision (a living will) or a statement of wishes and preferences.

The Huntington's Disease Association has more information about eating and swallowing (PDF, 320kb). You can also email the Royal Hospital for Neuro-disability for further information and advice about swallowing difficulties and artificial nutrition. Their telephone number is 020 8780 4500, or you can email them on info@rhn.org.uk.

Occupational therapy

An occupational therapist (OT) can help with day-to-day activities. Your home can be adapted by social services to make life easier for a person with Huntington's disease, as they may be at risk of injury from a fall or accidentally starting a fire. 

Your shower, bath, chairs and bed may need to be adapted. You may also need to think about wheelchair access. 

Physiotherapy

A physiotherapist can help with mobility and balance by using a range of treatments, including manipulation, massage, exercise, electrotherapy and hydrotherapy. You may be referred to a physiotherapist through your GP or social services.

Electronic assistive technology

The Royal Hospital for Neuro-disability provides an electronic assistive technology (EAT) service. It's made up of a team of healthcare professionals who provide EAT equipment for patients and residents within the hospital, as well as for people with disabilities living in the community or at other hospitals or units.

Equipment includes:

• communication aids 
• computers and software 
• switches and other access devices 
• powered wheelchair controls 
• environmental controls

Huntington's disease

The Huntington's Disease Association has a number of useful facts heels that provide advice about a range of topics, including:

• behavioural problems 
• communication skills 
• sexual problems 
• diet, eating and swallowing 
• driving (see below) 
• seating, equipment and adaptations 
• information for teenagers  

The charity can also help you explore the housing options available when full-time care is needed.

It's also worth finding out what benefits you may be entitled to if you have Huntington’s disease, or if you're looking after someone with it.

You can do this through the Huntington's Disease Association or by contacting the CAB.

Driving

A person diagnosed with Huntington's disease who's started to experience clinical features should inform the DVLA because it will affect their ability to drive. 

The DVLA will write to your doctor, with your permission, to ask for their opinion about your condition. Based on that information, a decision will be made about whether you can still drive and for how long before another assessment is needed.

There's no need to tell the DVLA if you're carrying the faulty gene but haven't yet developed the features of the condition.

perspective

"I'm not as whole as I was. My thought processes have slowed down and it takes enormous self-discipline to do ordinary things like getting dressed – it's exhausting.

"I recognised these changes in myself years before anyone else did, and it's important that other people (including healthcare professionals) just accept this. The changes don't have to be measurable.

"They can't reassure me that all is well, but they can support me. By accepting that changes are happening, they give me permission to adapt my life at an early stage. 

"I have changed my high-powered job to an 'ordinary' job, for example, which has taken pressure off me and allowed me to put energy into other things. 

The end stage of Huntington's disease will happen no matter what, but I will live most of my life before this point and I want to make the most of it."

Sue Walters, Hertfordshire

     

Tuberculosis (TB)

Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis.

The condition is spread when a person with an active TB infection in their lungs coughs or sneezes and someone else inhales the expelled droplets, which contain TB bacteria.

Although it is spread in a similar way to a cold or the flu. TB is not as contagious. You would usually have to spend prolonged periods in close contact with an infected person to catch the infection yourself.

For example, TB infections usually spread between family members who live in the same house. It would be highly unlikely to become infected by sitting next to an infected person on a bus or train.

Not everyone with TB is infectious. Generally, children with TB or people with TB that occurs outside the lungs (extrapulmonary TB) do not spread the infection.

Latent or active TB

In most healthy people the immune system is able to destroy the bacteria that cause TB. However, in some cases the bacteria infect the body but don't cause any symptoms (latent TB), or the infection begins to cause symptoms within weeks or months (active TB).

Up to 10% of people with latent TB eventually develop active TB years after the initial infection. This usually happens when the immune system is weakened – for example, during chemotherapy.

Who's most at risk?

Anyone can catch TB, but people particularly at risk include those:

• who live in, come from, or have spent time in a country or area with high levels of TB – around three in every four TB cases in the UK affect people born outside the UK 
• in prolonged close contact with someone who is infected 
• living in crowded conditions 
• with a condition that weakens their immune system, such as HIV.
• having treatments that weaken the immune system, such as corticosteroids, chemotherapy or tumour necrosis factor (TNF) inhibitors (used to treat some types of arthritis and certain gut conditions) 
• who are very young or very old – the immune systems of people who are young or elderly tend to be weaker than those of healthy adults 
• in poor health or with a poor diet because of lifestyle and other problems, such as drug misuse, alcohol misuse or homelessness

Diagnosing Tuberculosis 

Several tests are used to diagnose tuberculosis (TB), depending on the type of TB suspected. 

Your GP may refer you to a TB specialist for testing and treatment if they think you have TB.

Pulmonary TB

A diagnosis of pulmonary TB (TB that affects the lungs) can be difficult and several tests are usually needed.

This will include a chest X-ray to look for changes in the appearance of your lungs that are suggestive of TB. Samples of phlegm will also often be taken and checked for the presence of TB bacteria.

These tests are important in helping to decide on the most effective treatment for you.

Extrapulmonary TB

If you have suspected extrapulmonary TB (TB that occurs outside the lungs), several tests can be used to confirm a diagnosis. These may include:

• a CT scan, MRI scan  or ultrasound scan of the affected part of the body 
• urine and blood tests
• a biopsy – a small sample of tissue or fluid is taken from the affected area and tested for TB bacteria 

You may also have a lumbar puncture.This involves taking a small sample of cerebrospinal fluid (CSF) from the base of your spine. CSF is fluid that surrounds the brain. It can be checked to see whether TB has infected your central nervous system (brain and spinal cord).

Screening for latent TB

In some circumstances, you may need to be tested to check for latent TB (when you have been infected with TB bacteria but do not have any symptoms).

For example, you may need to be screened if you have been in close contact with someone known to have an active TB infection (an infection that causes symptoms), or if you have recently spent time in a country where TB levels are high. 

If you have just moved to the UK from a country where TB is common, you may be screened when you arrive or your GP may suggest screening when you register as a patient. 

Mantoux test

The Mantoux test is a widely used test for latent TB. It involves injecting a substance called PPD tuberculin into the skin of your forearm. It's also called the tuberculin skin test (TST).

If you have a latent TB infection, your skin will be sensitive to PPD tuberculin and a hard red bump will develop at the site of the injection, usually within 48 to 72 hours of having the test. If you have a very strong skin reaction, you may need a chest X-ray to confirm whether you have an active TB infection. 

If you do not have a latent infection, your skin will not react to the Mantoux test. However, as TB can take a long time to develop, you may need to be screened again at a later stage. 

If you have had the BOG vaccination,  you may have a mild skin reaction to the Mantoux test. This does not necessarily mean you have latent TB.

Interferon gamma release assay (IGRA) 

The interferon gamma release assay (IGRA) is a newer type of blood test for TB that is becoming more widely available.

The IGRA may be used to help diagnose latent TB:

• if you have a positive Mantoux test 
• if you previously had the BCG vaccination (as the Mantoux test may not be reliable in these cases) 
• as part of your TB screening if you have just moved to the UK from a country where TB is common 
• as part of a health check when you register with a GP 
• if you are about to have treatment that will suppress your immune system 
• if you are a healthcare worker

Treating tuberculosis 

Treatment for tuberculosis (TB) will usually involve a long course of antibiotics lasting several months.

While TB is a serious condition that can be fatal if left untreated, deaths are rare if treatment is completed.

For most people, a hospital admission during treatment is not necessary.

Pulmonary TB

If you are diagnosed with active pulmonary TB (TB that affects your lungs and causes symptoms), you will be given a six-month course of a combination of antibiotics. The usual course of treatment is:

• two antibiotics (isoniazid and rifampicin) every day for six months 
• two additional antibiotics (pyrazinamide and ethambutol) every day for the first two months 

It may be several weeks or months before you start to feel better. The exact length of time will depend on your overall health and the severity of your TB. 

After taking the medicine for two weeks, most people are no longer infectious and feel better. However, it is important to continue taking your medicine exactly as prescribed and to complete the whole course of antibiotics. 

Taking medication for six months is the most effective method of ensuring the TB bacteria are killed. If you stop taking your antibiotics before you complete the course, or you skip a dose, the TB infection may become resistant to the antibiotics. This is potentially serious as it can be difficult to treat and will require a longer course of treatment.

If you find it difficult to take your medication every day, your treatment team can work with you to find a solution. This may include having regular contact with your treatment team at home, the treatment clinic, or somewhere else more convenient.

If treatment is completed correctly, you should not need any further checks by a TB specialist afterwards. However, you may be given advice about spotting signs that the illness has returned, although this is rare.

In rare cases TB can be fatal, even with treatment. Death can occur if the lungs become too damaged to work properly.

Extrapulmonary TB

Extrapulmonary TB (TB that occurs outside the lungs) can be treated using the same combination of antibiotics as those used to treat pulmonary TB. However, you may need to take them for 12 months.

If you have TB in areas such as your brain, you may also be prescribed a corticosteroid such as prednisolone for several weeks to take at the same time as your antibiotics. This will help reduce any swelling in the affected areas. 

As with pulmonary TB, it's important to take your medicines exactly as prescribed and to finish the whole course.

Latent TB

Latent TB is when you have been infected with the TB bacteria but do not have any symptoms of active disease. Treatment for latent TB is usually recommended for:

• people aged 35 years or under  
• people with HIV, regardless of their age 
• healthcare workers, regardless of their age  
• people with evidence of scarring caused by TB, as shown on a chest X-ray, but who never received treatment  

Treatment is not recommended for people who have latent tuberculosis and are over the age of 35, do not have HIV and are not healthcare workers. This is because the risk of liver damage caused by antibiotic treatment increases with age, and the risks of treatment may outweigh the benefits.

Latent TB is also not always treated if it's suspected to be drug resistant. If this is the case, you may be regularly monitored to check the infection does not become active.

In some cases, testing and treatment for latent TB may be recommended for people who require treatment that will weaken their immune system, such as long-term corticosteroids, chemotherapy or TNF inhibitors. This is because there is a risk of the infection becoming active.

Treatment for latent TB generally involves either taking a combination of rifampicin and isoniazid for three months, or isoniazid on its own for six months.

Side effects of treatment

Rifampicin can reduce the effectiveness of some types of contraception, such as the combined contraceptive pill. Use an alternative method of contraception, such as condoms, while taking rifampicin. 

In rare cases the antibiotics used to treat TB can cause damage to the liver or eyes, which can be serious. Your liver function therefore may be tested before you begin treatment. 

If you are going to be treated with ethambutol, your vision should also be tested at the beginning of the course of treatment. 

Contact your TB treatment team if you develop any worrying symptoms during treatment, such as:

• being sick  
• yellowing of your skin and whites of your eyes (jaundice)
• an unexplained high temperature (fever) 
• tingling or numbness in your hands or feet 
• a rash or itchy skin 
• changes to your vision, such as blurred vision

Preventing the spread of infection

If you are diagnosed with pulmonary TB, you will be contagious up to about two to three weeks into your course of treatment.

You will not normally need to be isolated during this time, but it's important to take some basic precautions to stop TB spreading to your family and friends. You should:

• stay away from work, school or college until your TB treatment team advises you it is safe to return  
• always cover your mouth – preferably with a disposable tissue – when coughing, sneezing or laughing 
• carefully dispose of any used tissues in a sealed plastic bag  
• open windows when possible to ensure a good supply of fresh air in the areas where you spend time 
• do not sleep in the same room as other people as you could cough or sneeze in your sleep without realising it 

What if someone I know has TB? 

When someone is diagnosed with TB, their treatment team will assess whether other people are at risk of infection. This may include close contacts, such as people living with the person who has TB, as well as casual contacts, such as work colleagues and social contacts.

Anyone who is assessed to be at risk will be asked to go for testing, and will be given advice and any necessary treatment after their results.