Allergy & the Military
Every year we receive many inquiries from people with allergies who want to join the armed forces. Serving in the forces requires a certain standard of fitness and health, and these standards are set by the respective services. This Factsheet focuses on the Army because it is the largest service but similar considerations apply to the Royal Navy, Royal Marines and Royal Air Force.
Unlike most other forms of chronic illness, people with allergies are usually fit between attacks and may have high levels of personal fitness. However, if you are prone to severe allergic reactions due to food, insect stings or drugs, this may present a difficulty for the Army. Firstly, the Army cannot guarantee to serve food that is free from nuts or other potential allergens. Secondly, if a soldier has an allergic reaction while on deployment, it doesn’t just incapacitate them and deprive their unit of their skills, it also ties up one or more other personnel to look after the allergic casualty. This is a particular problem if on active service.
The Armed Forces are exempt from disability discrimination legislation and even if they were not, they could argue that the ability to eat any food is a genuine occupational requirement for serving personnel. While it is true that some forces’ postings are in places where allergy-free diets could be provided and where having an allergic reaction is no more inconvenient than in civilian life, if someone is not fully deployable they are less useful to the services. If serving personnel develop allergies while in the forces, there is sometimes scope to retain them by limiting their deployment. However, for new recruits, a serious food or drug allergy is a clear barrier to joining up.
Current health requirements for the services are available on the web. For the Army see:
http://www.army.mod.uk/join/How-to-join.aspx and then click on “how to join”. Next scroll down to the section on “can I join” and then click on medical conditions which lists the medical conditions which will stop you joining. Allergies are covered under “other conditions” where there is specific mention of “severe nut allergy” and “severe allergic reactions or anaphylaxis requiring adrenaline injection” as barriers to recruitment. Active asthma and eczema are also mentioned in the respiratory and skin sections.
If you have a current diagnosis of anaphylactic allergy to nuts or other foods and you really are allergic to these, you cannot join up. If you are allergic to wasp or bee stings you may be eligible but only if you have been desensitised and no longer need to carry an adrenaline auto injector (AAI). If you carry or still require an AAI you will be unable to serve. However, some people who have been prescribed an AAI may be at low risk and therefore, if your doctor assesses you and concludes you do not require an AAI, it may be possible to get approved and join up.
The commonest grey areas are:
(1) people who have been given a label of food allergy in childhood but have not had any recent reactions and may not actually ever have had an allergy
(2) people who had mild food allergy in childhood but have “grown out of it”
(3) people who only get mild symptoms on exposure to nuts etc, e.g. the oral allergy syndrome, but their medical notes state that they are allergic to nuts etc.
(4) people who have been prescribed an AAI “as a precaution” but may never have needed it and have never used it
If you apply to join the army you will have to fill in a health questionnaire. It is important that you are honest in completing this as failure to disclose a condition will automatically disqualify you. If you pass the initial scrutiny, an army-approved doctor will review your GP records to see if you have any of the conditions which preclude recruitment. If there is any mention of food allergy in your GP record, this will be flagged up and you will need to get clearance before you can join up, even if you do not have any current problems. Often it is difficult to know exactly what happened in early childhood, as many children are sick or get rashes for unrelated reasons and are incorrectly labelled as food or drug-allergic.
If you are planning to join the forces and you know that your history of allergic symptoms will be flagged up, you can ask an allergy specialist to assess you and give an opinion on whether your allergy will prevent you serving in the forces. This work falls outside the National Health Service and there will usually be a charge for the assessment. You should check with your doctor before the appointment to make sure you know what the fee is likely to be. Please note that the final decision rests with the respective service – sometimes the Navy will take people that are turned down by the Army etc. All Allergists will be able to give a preliminary opinion on whether assessment is needed, and this can be requested via your GP, who will know who to speak to in the local allergy service. However, if you do decide to go ahead and get a private specialist opinion, do make sure that the doctor you see is on the list of Allergists and Immunologists approved by the Army – otherwise you will end up having to get another opinion from an approved allergist and you will incur unnecessary additional costs.
Non-approved allergists can give a perfectly good clinical opinion, but the Army’s view is that they would like this work undertaken by a small number of allergy and immunology specialists and centres who are familiar with service requirements, and whose opinion can be accepted by the Army’s occupational health service. This is why the army has restricted the number of allergy centres that are approved to give an opinion. Details of currently approved centres are available from the British Society for Allergy & Clinical Immunology website under find a clinic https://www.bsaci.org/find-a-clinic/index.htm[NS1] or from the Army itself.
Assessment will usually involve taking a detailed history of the problem and some tests of allergic sensitisation (either skin tests or blood tests, sometimes both). A formal food challenge may be needed to show that your history of allergy is no longer valid or is so mild that it does not present a problem for the forces. If you already eat foods to which you used to be allergic, please do inform the clinical staff, but if you are currently avoiding foods because of concerns about possible allergies, please do not try these out at home until you have been assessed!
Similar considerations apply to people with a history of drug allergy or insect venom allergy but the assessment and management of these is too varied to be described here. Again, the Army will only accept an opinion from one of their approved centres so do check before spending your money on a private consultation.
Written by Prof Tony Frew MA MD FRCP and updated by Dr Shuaib Nasser MA MD FRCP
Updated March 2019