Lyme Disease Action (in the UK) filed a submission with the IDSA contesting the IDSA 2006 Lyme disease guidelines. The submission points out that the presentation of Lyme disease in the UK may be different than the presentation in the US, and the application of the guidelines in the UK lead to under-diagnosis and under-treatment of patients with Lyme disease.

The submission states:

Despite the facts that Lyme disease is caused by at least two further genospecies of Borrelia burgdorferi sensu lato in Europe than in the USA and that there are clear differences in the resulting disease presentation, the IDSA guidelines are recommended for use within Europe and specifically within the UK by the UK Health Protection Agency (HPA). Lyme Disease Action believes that the IDSA guidelines should be presented with a clear delimitation of usage to the USA and a warning that other national authorities must conduct clinical trials and develop and publish independent guidelines specific to the conditions in their own regions.