Du Toit G.,Guys And St Thomas Nhs Foundation Trust |
Sinnott L.,North West Specialised Commissioning Team |
Forster D.,The London Clinic |
Austin M.,Anaphylaxis Campaign |
And 4 more authors.
Archives of Disease in Childhood | Year: 2011
Aims: The Royal College of Paediatrics and Child Health (RCPCH) was commissioned by the Department of Health to develop a drug allergy pathway. It focuses on defining the competences to improve the equity of care received by children. Method: The drug pathway was developed by a multidisciplinary working group and was based on a comprehensive review of evidence. The team decided to focus on IgE-mediated reactions as these have the greatest potential to be life-threatening. Results: The results are presented in four parts: evidence review, pathway mapping, external review and core knowledge documents. The evidence review found a high percentage of putative penicillin allergy is not confirmed by objective testing and that resensitisation to β-lactam drugs was infrequent. It also highlighted the importance of a detailed history and accurate diagnosis along with clear communication of test results to both family and primary care. Conclusions: This pathway demonstrates the spectrum of drug allergy is varied and may differ for young children compared with older children and adults. The authors highlight the paucity of evidence to support allergy testing for most drugs, in children, other than supervised incremental provocation tests (when indicated). Acute presentations require emergency health professionals to address underlying allergic issues, including recognition and avoidance of potential drug allergy triggers. Non-acute presentations may include multi-system symptoms which may have a broad differential diagnosis; this document signposts to the relevant partners in the RCPCH care pathway portfolio. Management combines a care package including a definitive diagnosis, initiating treatments and ongoing education.
Clark A.,Addenbrookes NHS Trust |
Sheikh A.,University of Edinburgh |
Alfaham M.,University of Wales |
East M.,Anaphylaxis Campaign |
And 9 more authors.
Archives of Disease in Childhood | Year: 2011
Aims: Numerous studies have identified shortcomings in the management of children at risk of severe acute allergic reactions (anaphylaxis). The Science and Research Department at the Royal College of Paediatrics and Child Health (RCPCH) was commissioned by the Department of Health to develop competence based national care pathways for children with allergies. Anaphylaxis is the first completed pathway. Methods: The anaphylaxis pathway was developed by a multidisciplinary working group, reviewed by a broad group of stakeholders and approved by the Allergy Care Pathways Project Board and the RCPCH Clinical Standards Committee. Results: Pathway development is described under five headings: evidence review, mapping, external review, core knowledge documents and key recommendations. The full pathway can be downloaded from www. rcpch.ac.uk/allergy/anaphylaxis. This document describes the entry points and the ideal pathway of care from self-care through to follow-up. The five key recommendations focus on: (1) prompt administration of adrenaline by intramuscular injection; (2) referral to specialists with competence in paediatric allergies; (3) risk analysis; (4) provision of a self-management plan; and (5) suggested creation of a national anaphylaxis death register. Conclusions: We present the first national care pathway for anaphylaxis, which is based on a critique of published evidence, expert consensus and multi-stakeholder input including patient representation via the Anaphylaxis Campaign. The Project Board urges health professionals to work together across networks to improve care for children at risk of anaphylaxis, in particular during the period after an acute reaction. Additionally, the Project Board strongly recommends the funding of a national anaphylaxis register.
Madsen C.B.,Technical University of Denmark |
Crevel R.,Colworth Science Park |
Chan C.H.,Food Standards Agency |
Dubois A.E.J.,University of Groningen |
And 10 more authors.
Regulatory Toxicology and Pharmacology | Year: 2010
We have reached a point where it is difficult to improve food allergy risk management without an agreement on levels of acceptable risk. This paper presents and discusses the perspectives of the different stakeholders (allergic consumers, health professionals, public authorities and the food industry) on acceptable risk in food allergy. Understanding where these perspectives diverge and even conflict may help develop an approach to define what is acceptable.Uncertainty about food allergy, its consequences and how to manage them is the common denominator of the stakeholders' views. In patients, uncertainty is caused by the unpredictability of reactions and the concern about whether avoidance strategies will be effective enough. Variability of symptoms and the lack of markers do not allow stratification of patients according to their reactivity, and force health professionals to give the same advice to all patients despite the fact that the risk to each is not identical. Regulators and the food industry struggle with the fact that the lack of management thresholds forces them to make case-by-case decisions in an area of uncertainty with penalties for under- or over-prediction. As zero risk is not a realistic possibility, consensus on acceptable risk will be needed. © 2010 Elsevier Inc.
Kindratt T.B.,Brighton and Sussex Medical School |
Reading D.,Anaphylaxis Campaign
Clinical and Translational Allergy | Year: 2014
A previous cross-sectional survey highlighted that restaurant staff in Brighton had gaps in their knowledge of food allergy, which could lead to the provision of unsafe meals to food-allergic customers. A food allergy training event was developed by a multi-disciplinary team (health service researcher, clinician, teacher and patient group representative) to equip restaurant staff with the knowledge and skills necessary to safely serve food-allergic customers. This evaluation summarises the training event's impact on participants' knowledge of food allergy and their satisfaction with the event. No attendee had previously attended any formal training on food allergy. The percentage of participants who answered all true-false questions correctly increased from 82% before the training event to 91% afterwards. The percentage of participants who were able to name at least three common allergens increased from 9% to 64%. Both quantitative and qualitative feedback was positive. Restaurant staff require a good understanding of food allergy to ensure that food-allergic customers are kept safe, and their restaurants operate within the law. This food allergy training event improved participants' absolute knowledge of food allergy, and attendees changed practice. Recommendations are made which could improve the impact and uptake of future food allergy training events. © 2014 Bailey et al.; licensee BioMed Central Ltd.
Salvilla S.A.,University of Edinburgh |
Dubois A.E.J.,University of Groningen |
Flokstra-De Blok B.M.J.,University of Groningen |
Panesar S.S.,University of Edinburgh |
And 13 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2014
This is one of seven interlinked systematic reviews undertaken on behalf of the European Academy of Allergy and Clinical Immunology as part of their Guidelines for Food Allergy and Anaphylaxis, which focuses on instruments developed for IgE-mediated food allergy. Disease-specific questionnaires are significantly more sensitive than generic ones in measuring the response to interventions or future treatments, as well as estimating the general burden of food allergy. The aim of this systematic review was therefore to identify which disease-specific, validated instruments can be employed to enable assessment of the impact of, and investigations and interventions for, IgE-mediated food allergy on health-related quality of life (HRQL). Using a sensitive search strategy, we searched seven electronic bibliographic databases to identify disease-specific quality of life (QOL) tools relating to IgE-mediated food allergy. From the 17 eligible studies, we identified seven disease-specific HRQL instruments, which were then subjected to detailed quality appraisal. This revealed that these instruments have undergone formal development and validation processes, and have robust psychometric properties, and therefore provide a robust means of establishing the impact of food allergy on QOL. Suitable instruments are now available for use in children, adolescents, parents/caregivers, and adults. Further work must continue to develop a clinical minimal important difference for food allergy and for making these instruments available in a wider range of European languages. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PubMed | German Allergy and Asthma Association Deutscher Allergie und Asthmabund DAAB, MoniQA, DTS, Hospital Clinico San Carlos and 21 more.
Type: Journal Article | Journal: Allergy | Year: 2015
Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the possibility of reaction from the unintended presence of allergens in foods. However, in its current form, PAL is counterproductive for consumers with food allergies. This review aims to summarize the perspectives of all the key stakeholders (including clinicians, patients, food industry and regulators), with the aim of defining common health protection and risk minimization goals. The lack of agreed reference doses has resulted in inconsistent application of PAL by the food industry and in levels of contamination that prompt withdrawal action by enforcement officers. So there is a poor relationship between the presence or absence of PAL and actual reaction risk. This has led to a loss of trust in PAL, reducing the ability of consumers with food allergies to make informed choices. The result has been reduced avoidance, reduced quality of life and increased risk-taking by consumers who often ignore PAL. All contributing stakeholders agree that PAL must reflect actual risk. PAL should be transparent and consistent with rules underpinning decision-making process being communicated clearly to all stakeholders. The use of PAL should indicate the possible, unintended presence of an allergen in a consumed portion of a food product at or above any proposed action level. This will require combined work by all stakeholders to ensure everyone understands the approach and its limitations. Consumers with food allergy then need to be educated to undertake individualized risk assessments in relation to any PAL present.
News Article | November 28, 2016
School first aiders, community pharmacists and GP practice nurses overestimate the risk of fatal reaction for children with food allergy, suggests a new study, yet some are unable to treat allergic reactions safely School first aiders, community pharmacists and GP practice nurses overestimate the risk of fatal reaction for children with food allergy, suggests a new study, yet some are unable to treat allergic reactions safely. The team behind the research, from Imperial College London, asked 90 people (30 school first aiders, 30 GP practice nurses and 30 community pharmacists) to estimate the likelihood that a child with food allergy will suffer a fatal allergic reaction. The team, who published their findings in the journal Clinical and Experimental Allergy, also asked how they would recognise and treat a life-threatening allergic reaction in children. The results showed all three groups significantly overestimated the risk of a child dying from a fatal allergic reaction. However despite heightened risk perception, the researchers found the study group were not able to adequately treat life-threatening allergic reactions in children. Most of the people surveyed in the study could not correctly administer an adrenaline auto-injector device such as EpiPen. These life-saving devices, which resemble a thick marker pen, must be used within minutes of a severe allergic reaction. They inject adrenaline into the body, which quickly reduces swelling in the throat and mouth, and allows breathing to return to normal. One in three school first aiders were unable to correctly use the device, which is usually pressed into the thigh. More than eight in ten (83 per cent) GP nurses used the device incorrectly, along with three in five pharmacists. Most of the study group previously said they were very confident in using an adrenaline auto-injector. The most common mistake was to not hold the device in place for five seconds - the time needed for the adrenaline to move into the thigh muscle. Other mistakes included not removing the safety cap or trying to inject the wrong end into the leg. Some people would have accidently injected themselves. The team said that although the study was small, the findings suggest all professionals who may need to treat severe allergies should have mandatory training, and practise with trainer devices on a regular basis. Heather Hanna, allergy research nurse and an author on the study from the Department of Medicine at Imperial said: "Although severe allergic reactions are rare, they can be life-threatening. The results from this study showed that many of the professionals questioned over-estimated the risk of death from these reactions. However, this over-estimation didn't result in people being better prepared - as only 40 per cent of all people in the study could correctly administer a trainer adrenaline auto-injector device." The team said the findings surrounding school first aiders was particularly worrying, as previous studies have shown up to one in five allergic reactions in children occur in school. It's also thought that outcomes of serious reactions may be worse when they occur at school as opposed to occurring at home. Mrs Hanna added: "There are good resources available for learning about treating allergic reactions, as well as adrenaline auto-injector trainer devices. We recommend people regularly practice using their trainer device." Severe allergic reactions kill around one to two people per month in the UK. Most are triggered by a reaction to foods, such as peanuts, or to medicines. The reactions, called anaphylaxis, can quickly trigger swelling in the skin, lips, mouth and throat, making breathing difficult. They also cause a sudden drop in blood pressure, leading to a person becoming weak and floppy, and in some cases collapsing or losing consciousness. Food allergies - most commonly nut allergy - are the leading cause of fatal anaphylaxis in children. In the study, the team gave the 90 study participants potential scenarios of a child suffering an allergic reaction to food, and then asked them how they would respond. They also asked the group to inject a child mannequin with an adrenaline auto-injector. In the event of a severe allergic reaction, an auto-injector should be give immediately - and then an ambulance should be called, and other medication may be given. However, in the practise scenario under half of school first aiders said they would give an auto-injector as first line treatment. A third said they would give an inhaler first, and around one in five said they would give antihistamines. The findings echo previous research from Dr Robert Boyle, another author of the new study from the Department of Medicine at Imperial. His previous work suggested over half of mothers of children with severe allergies could not correctly administer an auto-injector, just six weeks after they received thorough training. Dr Boyle said this stresses the need for better designed devices. "These devices could be the difference between life and death, yet their design is not simple or intuitive enough for use in an emergency situation. We need to develop easier-to-use treatments for severe allergic reactions." He also added that the risks associated with allergy, particularly food allergy, should be included in information leaflets and training packages for professionals and patients, in order to avoid the heightened risk perception identified in this study. "This misperception of risk by school first aiders, pharmacists and practice nurses may lead to increased anxiety and restriction of activities for food-allergic children" said Dr Boyle. Training on how to use adrenaline auto-injectors such as EpiPen is available in the UK through the Anaphylaxis Campaign's 'Allergywise' programme - http://www. .
PubMed | Anaphylaxis Campaign, Edinburgh EH17 8UD, University of Edinburgh and University College London
Type: Journal Article | Journal: JRSM open | Year: 2016
To examine the circumstances, features and management of anaphylaxis in children and adults.Self-completed questionnaire.The age of participants ranged from 0 to 72 years.We analysed data from self-completed questionnaires collected over a 12-year period, i.e. 2001-2013, available to people by phone and, since 2012, for online completion through the Anaphylaxis Campaign.We analysed data from self-completed questionnaires collected over a 12- year period, i.e. 2001-2013, available to people by phone and, since 2012, for online completion through the Anaphylaxis Campaign.In total, 356 questionnaires were submitted, of which 54 did not meet the criteria for anaphylaxis. The remaining 302 anaphylactic reactions originated from 243 individuals; 193 (64%) of these reactions were in children. Approximately half of all reactions occurred at home (These data suggest that the majority of anaphylaxis reactions are triggered by exposure to known food allergens and that approximately half of these reactions occur at home. Access to self-injectable adrenaline was sub-optimal and when available it was only used in a minority of cases. Avoiding triggers, access to self-injectable adrenaline and its prompt use in the context of reactions need to be reinforced.
Monks H.,University of Southampton |
Gowland M.H.,Anaphylaxis Campaign |
MacKenzie H.,University of Portsmouth |
Erlewyn-Lajeunesse M.,University of Southampton |
And 3 more authors.
Clinical and Experimental Allergy | Year: 2010
Summary Background The peak incidence of deaths from anaphylaxis associated with nut allergy occurs in teenagers and young adults. During adolescence, the management of food allergy shifts from being the responsibility of parents to that of the young person. This is a group who therefore need special attention in the clinic. Objective This study aimed to understand the practical challenges that teenagers with food allergy experience using a qualitative approach and generate potential interventions for tackling these. Methods Teenagers aged 1118 years with food allergy completed a questionnaire about their food allergy and underwent a focused, semi-structured interview with open questions guided by a priori topic areas. Interviews were recorded, transcribed and analysed using a thematic approach. Results The study enrolled 18 teenagers with a median age of 15 years (10 females); the most common food allergens were peanuts and tree nuts. Three key themes emerged: avoidance of allergens, preparation for reactions and the treatment of reactions. The majority of teenagers reported eating foods labelled as 'may contain' an allergen as they perceive that they are actually very unlikely to contain an allergen. Many of the teenagers only carried their self-injectable adrenaline when they thought they are particularly at risk of a reaction. Some do not know how to appropriately treat an allergic reaction. More than half believed that educating other students at school about the seriousness of food allergies would make it easier to live with their food allergy. Conclusions A significant number of teenagers demonstrate risk-taking behaviour in the management of their food allergies. Teenagers also felt it would be helpful for their peers to be educated about food allergy. This novel strategy might help them to avoid trigger foods and enable teenagers to access help more readily if they suffer a reaction. © 2010 Blackwell Publishing Ltd.