Entity

Time filter

Source Type

London, United Kingdom

Fitzsimons R.,Kings College London | van der Poel L.-A.,Childrens Allergy Service | Thornhill W.,Evelina Childrens Pharmacy | du Toit G.,Great Ormond Street Hospital | And 2 more authors.
Archives of Disease in Childhood: Education and Practice Edition | Year: 2014

This review provides an overview of the use of antihistamines in children. We discuss types of histamine receptors and their mechanism of action, absorption, onset and duration of action of first-generation and second-generation H(1)-antihistamines, as well as elimination of H(1)-antihistamines which has important implications for dosing in children. The rationale for the use of H(1)-antihistamines is explored for the relief of histamine-mediated symptoms in a variety of allergic conditions including: non-anaphylactic allergic reactions, atopic eczema (AE), allergic rhinitis (AR) and conjunctivitis, chronic spontaneous urticaria (CSU) and whether they have a role in the management of intermittent and chronic cough, anaphylaxis, food protein-induced gastrointestinal allergy and asthma prevention. Second-generation H(1)-antihistamines are preferable to first-generation H(1)-antihistamines in the management of non-anaphylactic allergic reactions, AR, AE and CSU due to: their better safety profile, including minimal cognitive and antimuscarinic side effects and a longer duration of action. We offer some guidance as to the choices of H(1)-antihistamines available currently and their use in specific clinical settings. H(1)-antihistamine class, availability, licensing, age and dosing administration, recommended indications in allergic conditions and modalities of delivery for the 12 more commonly used H(1)-antihistamines in children are also tabulated. © 2014 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health. Source


Ludman S.,University of Lausanne | Wassenberg J.,University of Lausanne | Du Toit G.,Childrens Allergy Service | Fox A.T.,Childrens Allergy Service | And 2 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2013

Background: There are guidelines on how to develop a food challenge protocol, but at present there is no gold standard guidance on method, and separate units produce differing protocols. Methods: We performed a retrospective analysis of 200 patients' data from the paediatric allergy units in Lausanne and Geneva, Western Switzerland, and St Thomas' Hospital (STH), UK. Results: St Thomas' Hospital has a younger cohort with a lower overall mean spIgE (2.36 kU/l vs 8.00 kU/l, P = 0.004). The target peanut protein volumes differed: Switzerland 4.4 g vs STH 8.4 g. Despite this, the dose actually achieved in positive challenges was not significantly different (2.33 g vs 1.49 g, P = 0.16). 26% of challenges reacted at 4 g or more of peanut protein. Conclusions: The differences in results highlight how the variation in reasoning behind food challenge alters the outcome. Standardization of food challenges would allow easy comparison between hospitals and geographical areas for research purposes. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd. Source


Fitzsimons R.,Childrens Allergy Service | Fitzsimons R.,Kings College London | Van Der Poel L.-A.,Childrens Allergy Service | Thornhill W.,Evelina Childrens Pharmacy | And 6 more authors.
Archives of Disease in Childhood: Education and Practice Edition | Year: 2015

This review provides an overview of the use of antihistamines in children. We discuss types of histamine receptors and their mechanism of action, absorption, onset and duration of action of first-generation and second-generation H(1)-antihistamines, as well as elimination of H(1)-antihistamines which has important implications for dosing in children. The rationale for the use of H(1)-antihistamines is explored for the relief of histamine-mediated symptoms in a variety of allergic conditions including: nonanaphylactic allergic reactions, atopic eczema (AE), allergic rhinitis (AR) and conjunctivitis, chronic spontaneous urticaria (CSU) and whether they have a role in the management of intermittent and chronic cough, anaphylaxis, food protein-induced gastrointestinal allergy and asthma prevention. Second-generation H(1)-antihistamines are preferable to first-generation H(1)-antihistamines in the management of nonanaphylactic allergic reactions, AR, AE and CSU due to: their better safety profile, including minimal cognitive and antimuscarinic side effects and a longer duration of action. We offer some guidance as to the choices of H(1)-antihistamines available currently and their use in specific clinical settings. H(1)-antihistamine class, availability, licensing, age and dosing administration, recommended indications in allergic conditions and modalities of delivery for the 12 more commonly used H(1)-antihistamines in children are also tabulated. Source


Wauters L.,Catholic University of Leuven | Brown T.,Childrens Allergy Service | Venter C.,University of Portsmouth | Dziubak R.,Great Ormond Street Hospital for Children NHS Foundation Trust | And 5 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2016

Objectives: Cow's milk allergy (CMA) is the most common food allergy in children with many clinical manifestations, leading to misdiagnoses such as gastro-oesophageal reflux, infantile colic, and lactose intolerance with inappropriate prescribing. We aimed to determine the impact of infant feeding guidelines on CMA prescribing in UK primary care using a simple and inexpensive training package. Methods: Prospectively collected data of infant feeding prescriptions in Northern Ireland from June 2012 to March 2014 were analysed with the intervention period between November 2012 and March 2013. A comparison was made between hypoallergenic formulae, appropriate for CMA, versus alternative prescriptions including antiregurgitation and colic products, lactose-free and partially hydrolysed milks, or infant Gaviscon. Results: Comparing pre- and postintervention period, the total quantity of hypoallergenic formulae increased by 63.2% and alternative prescriptions decreased by 44.6% (P<0.001). The total amount of all prescribed products decreased by 41.0% (P<0.001). During the study period, the proportion of recommended CMA treatment increased from 3.4% before training to 9.8% in the short- and long-term follow-up (P<0.001). The overall increase was £33,508 per year or £95.5 per general practitioner's surgery. Conclusions: We present the first study evaluating the impact of infant feeding guidelines on CMA prescribing in UK primary care. Practical advice and teaching of health professionals allowed for effective implementation of regional and national guidelines, with a significant impact on prescription patterns. This study shows promising results for prospective research on a national scale, including socioeconomical impact and cost-effectiveness. © 2016 by ESPGHAN and NASPGHAN. Source


Fitzsimons R.,Childrens Allergy Service | Fitzsimons R.,University of Southampton | Fitzsimons R.,Kings College London | Fox A.T.,Childrens Allergy Service | And 5 more authors.
Current Allergy and Clinical Immunology | Year: 2013

Background: The international group, Allergic Rhinitis and Its Impact on Asthma (ARIA) developed guidelines for the management of allergic rhinitis (AR) defining criteria to enable clinicians to identify those suitable for specific immunotherapy (SIT). This article examines the management of AR in children and describes a service evaluation which examines the safety and efficacy of SIT in a children's tertiary allergy service. Methods: Data for the service evaluation were gathered from the clinic notes of children who commenced either sublingual (SLIT) or subcutaneous immunotherapy (SCIT) to tree or grass pollen prior to the 2011 season. Results: Data were obtained from 54 (66.7%) children receiving grass and 27 (33.3%) receiving tree pollen SIT. Children who had immunotherapy administered via the subcutaneous route had more reactions on administration (77.8%); none of the reactions were life-threatening or required administration of adrenaline. There was a significant improvement in quality of life questionnaire (QLQ) scores in children receiving SIT; 90.9% of parents felt there was improvement (p<0.0001). Conclusion: Both modalities of SIT were shown to be safe in this cohort of children. Despite only having 1 year's treatment with immunotherapy there was a significant improvement in QLQ scores for children in both the SCIT and SLIT groups. Source

Discover hidden collaborations