Reviewed on : 5 Dec 2019

Reviewed by : Jessica Daniel Consultant Paediatrician UHCW

Expires : 5 Dec 2021

Drug Allergy in Children

Guidance regarding referral advice for the Paediatric Allergy Service.

It should be read in conjunction with NICE CG183 Diagnosis and Management of drug allergy www.nice.org.uk/guidance/cg183

Drug allergy Assessment

• Immediate reactions usually <1hour after drug exposure
• Non–Immediate  reactions occur within a few days or weeks

See Nice.org.uk CG183 pages 10-11 for distinguishing features www.nice.org.uk/guidance/cg183

Inclusion Criteria

1. Anaphylaxis
2. Severe non-immediate cutaneous reactions eg Stevens Johnson Syndrome
3. Drug allergy during general anaesthesia
4. If in case of presumed beta lactam and or cephalosporin / cephalosporin allergy a specific condition can only be treated by a beta lactam
5. If there is likely to be recurrent requirement for that drug in the future eg beta lactam allergy in patient with immunodeficiency

Allergy to more than one class of antibiotic If the reaction was an immediate type please refer to the Paediatric allergy team and whilst waiting for the appointment please give the following advice:

Complete avoidance of the allergen is the most important aspect of management

If signs of anaphylaxis prescribe an Adrenaline Auto Injector and an Anti-Histamine. Guidance and doses can be found in the BNFc, Anaphylaxis Campaign and Resuscitation Council:

https://bnfc.nice.org.uk/

https://www.anaphylaxis.org.uk/hcp/what-is-anaphylaxis/medication/

https://www.resus.org.uk/anaphylaxis/emergency-treatment-of-anaphylactic-reactions/

Referral information required

• Clear history of events and examination findings
• Drug implicated
• Strength/formulation/route
• Condition being treated
• Previous exposure history
• Time between administration of dose and onset of symptoms
• Number of doses before onset

NO testing is required prior to referral

Referrals should be directed to the paediatric allergy team at UHCW NHS Trust

Exclusion Criteria

The following groups of patients should be referred to General Paediatric clinics and NOT the allergy service:

• Infant feeding and possible Cow’s Milk Protein Intolerance (Very few children with reflux actually have an intolerance and true IgE mediated cow’s milk protein allergy is very rare – only 2.22% of children with a Cow’s milk intolerance have a true IgE mediated allergy )
• Urticaria with no identifiable allergen

Further information

Demand for allergy services nationwide is rising due to raised awareness of allergic conditions high profile cases in the media and an increase in the incidence of several types of food and airborne allergies.

Currently there is a 6 month waiting list for new patients

GP expediting of appointments is not possible except in children with true anaphylaxis (cardiovascular or respiratory compromise or altered conscious state as a result of exposure to an allergen).

Please bear this in mind when discussing appointments with patients.

Advice & Guidance

Email: childrensallergy@uhcw.nhs.uk. (We will endeavour to respond within a week)