Paediatric Allergy Service

Reviewed on : 10 Oct 2022

Reviewed by : Anjli Jethwa Consultant Paediatrician

Expires : 10 Oct 2024

About the Paediatric Allergy Service

The members of the UHCW NHS Trust team include:

Dr Anjli Jethwa Consultant Paediatrician with Allergy Interest
Dr Colin MacDougall Consultant Paediatrician with Allergy Interest

Lead Health Professionals

Ms Louise Bashford Children’s Allergy Specialist Nurse
Ms Sarah Pitts Children’s Allergy Specialist Nurse
Ms Catherine Weller Children’s Allergy Specialist Nurse
Ms Hayley James Children’s Respiratory Specialist Nurse
Ms Katherine Brady Children’s Respiratory Specialist Nurse

Pollen Food Allergy (PFS)* new BSACI guideline content

Pollen food syndrome (PFS) is a common, IgE- mediated food allergy, characterised by immediate mild oro-pharyngeal symptoms after the consumption of raw plant foods due to ross reactions between pollen antibodies and unstable plant food allergens.

Main pollens involved in the UK are tree pollens, principally birch tree pollen, hazel and alder.
Usually affects adolescents or adults, but can occur in children of any age, especially those who suffer from spring or summertime hay fever.
The diagnosis and management of PFS can often be wholly managed in Primary Care but differentiating between PFS and an allergy to tree nuts/peanuts can be difficult, so reactions to the latter usually require onward referral to Secondary Care.

Clinical History

A thorough clinical history alone can be diagnostic. The history taking should include questions regarding:

Reported symptoms – PFS is characterised by mild immediate itching and/or swelling of the oropharynx, which responds to antihistamine but may resolve without any treatment
Food triggers – PFS involves symptoms only to raw (uncooked) plant foods, with cooked or processed foods usually tolerated.
The most common food triggers include:

o apples, cherries, plums, peaches, kiwifruit, pear, carrot, celery, or tomato

o hazelnuts, almonds, walnuts, or peanuts

o soya milk, soya protein powder or edamame beans

o peeling potatoes or other root vegetables – causes itchy hands

History of allergic rhinitis – PFS is most common in people reporting hay fever in springtime, but often also experience symptoms in the summer or autumn.

Management

If symptom history and food triggers are consistent with PFS, and reactions are only to fruits or vegetables, then there is no need for allergy tests or onward referral to secondary care.

These patients should be:

Advised to avoid only those raw foods which have already provoked symptoms
Provided with patient information leaflets on PFS
Referred to a community dietitian if many fruits or vegetables trigger reactions, or the diet is already compromised due to other dietary restrictions
Treated optimally for co-morbidities such as rhinitis, asthma and eczema.

When to Refer to a Secondary Care Allergy service

Those reporting any symptoms to:
Tree nuts
Peanuts whether mild, moderate or severe
Soya milk and/or raw/cooked fruits/vegetables (systemic or severe reactions)
Use Advice and Guidance service if uncertainty whether reported symptoms merit referral, or if any specific blood tests should be undertaken,

When making a referral please consider the following:

Providing details on triggers, symptom type, time to onset and whether triggers include both cooked and raw foods will help the specialist allergy service risk assess the patient
Those reporting severe reactions, especially if they also have asthma, will need to be prescribed adrenaline auto-injectors (AAI), and trained to understand how and when to use them, so that they are safety netted prior to being seen in secondary care
Most people with PFS do not need AAI, so the continued need for an adrenaline autoinjector will be reassessed by the Allergy Service following the referral
Once the referral has been accepted, the patient should be advised that they will be contacted by the allergy service regarding any instructions preparatory to allergy testing, such as discontinuation of antihistamine.

Patient information leaflet

Click on image below or link on right

Drug Allergy in Children (Suspected Antibiotic Allergy only)* restricted service available

Guidance regarding referral advice for the Paediatric Allergy Service 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 occur <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

Anaphylaxis
Severe non-immediate cutaneous reactions eg Stevens Johnson Syndrome
If in case of presumed beta lactam and or cephalosporin / cephalosporin allergy a specific condition can only be treated by a beta lactam
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:

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.