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Managing Food Allergy in Children

00:00 / 00:00

Introduction

Practice Nurse Prescriber and Member of the NICE British National Formulary for Children Nurse Prescribers' Advisory Group

The NICE guidelines published in 2011 highlighted the importance of successfully diagnosing food allergies in children and young people early in their management. This CPD module has been collated to help you further understand the NICE guidelines and implement the recommendations.

Each year around 3 million people with allergic conditions are seen by GPs in the UK.1 Food allergy is a major allergic disease in young people and causes significant morbidity in many. Early diagnosis and management of food allergy not only relieves patients' symptoms but also reduces the costs associated with unnecessary prescriptions and referrals, as well as reducing repeat consultations.

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What can you expect from each section

This CPD module comprises 7 sections

Short video presentations

Interactive virtual patient case studies

A few questions will be asked at after each presentation which will check your understanding. The module should take approx. 1 hour to complete and will earn you at least

From the Royal College of Nursing

Each section meets a learning objective via a series of questions, all of which must be answered correctly

Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
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References
  1. Department of Health. A review of services for allergy - the epidemiology, demand for and provision of treatment and effectiveness of clinical interventions. 2006.
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Section 1
Section 2
Section 3
Section 4
Section 5

Section 1 Nurse Jill Shearer

The Burden of Food Allergy

00:00 / 00:00

Nurse Jill Shearer Practice Nurse Prescriber and Member of the NICE British National Formulary for Children Nurse Prescribers' Advisory Group

Continue
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
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Section 1
Section 2
Section 3
Section 4
Section 5

Summary

  • Food allergy is a highly prevalent condition and an increasing burden on the healthcare system1-3
  • Identifying the food allergy and removing the offending food from the patient's diet can alleviate symptoms and help to reduce the healthcare burden4
  • Since 1990 hospital admissions for food allergy have increased by approximately 500%2
  • Food allergy is costing Primary Care as much as £900 million per annum3
  • Approximately 8% of UK children have a confirmed food allergy1
  • Approximately 40% of infants and young children with eczema suffer from food allergy, with hen's egg, cow's milk, soya bean and wheat accounting for about 90% of allergenic foods4
  • When managing asthma it is important to identify and minimise exposure to the primary trigger as this can improve symptoms4
  • An early diagnosis followed by active management can reduce asthma costs by more than half4
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Questionnaire

How much have hospital admissions for food allergy increased by since 1990?
50%
100%
200%
500%
What proportion of UK children have a confirmed food allergy?
5%
8%
11%
15%
What 4 food allergens account for approximately 90% of allergenic foods?
Hen's egg, cow's milk, soy and wheat
Peanut, hen's egg, cow's milk and soy
Peanut, hazelnut, soy and wheat
Peanut, strawberry, cow's milk and shellfish
Check your answers
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Section 2 Dr Adam Fox

Introduces the NICE guidelines

00:00 / 00:00

Dr Adam Fox Consultant Paediatric Allergist and member of the NICE Guideline Development Group

Continue
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Summary

  • Food allergy is a major cause of allergic disease in young people1
  • The NICE guidelines clearly define the roles of primary and secondary care
  • The NICE guidelines provide a framework of assessment to allow a clear, prompt diagnosis to be reached
  • Patients can present with a wide range of symptoms including anaphylaxis, eczema, itch and GI symptoms
  • The first step in diagnosing a food allergy is to take an allergy-focused patient history
  • If IgE-mediated allergy is suspected conduct a blood test or skin-prick test*
  • If non-IgE-mediated allergy is suspected an exclusion/reintroduction diet may be considered
  • Allergy test results should be interpreted in the context of a thorough clinical history
  • Implementing the NICE guidelines should
    • Reduce the number of children on unnecessary restriction diets
    • Reduce the amount of unnecessary medication children are receiving
    • Provide a clear confirmed diagnosis
    • Lead to a prompt diagnosis, resulting in efficient use of resources
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Questionnaire

Which one element should form the foundation for diagnosing food allergy in primary care?
An allergy-focused patient history
A referral to an allergy specialist
An exclusion/reintroduction diet
Identify the two benefits likely to be gained from implementing the NICE guidelines.
Reduction in number of children on unnecessary restriction diets
Reduction in amount of medication that children are receiving unnecessarily
Increase in number of unnecessary referrals
What is required to interpret a positive allergy test?
Just the test result
An allergy-focused patient history
Report of additional allergy symptoms
Check your answers
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Section 3 Prof Aziz Shiekh

Outlines the importance of taking an allergy-focused patient history

00:00 / 00:00

Nurse Jill Shearer Practice Nurse Prescriber and Member of the NICE British National Formulary for Children Nurse Prescribers' Advisory Group

Continue
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Summary

  • Implementing the NICE guidelines will reduce the need for unnecessary referral
  • The NICE guidelines advocate a detailed clinical assessment including an in depth clinical history. The answers to questions in a few key areas will help identify if the food allergy is IgE-mediated or non-IgE-mediated:
    • Biological history: Personal and family history of allergy
    • Food type: A number of common food types are known to mediate IgE based reactions, for instance peanuts, hen's eggs, cow's milk and wheat
      • Reported symptoms: If the patient has reported a history of cardiovascular or wheezing symptoms then anaphylaxis should be considered. Respiratory symptoms can be upper (lump in throat) or lower (cough/ wheeze). Symptoms affecting the GI tract or skin can also be indicative i.e. frequent itch
      • Speed of reaction: IgE-mediated reactions are rapid in onset and in progression of symptoms
      • Exposure required for symptoms: IgE-mediated reactions can require very small quantities of exposure to initiate a reaction
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Questionnaire

Taking an allergy-focused patient history will help identify if the allergy is IgE-mediated or non-IgE-mediated
True
False
Which two of these indicates IgE-mediated food allergy?
Indicative history
Symptoms appear several hours after ingestion of food
Symptoms occur after small amounts of food are ingested
Which two of these systems are principally anaphylactic reactions?
Endocrine
Cardiovascular
Nervous
Respiratory
Check your answers
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Section 4 Dr Lee Noimark

Outlines the advantages of testing

00:00 / 00:00

Nurse Jill Shearer Practice Nurse Prescriber and Member of the NICE British National Formulary for Children Nurse Prescribers' Advisory Group

Continue
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Summary

  • The first step in diagnosing a food allergy is to take a complete clinical history, including physical examination and an allergy-focused patient history
  • Food allergy should be considered as part of the differential diagnosis in children with moderate to severe atopic eczema
  • Children with eczema may be prescribed medications which may provide some symptomatic relief but will not get to the root cause which is often food allergy
  • One third of children with eczema will have a food allergy1
  • The presence of a food allergy increases the likelihood of the development of rhinitis and asthma2
  • If the allergy-focused patient history indicates an IgE-mediated allergy, a blood test or skin-prick test* should be carried out
  • Testing is an efficient use of resources and is a good prompt for diagnosis, alleviating the root cause of symptoms without:
    • Unnecessary prescriptions
    • Repeat patient visits
    • Food avoidance
    • Referrals
  • Testing for food allergy ensures patients are on the right treatment path, an efficient use of resources
  • A successful IgE test:
    • Supports diagnosis of food allergy
    • Could reduce food challenges by 40-50%
    • Provides a baseline for future management and monitoring of the patient
    • May allow patients to eat foods they have unnecessarily avoided
  • 1 ml of blood is enough to test the main food allergens
  • Results should be read in conjunction with the history; a value of ≥0.35 kUA/L indicates a positive result
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Questionnaire

A food allergy should be considered when children with moderate to severe atopic eczema present and are experiencing worsening symptoms after eating certain foods
True
False
Which two of these can be avoided with prompt diagnosis of a food allergy?
Unnecessary prescriptions
Taking an allergy-focused patient history
Referrals
What proportion of children under 12 months presenting with moderate to severe eczema can be expected to have a food allergy?
1 / 4
1 / 3
1 /2
What volume of blood is required to test for the main food allergens?
1 ml
5 ml
10 ml
Which one of these results indicates an allergy in conjunction with a positive history?
≥0.1 kUA/L
<0.15 kUA/L
<0.25 kUA/L
Check your answers
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Section 5 David Rist

Gives some guidance on phlebotomy in children

00:00 / 00:00
Continue
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 1
Section 2
Section 3
Section 4
Section 5

Summary

  • Taking blood from children is the same basic process as taking blood from adults and there are no reasons this cannot be done on a regular basis
  • Blood should be taken from the veins of the antecubital fossa and should not be taken from the back of the hand unless really necessary
  • NICE recommends that allergy testing is performed in primary care where, due to the lack of risk for anaphylaxis, the preferred allergy test is a blood test
  • 1 ml of blood is sufficient to test for 10 allergens and, if necessary, can be obtained from a finger or heel prick
  • When taking blood from children you should think about:
    • The method you use
    • The site you choose
    • The time it will take
    • Any distractions or magic therapies
    • The positioning of the child
    • The parents role
    • The environment in which you take the sample
    • The overall patient experience
  • When taking a blood sample for allergy testing you should use a blue or orange butterfly needle with a 2 ml syringe
  • A short draw vaccutainer can also be used in children ≥12 years
  • Do not use a vaccutainer for children <12 years
  • Consider organising appointments so that all the children that you need to take blood from come in on one day
  • If you feel you need additional support or more training contact your local hospital phlebotomy team
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
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Section 1
Section 2
Section 3
Section 4
Section 5

Questionnaire

What is the correct reason for not taking blood from children in primary care?
There is no reason
There is insufficient time
It is dangerous to take blood from a child
Skin prick testing is less of a risk
Other than venepuncture, what are the available methods of obtaining the 1 ml of blood required for allergy testing?
Heel prick
Finger prick
Skin prick test
There are no other methods
Which of the answers below is the recommended method of taking blood from children <12 years?
Blue or orange butterfly needle with a 2 ml syringe
Blue or orange butterfly needle with a 4 ml syringe
Blue or orange butterfly needle with a vaccutainer
Blue or orange butterfly needle with a short draw vaccutainer
Which two answers below are recommended methods of taking blood from children ≥12 years?
Blue or orange butterfly needle with a 2 ml syringe
Blue or orange butterfly needle with a 4 ml syringe
Blue or orange butterfly needle with a vaccutainer
Blue or orange butterfly needle with a short draw vaccutainer
Check your answers
Previous
Next
Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 6 Interactive Case Studies

14-month-old boy with swelling of the lips and hives following food. Mother is worried about a possible allergy. 

Section 6 Interactive Case Studies

Take an allergy-focused patient history

Personal/ Family history:

5-year-old brother with asthma and allergy to pet birds

Patient also has patchy eczema


Age of onset of symptoms:

13 months


Food type:

Patient's reaction tends to occur following solid foods. There is no apparent reaction from formula milk. The patient has reacted three times to small amounts of different meals. The first reaction was to homemade cupcakes. The second reaction was to a traditional vanilla ice cream. The third reaction was to a small amount of tomato bread.


Upon further investigation all three food sources contained cow's milk and egg. Mother was unable to recall any previous exposure to egg, however, she was able to recall repeated exposures to milk.


Reported symptoms:

Immediate swelling of lips

Hives on the face


Speed of reaction:

Within one to two minutes

Section 6 Interactive Case Studies

Refer to Allergist

NICE recommends only specific types of patients should be referred to an allergist.

This is following an allergy focussed patient history.

See summary from Professor Aziz Sheikh on AIM

Section 6 Interactive Case Studies

Test for allergens

Based on the clinical history above, please select the most appropriate allergen

Based on the clinical history, the most appropriate allergen is hen’s egg. Although all three food sources contain cow’s milk and hen’s egg, there have been no symptoms with milk exposure.

Section 6 Interactive Case Studies

Consider exclusion diet

NICE recommend exclusion diets should only be started with a dietitian following the
receipt of positive test results.

Section 6 Interactive Case Studies

Specific IgE test

Results:

A positive result is indicated by a value ≥0.1 kUA/L
While waiting for results, consult with a dietitian and provide the parent with advice on excluding suspected allergen1.43 kUA/L

Diagnose egg allergy and then, depending on what is recommended in your practice, provide mother with a written allergy management plan or consult a GP.
In either case egg should be removed from the child’s diet and a consultation with a dietitian should be arranged.

Click here to download the case study

Section 6 Interactive Case Studies

Skin prick test (SPT)

NICE recommends skin prick tests should only be performed by trained, competent
clinical staff, in a clinical environment with sufficient clinical support and facilities to
manage anaphylaxis.
Do you have these facilities?

Section 6 Interactive Case Studies

Yes

Results:
Negative control0 mm
Hen's egg7 mm

Diagnose egg allergy and then, depending on what is recommended in your practice, provide mother with a written allergy management plan or consult a GP. In either case egg should be removed from the child's and a consultation with a dietitian should be arranged.

Click here to download the case study

Section 6 Interactive Case Studies

No

NICE recommends skin prick tests should only be performed by trained, competent clinical staff, in a clinical environment with
sufficient clinical support and facilities to manage anaphylaxis.

Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.
Exit CPD
Save Progress

Please enter your email address below and we'll send you a link which you can use to access the CPD module from the current section. We will not use your email for anything else.

Section 7 Interactive Case Studies

7-month-old girl presents with a rash around the mouth and vomiting after formula milk. Mother is in the
process of stopping breast feeding.
Mother is worried about a possible allergy.

Section 7 Interactive Case Studies

Take an allergy-focused patient history

Personal/ Family history:
Paternal cousin is allergic to dogs and mother has hay fever
Age of onset of symptoms:
7 months
Has had one episode of acute otitis media
Food type:
Mother reports that she is in the process of stopping breast feeding. Patient has reacted
twice following approximately half a 6 oz bottle of formula milk.
Mother is also concerned about egg as following the consumption of a small bowl of
scrambled egg the patient has very loose stools.
Reported symptoms:
Rash around mouth
Vomiting
Loose stools
Speed of reaction:
Within three minutes for vomiting
On next bowel movement, normally less than one hour

Section 7 Interactive Case Studies

Refer to Allergist

NICE recommends only specific types of patients should be referred to allergist.
This is following an allergy focussed patient history.
See summary from Professor Aziz Sheikh on AIM.

Section 7 Interactive Case Studies

Test for allergens

Based on the clinical history above, please select the two most appropriate allergens

Based on the clinical history, the most appropriate allergen is cow’s milk. The history of egg exposure does not sound typical of egg allergy, therefore it is not appropriate to test. However, as the patient may need to go on to soya milk it is also wise to test for sensitivity to soya.

Section 7 Interactive Case Studies

Consider exclusion diet

NICE recommend exclusion diets should only be started with a dietitian following the receipt of positive test results.

Section 7 Interactive Case Studies

Specific IgE test

Results A positive result is indicated by a value ≥0.1 kUA/L While waiting for results, consult with a dietitian and provide the parent with advice on excluding the suspected allergens

Cow’s milk 2.4 kUA/L

Soya bean <0.1 kUA/L

Diagnose milk allergy and then, depending on what is recommended in your practice, provide mother with a written allergy management plan or consult a GP. In either case the milk should be removed from the child’s diet and a consultation with a dietitian should be arranged.

Click here to download the case study

Section 7 Interactive Case Studies

Skin prick test (SPT)

NICE recommends skin prick tests should only be performed by trained, competent clinical staff, in a clinical environment with sufficient clinical support and facilities to manage anaphylaxis. Do you have these facilities?

Section 7 Interactive Case Studies

Yes

Results

Negative control 0 mm

Cow’s milk 8 mm

Soya bean 0 mm

Diagnose milk allergy and then, depending on what is recommended in your practice, provide mother with a written allergy management plan or consult a GP. In either case the milk should be removed from the child’s diet and a consultation with a dietitian should be arranged.

Click here to download the case study

Section 7 Interactive Case Studies

No

NICE recommends skin prick tests should only be performed by trained, competent clinical staff, in a clinical environment with sufficient clinical support and facilities to manage anaphylaxis.

Select section

Select a section you would like to start from below:

Section 1
  • Nurse Jill Shearer
  • The Burden of Food Allergy
Section 2
  • Dr Adam Fox
  • Introduces the NICE guidelines
Section 3
  • Prof Aziz Shiekh
  • Outlines the importance of taking an allergy-focused patient history
Section 4
  • Dr Lee Noimark
  • Outlines the advantages of testing
Section 5
  • David Rist
  • Gives some guidance on phlebotomy in children
Section 6
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Section 7
  • Interactive Case Studies
  • On how you would manage patients from initial consultation to eventual diagnosis
Close
Start FULL CPD course
References
  1. Allergy UK. Allergy statistics. Available here; last accessed November 2013.
  2. Hadley C. EMBO Rep 2006; 7(11): 1080-1083.
  3. House of Commons Health Committee. The Provision of Allergy Services 2003-3004. Available here; last accessed November 2013.
  4. Pawankar (Ed) et al. White book on allergy, 2011; World Allergy Organisation UK.