The launch of the 6th National Audit Project - BSACI
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Summer 2018 Issue 31 through education, training and research The launch of the 6th National Audit Project Anaesthesia, Surgery and Life-Threatening Allergic Reactions Page 4 Editor’s choice Spare pens in schools Personal allergic march Page 6 Page 7 Page 12
FOR HEALTHCARE PROFESSIONAL USE ONLY Breastfeeding is best for babies THE FIRST AND ONLY EHF TO CONTAIN GOS/FOS‡ PREBIOTICS Aptamil Aptamil Pepti Pepti Clinically proven to REDUCE allergic manifestations for up to five years1–3 the step step in the effective management of cows’ milk allergy is extensively hydrolysed formula† † For the management of mild to moderate cows’ milk allergy, the iMAP guideline 4 recommends an Extensively Hydrolysed Formula (EHF) as the first step for formula feeding or mixed feeding (if symptoms only with introduction of top-up feeds) infants. ‡ Galacto-oligosaccharides and fructo-oligosaccharides. References: 1. Arslanoglu S et al. Early dietary intervention with a mixture of prebiotic oligosaccharides reduces the incidence of allergic manifestations and infections during the fi rst two years of life. J Nutr. 2008;138:1091-5. 2. Arslanoglu S et al. Early neutral prebiotic oligosaccharide supplementation reduces the incidence of some allergic manifestations in the fi rst 5 years of life. J Biol Regul Homeost Agents. 2012;26:49-59. 3. Pampura AN et al. Ros Vestn Perinatol Paediat 2014;4:96-104. 4..Venter C et al , 2017. Better recognition, diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy: iMAP-an international interpretation of the MAP (Milk Allergy in Primary Care) guideline. Clin Transl Allergy. August, vol. 7, no. 26. IMPORTANT NOTICE: Aptamil Pepti 1 & 2 are foods for special medical purposes for the dietary management of cows’ milk allergy. They should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Aptamil Pepti 1 is suitable for use as the sole source of nutrition for infants from birth, and/or as 18-044 (GOS/FOS)/Date of Prep: March 2018 part of a balanced diet from 6-12 months. Aptamil Pepti 2 is suitable for babies over 6 months as part of a mixed diet. © Danone Nutricia Early Life Nutrition 2018 Healthcare Professional Helpline: 0800 996 1234 www.eln.nutricia.co.uk/cma
Editorial Allergy update Welcome to Issue 31! Contents Anaesthesia, surgery and Team based at Hull & East life-threatening allergic Yorkshire and we also, for the first reactions 4 time, have an Regional Allergy Network spotlight on Dr Rubaiyat Message from the President 5 Haque’s Guy’s Regional Allergy Happy retirement, Chris! 6 Network (GRAN) - please do get in touch if you wish to feature your Spare pens in schools 7 regional network in Allergy Update. Regional Allergy Service It is also with great delight spotlight 9 that Allergy Educator, Associate Professor Jude Holloway, has Award winners 10 written an article on Allergy Dr Tak Chin, (Editor) Education. Our Allergy Registrars, My personal allergic march 12 Consultant Allergist, Dr Shalini Chandel & Dr Erika National Allergy Registrar Southampton General Hospital Harnik also report on Allergy training day and National Registrar training days this year. allergy SpR training day Plus, we wish Professor Chris reports 13 In this issue, our feature is the Corrigan a very happy retirement report on the Royal College of and highlight his significant Committee & Group updates 14 Anaesthetists’ 6th National Audit contributions to the Specialty of Project: Perioperative Anaphylaxis Guy’s Regional Allergy Network Allergy and give congratulations to (NAP6) summarised by Professor the winners of this year’s awards (GRAN) 18 Nigel Harper. (Professor Hannah Gould, Dr Dr Paul Turner and Dr Gary Claudia Gore and Professor Graham BSACI staff Stiefel report on the new Roberts). Chief Executive: legislation on spare pens in Also please find enclosed Fiona Rayner schools. election papers for the posts of fiona@bsaci.org Our Allergy Service spotlight BSACI Secretary and BSACI Council Clinical Guidelines this issue is Dr Bryan Fernandes’s Member. & Research Co-ordinator: Maryam Shayeghi maryam@bsaci.org Contributions should be e-mailed to: Finance & Administration Officer: tak_chin@hotmail.com Ethlyn Johnson-Bellot ethlyn@bsaci.org Editor Elected Council Members Membership Officer Dr Tak Chin Dr Nicola Brathwaite Gill Cotton Dr William Egner gill@bsaci.org Feature Editor Ms Roisin Fitzsimons Training & Education Dr Shelley Dua Dr Elizabeth Griffiths Coordinator: Layout Dr Nicola Jay Marie Gibbs INQ Design Ltd 020 737 5775 Dr Tom Marrs marie@bsaci.org (Deputy Meetings Secretary) Managing Editor, Clinical & BSACI President Dr Mohamed Shamji Experimental Allergy: Dr Shuaib Nasser Catherine Hyland President Elect Ex-Officio Members catherine@bsaci.org Dr Adam Fox Dr Andrew Clark Secretary Dr Pamela Ewan BSACI Dr Stephen Till Dr Adam Fox Studio 16, Cloisters House Dr Tariq El-Shanawany 8 Battersea Park Road Treasurer Professor Syed Hasan Arshad Dr Susan Leech London SW8 4BG Dr Helen Howells Editor of Clinical & Ms Kathryn Powrie E-mail: info@bsaci.org Experimental Allergy Tel: 0207 501 3910 Prof Graham Roberts Co-opted Members Fax: 0207 627 2599 Meetings Secretary Professor Chris Corrigan Website: www.bsaci.org Dr Guy Scadding Dr Erika Harnik Ms Hannah Hunter Registered charity no: 1069199 3
Feature Allergy update Anaesthesia, surgery and life-threatening allergic reactions perioperative anaphylaxis. The NAP6 Professor Panel included BSACI representation. Nigel Harper Guidelines published by BSACI, NICE, NAP6 Clinical Resuscitation Council (UK) and Lead, Honorary Association of Anaesthetists of Great • UK anaesthetic workload, Consultant Britain and Ireland (AAGBI) were patient demographics anaesthetist, used. The project comprised a case- and anaesthetic Manchester reporting phase and several surveys. techniques. University NHS • Exposure to potentially- Foundation Trust NAP6 main case-reporting phase allergenic drugs and • Local co-ordinator anaesthetists other substances in every NHS hospital reported during the perioperative The report of the Royal College of anonymised cases over a period, providing Anaesthetists’ 6th National Audit one-year period, including the denominator data for Project: Perioperative Anaphylaxis information provided to the incidence estimation. was launched in May 2018. anaesthetist by allergy clinics. • Anaesthetists’ perceptions A panel of anaesthetists, of perioperative anaphylaxis allergists, clinical immunologists NAP6 surveys and avoidance behaviours. and patient groups audited the • Services provided by UK clinical management, investigation specialist adult and paediatric Of the 541 cases submitted, 266 and outcomes of life-threatening allergy clinics. had complete data and were analysed. Shortfalls in immediate management, investigational Key findings from case-reports in relation to investigation pathways and reporting were • Adherence to existing guidelines is poor and confirms deficiencies identified and recommendations in service availability, capacity, harmonisation of investigation and made. Ten patients died and adverse reporting. outcomes were not uncommon. The • The average wait time before being seen in allergy clinic was 101 anaphylaxis rate for teicoplanin was days. (range 0–450 days). Only 39 (16%) were seen within the ideal higher than for any other antibiotic six weeks and 7% waited longer than six months. or any muscle relaxant. Patent Blue dye had the second highest rate. • Waiting times for urgent referrals were not shorter than for Chlorhexidine accounted for almost non-urgent referrals. 10% of cases. Reporting to MHRA • Mast-cell tryptases (MCTs): was extremely poor. – at least three MCT samples were available in 67% of cases, two in There is space in this article 19% and one in 8% only to present some key findings – 45% of early samples met BSACI guidance for ‘immediate’ in relation to investigation (see sampling, panel): the full report, including – earlier samples gave higher MCT levels which rapidly fell within clinical management, outcomes, 30 minutes epidemiology, reporting, – MCT level did not correlate with severity of clinical features recommendations and resources – the dynamic-tryptase algorithm [(baseline tryptase x1.2) for allergy clinics, as well as results +2 mcg/L] was found useful for detecting mediator release of the surveys can be accessed via especially when peak tryptase was within the reference trance the home page of the new BSACI and increased yield by 16%. website www.bsaci.org.uk • Clinic investigations adhered fully to AAGBI guidance in 32% and The author would like to thank to BSACI guidance in 17%; most non-adherence was through failing everyone who completed the to test for all potential culprit agents and poor communication. surveys, the Local Co-ordinators, the NAP6 Panel and NAP6 • All potential culprit agents had been adequately investigated in Moderator for freely giving their only 27%. time, and the NAP6 team at the • 10% of assessments were good, 49% good and poor, 41% poor. Royal College of Anaesthetists which funded the project. 4
President’s message Allergy update Message from the President is also an election for the new and provides a reliable protocol to Junior Members’ representative desensitise appropriate patients. I as Erika Harnik will be rotating hope to be able to follow up with off later this year. Two election new sections on the website to papers are enclosed in this edition support our members practicing for Secretary and Council member food allergy, urticaria, eczema and and I would encourage interested immunotherapy. Over the coming members to consider applying in months, these sections will come order to contribute to the future on-stream. success of your Society. Finally, BSACI members who BSACI co-badged the Dubai wish to join EAACI can now do so Dr Shuaib Nasser Allergy Society which took place at a reduced membership rate of President, BSACI on the 5th/6th April 2018. Many 30 euros via a joint scheme that of the speakers were from the is available via the BSACI website. UK and I have heard that this was This constitutes a considerable a successful meeting with many saving on the full membership price attendees. BSACI supported this and allows access to EAACI journals BSACI Council has a number of new meeting as allergy is in its infancy and to the member rate for most members. Kathryn Powrie is the in the Middle East and we hope EAACI meetings except for the new chair of the Nurses Committee to cultivate a relationship that annual congress. and Helen Howells has taken over will allow the growth of allergy from Joanne Walsh as chair of the education and practice in that part Primary Care Committee. Council of the world. welcomes back Sue Leech who BSACI have launched the new was elected BSACI treasurer at the Drug Allergy section on the website. AGM last year. Stephen Till has The section contains resources completed his three year term as supporting our members in their Secretary and there will be four drug allergy practice. There is also further vacancies on Council as a drug desensitisation calculator current members rotate off. There which safely removes the arithmetic Fast Publication Times – Submit your article today! Clinical & Experimental Allergy Free to BSACI members Impact Impact The Official Journal Factor Factor of the British Society for 5.587 5.264 Allergy & Clinical Immunology wileyonlinelibrary.com/CEA 5
Editor’s choice Allergy update Happy retirement Chris – we shall miss you! Not many people know that Professor Corrigan obtained his BA in Physiological Sciences at Oxford with the highest first class honours in his year, the start of a star-studded career in science over 40 years. Having completed his PhD with Barry Kay at the National Heart and Lung Institute, their partnership led the way in demonstrating the role of T cell activation and Th2 cytokines in asthma, key observations that took 20 years to evolve into the current avalanche of novel biologics that successfully target the Th2 pathway in severe therapy-resistant asthma. His other achievements include landmark studies on steroid- resistant asthma, the role of innate epithelial-derived cytokines in asthma and, with Hannah Gould, the role of IgE in non-atopic set up a formative Knowledge-based asthma. He has demonstrated the “Chris is not only gifted in role of allergoids (modified allergen Assessment that Allergy SpRs take vaccines) as effective, shorter, science, he is a stunning in their final years of training. more convenient strategies of musicologist and an Chris is not only gifted in science, immunotherapy for hay fever. extraordinary stand-up he is a stunning musicologist and an Chris has supported the specialty comic.” extraordinary stand-up comic - as of Allergy in so many ways. At Guy’s we all know from his after-dinner hospital, having followed on from performances at BSACI annual a highly successful Adult Allergy Tak Lee, he has led and developed meetings! He is dedicated to his Service and Severe Asthma and wife Annie and their two boys, Allergen Immunotherapy clinics. Jonathan and Philip, who have Within BSACI, he is a former Hon. Secretary, a longstanding Council provided him amazing support over Member and has contributed as the years. We recently celebrated Scientific Meetings Organiser and with Chris over Annie’s receipt of Editor of Clinical Reviews, the her Alphege Award from Archbishop companion journal of Clinical and Justin Welby, the Archbishop of Experimental Allergy. He has been Canterbury. Chris is also a very keen honoured by receiving both the naturalist and birdwatcher – so we BSACI William Frankland Award need not worry about his being at a for Clinical Excellence in Allergy loose end during his retirement! and the Jack Pepys Award for his The society and your many outstanding contribution to allergy friends congratulate you on a life- research. He is best known and time of service to our specialty and appreciated by our allergy trainees on a great job, well done. We wish as the Chair of the Specialist Advisory Committee on Allergy of you, Annie and your family a very the Royal College of Physicians and happy and enjoyable time for the as Training Programme Director future. and Lead for the Specialist Training Committee for the London and South Professor Stephen Durham East Deanery. With Dr Alex Croom he and Dr Stephen Till 6
News Allergy update Spare pens in schools Dr Paul Turner Honorary consultant in paediatric allergy and immunology, Imperial College London Dr Gary Stiefel Consultant in paediatric allergy, NHS Leicester From October 2017, schools have been able to purchase, without prescription, adrenaline (Amendment) (No. 2) Regulations autoinjectors (AAIs) for use in the emergency treatment of 2017 now provides an exemption to “This project had significant anaphylaxis. This follows a change school staff with regards to ‘spare’ support from parents of AAI, and was the culmination of in legislation (similar to that in children with allergies, USA and Australia) to improve the over 2 years’ work by a working group representing BSACI, RCPCH, teachers and healthcare management of food-allergic school Allergy UK and the Anaphylaxis professionals, which resulted children. The rationale for this change Campaign. This project had in significant support from was simple: 1 in 5 cases of fatal significant support from parents the Department of Health anaphylaxis in children occur in of children with allergies, teachers in making the case for a schools. AAIs may be left at home and healthcare professionals, which resulted in significant support from change in legislation (a common problem in secondary the Department of Health in making to MHRA and the schools), used incorrectly or misfire, or perhaps be out of date. The the case for a change in legislation Minister of Health.” schools’ ‘spare’ back-up AAIs would to MHRA and the Minister of Health. therefore offer an additional safety The ‘spare’ AAI(s) are in addition parental approvals are in place on net, as well as opportunities to to any AAI devices a pupil might that child’s care plan. improve education and guidance for be prescribed and bring to school, The BSACI emergency action schools about food allergy. something still required by MHRA. plans have been updated to provide The new legislation was needed However, ‘spare’ AAI devices can a single page document which because AAIs were previously be used in any pupil known to meets the requirements of the new prescription-only medicines, so be at risk of anaphylaxis so long legislation, and can be downloaded legally an AAI could only be used as there is medical approval and written authorization from parents. via the BSACI website or at for the person it was prescribed to (with the exception of healthcare Importantly, this includes those www.sparepensinschools.uk, a professionals, the law does not children with a diagnosed IgE- new website funded by DoH to allow someone to administer an mediated food allergy who have provide a one-stop resource for AAI belonging to person A to not been prescribed an AAI, so long school staff, parents, school pupils person B). The Human Medicines as the appropriate medical and and healthcare professionals alike. 7
2 es de on lin ui ed l G lud na nc io w i E PTE CC a t No D BY • A N BY • A 1 D CC E PTE fluticasone propionate/ azelastine hydrochloride Mild Moderate/Severe More effective AH INS than FP or AZ at treating Rx entire rhinitis failure spectrum3 Check use, concordance, dose Combination Rx with INS and INAH Rx Onset of action failure 30 minutes in clinical Check use, concordance, dose practice4 Watery rhinorrhea Itch/sneeze/ Catarrh Blockage, Add (briefly) IN Add ipratropium extra-nasal itch/rash switch to Add LTRA if asthmatic decongestant non-sedating oral anti-H1 Rx Inflammatory rhinitis, Infection/structural problem, Course of OC, Surgical referral failure continue local Rx Efficacy confirmed in Consider immunotherapy real life5 if Rx predominantly due to one allergen Algorithm shows treatment pathway for allergic rhinitis, adapted from Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017;47:856-889 Abbreviations: FP - fluticasone propionate, AZ - azelastine, AH - antihistamine, INS - intranasal corticosteroid, INAH - intranasal antihistamine, LTRA - leukotriene receptor antagonist, IN - intranasal, OC - oral corticosteroids References: 1. https://www.scottishmedicines.org.uk/General/Homepage_Search_ 3. Meltzer E et al. Clinically relevant effect of a new intranasal therapy (MP29- allergic rhinitis: A randomized, double-blind, placebo-controlled trial of Results?q=dymista&Submit=Search 02) in allergic rhinitis assessed by responder analysis. Int Arch Allergy efficacy and safety. Allergy Asthma Proc 2012;33(4): 324–32. 2. Scadding GK,Kariyawasam HH,Scadding G,et al. BSACI guideline for the diagnosis Immunol 2013;161(4):369–77. 5. Klimek L et al. Effectiveness of MP29-02 for the treatment of allergic rhinitis and management of allergic and non-allergic rhinitis (Revised Edition 2017; 4. Meltzer E et al. MP29-02 (a novel intranasal formulation of azelastine in real-life: Results from a noninterventional study. Allergy Asthma Proc First edition 2007).Clin Exp Allergy. 2017;47:856-889. hydrochloride and fluticasone propionate) in the treatment of seasonal 2015;36:40–47. Dymista® Nasal Spray, Suspension (azelastine hydrochloride/fluticasone Dymista®. In patients with infections, recent surgery or injury to nose or mouth, weigh propionate) Prescribing Information benefits against risks of use. Contains benzalkonium chloride. Experience of use in Adverse events should be reported. Reporting forms and information pregnancy and lactation is limited. Dymista® should only be used if the potential can be found at www.mhra.gov.uk/yellowcard. Adverse events should Presentation: Nasal spray suspension. Each gram of suspension contains 1000 benefit justifies the potential risk. Dymista® has minor influence on ability to drive and also be reported to Mylan by phone: 0800 121 8267 or by email: micrograms of azelastine hydrochloride and 365 micrograms of fluticasone use machines. Undesirable Effects: Epistaxis, headache, dysgeusia, unpleasant ukpharmacovigilance@mylan.com propionate. Indications: Relief of symptoms of moderate to severe seasonal and smell, hypersensitivity reactions including anaphylactic reactions, angioedema, perennial allergic rhinitis if treatment with intranasal antihistamine or glucocorticoid bronchospasm, glaucoma, increased intraocular pressure, cataract, blurred vision, alone is not considered sufficient. Dosage and administration: Adults and septal perforation, nasal irritation, throat irritation, nausea, dizziness, sleepiness, adolescents (12 years and older): One actuation into each nostril twice daily. Children fatigue, rash, dry mouth, growth retardation may be possible in adolescents Meda Pharma GmbH, a Mylan company below 12 years: not recommended as safety and efficacy has not been established receiving prolonged treatment and growth should be monitored regularly. Consult DYM-2018-0210 Date of preparation: May 2018 in this age group. Contra-indications: Hypersensitivity to azelastine hydrochloride the Summary of Product Characteristics for other side effects. Package Quantities or fluticasone propionate or any of the other ingredients in this medicine. Warnings and Basic Price (UK): £14.80 for 23g bottle. Each spray (0.14 g) contains 137 and precautions: Avoid concomitant use with ritonavir. Systemic effects of nasal mcg of azelastine hydrochloride and 50 mcg of fluticasone propionate. Legal corticosteroids may occur. Systemic exposure in severe liver disease may be category: POM. Product Licence Holder: Meda Pharmaceuticals Ltd, Skyway increased. Dymista® may result in clinically significant adrenal suppression. Patients House, Parsonage Road, Takeley, Bishops Stortford CM22 6PU. Tel 0845 460 0000. may experience blurred vision or other visual disturbances. Monitor patients who Marketing Authorisation Number: PL 15142/0258. Date of preparation of experience changes in vision or have a history of ocular pressure, glaucoma and/ prescribing information: Nov 2017 or cataract. If adrenal function is impaired, take care when changing medication to UK/DYM/17/REF-28715
News Allergy services spotlight Allergy update Hull & East Yorkshire allergy service The East Yorkshire Regional Adult Immunology and Allergy Unit started out at the former Kingston General Hospital in 1986 with the arrival of Dr Philip Dore, Consultant Immunologist, followed by Jackie Moor Clinical Nurse Specialist, in 2001. The Unit is currently based at Castle Hill Hospital in Cottingham, and provides diagnostic and therapeutic allergy and immunology services for patients over 16 years from a wide geographical area including Hull, East and North Yorkshire, and North and East Lincolnshire, covering an extended population of around 1.2 million. The Unit is registered with the IQAS and Above: Front row: Dr Bryan Fernandes, QPIDS accreditation schemes. It Sarah Sholtysek, Rebecca Avison, Nada sees patients referred from primary Al-Muhandis, Jackie Moor. Back row: Beverley Fish, Pavels Gordins. Left: Rebecca Avison and secondary care with suspected performing intradermal testing drug, inhalant, venom and food allergen related conditions, as well as primary and secondary subcutaneous venom and pollen immunodeficiency. It also supports immunotherapy, and 35 receiving the Paediatric Immunology Service sublingual immunotherapy. The and Sheffield working together to where complex immunological department offers Omalizumab treatment for patients with severe develop standardised protocols and conditions are managed. The guidelines, conduct multi-centre Paediatric Allergy Department urticaria. The drug allergy clinic sees audits and organise educational is based at Hull Royal Infirmary complex patients referred for sessions for trainees. The Unit has managed by a Paediatrician suspected antibiotic, general and close links with Hull York Medical with a special interest in Allergy, local anaesthetic, analgesic and School. and supported by Paediatric latex allergy. Comprehensive allergy Rebecca Avison and Beverley Immunology nurses. tests are performed including skin Fish, Immunology and Allergy The team consists of one prick and intradermal testing, oral Specialist Nurses feel the Consultant in Allergy, one Consultant food and drug challenges, as well greatest successes have been in Immunology and Allergy, four Specialist Immunology and as drug desensitisation therapies offering the modified rush venom Allergy Nurses, one Healthcare and monthly patch testing clinics. immunotherapy regimen, as well Assistant and a Specialty Trainee The team meets fortnightly for as the range of preparations in Immunology. There are nine discussion of challenging cases. tailoring immunotherapy to those Consultant-led clinical sessions and The clinical diagnosis of allergic presenting with troublesome pollen one nurse-led allergy assessment and immunological conditions is allergy. Jackie Moor, Clinical Nurse session weekly. The Department supported by a highly specialised Specialist, has worked within the sees around 600 new general UKAS accredited Immunology service for 17 years and during this allergy, 150 new drug allergy and 100 Laboratory based at Hull Royal time has witnessed many changes new immunology patients per year. Infirmary. and challenges. She is proud to The nurse-led allergy clinic provides The Unit collaborates closely be part of such an enthusiastic initial assessment, investigations with the Dermatology and team of clinicians and nurses and management advice, seeing Gastroenterology Teams, and runs a who have worked hard to develop around 350 new allergy patients regular Respiratory multidisciplinary highly specialised services for both per year. Along with this, the nurse- meeting. It forms part of the immunology and allergy patients. led immunotherapy clinics review wider Trent Regional Allergy patients receiving subcutaneous and and Immunology Consortium Dr Bryan Fernandes sublingual immunotherapies. There (TRIAC) network with centres in Consultant Allergist at Hull and are around 80 patients receiving Scunthorpe, Leicester, Nottingham East Yorkshire Hospitals NHS Trust 9
Awards Allergy update Jack Pepys Lecturer Professor Professor Hannah Gould started her career in science as an undergraduate at Hannah Gould Radcliffe College, which was then the women’s part of Harvard. She graduated Professor of Cell in Biochemistry, and followed on to earn her MSc at Radcliffe and PhD at and Molecular Harvard with Paul Doty. The title of her PhD thesis was The Antigenicity of Biophysics Polypeptides. It was a time when the field of protein synthesis was emerging in King’s College an exciting way, and so she moved to London to work at the National Institute London for Medical Research on the structure of ribosomes and translation of globin mRNA. After a further year at University College London, continuing this work, and imperial College, changing to work on chromatin structure, she settled at King’s College London. Hannah carried on with her chromatin studies until the breakthrough of recombinant DNA technology. Returning to her interest in immunology, she made the critical decision to clone and express the human IgE epsilon heavy chain gene cDNA. This led to her research on the structure, function, and regulation of IgE and allergy, her continuing passion. William Frankland Award Dr Claudia Gore Dr Claudia Gore graduated in Germany 1995. Her MD (res) was awarded in 1996, Consultant in in Germany. She undertook her medical and specialist training from 1996 to Paediatric Allergy 2009 in the United Kingdom, with time out for a PhD in paediatric allergy. She and Immunology, has been a consultant since 2009, and is currently a consultant in paediatric Imperial College allergy and immunology at St Mary’s Hospital/Imperial College Healthcare Healthcare NHS NHS Trust. Trust St Mary’s As clinical lead for paediatric and adolescent allergy she has build and Hospital expanded the paediatric & adolescent allergy services in North West London together with her dedicated and passionate multidisciplinatry team. Claudia and her team, have built the most comprehensive, holistic ambulatory care service for children and adolescents with complex multisystem allergic disease and severe atopic eczema in the UK and are now one of the leading UK centres. Research and publication areas include probiotics and the gut microbiota in infant eczema, quality of life in allergic diseases, nutrition in allergic disease, allergen avoidance measures, impact of severe disease on adolescent patients and families. Harry Morrow Brown Award Professor Graham Roberts describes himself as a translational epidemiologist. He has been Graham Roberts involved in many of the landmark prevention trials in the last decade. Firstly, Professor of the 18 year follow-up of the Isle of Wight prevention trial that confirmed the Paediatric Allergy potential long-term impact of early life interventions. Secondly, the Mite Allergy and Respiratory Prevention Study demonstrating proof of the principle for using sublingual house Medicine at dust mite to prevent allergic sensitisation in early life. Lastly, the Learning Early University of About Peanut (LEAP) study which has re-shaped the international weaning Southampton, recommendations. These interventional studies have emerged from longitudinal Director of the epidemiological data. With Isle of Wight colleagues, he has just completed the 26 David Hide Asthma year follow up of the 1989 Birth cohort. With colleagues from across the UK, he is and Allergy recruiting a new birth cohort to investigate pre-school wheeze. Finally, Professor Research Centre Roberts has developed a research programme directed at understanding adolescents in order to assist healthcare professionals for a better management of this age group. Professor Roberts has been Editor-in-Chief of Clinical and Experimental Allergy for the last few years. He has overseen its successful transition into an online format. 10
Annual Meeting 2017 Allergy update bsaci The British Society for Allergy and Clinical Immunology Annual Meeting September 30th – October 2nd 2018 Telford International Centre UK For further information regarding the programme, registration and ongoing updates pleases visit: www.bsacimeeting.org Facebook “ f ” Logo CMYK / .eps Facebook “ f ” Logo CMYK / .eps #BSACI 11
Education Allergy update My personal allergic march or the Postgraduate Certificate, for genetic recombination on and upgrade to a Postgraduate a familiar background (patient Professor Diploma and finally the MSc itself. clinical cases), allows my students Judith Holloway This stepwise approach allows to access a subject that can feel Associate you to choose the modules that incomprehensible to them. Our Professor, most interests you and to tailor innovative curriculum is designed Programme the course to your needs. We also to promote students’ confidence Leader MSc offer full-time, and part-time study and familiarity in all areas of Allergy, University options, so you can take the course allergy, giving them a holistic of Southampton at the speed that suits you best. At understanding of the whole disease Southampton, we have trained over process, so improving their ability 250 students and currently have to make a complete and informed 56 allergy postgraduates studying appraisal of the treatment options My passion to influence the world with us. They come from across all for their patients. of allergy education stems from corners of the UK, Europe and the I was recently awarded the huge my own battle with allergies, world. honour of becoming a National my personal allergic march that Our modules are the building Teaching Fellow of the Higher started with severe eczema in blocks that can be used to make Education Academy in recognition infancy, and has nearly ended up whichever award you choose. for my work to inspire and educate a couple of times with severe A range of choices cover the more a new generation of allergy experts. anaphylaxis. My lifelong experience traditional aspects of clinical allergy I took over as Programme Leader as a patient with allergies that (such as Food Allergy, Eczema, of the MSc Allergy in Southampton affect both mine and my family’s Urticaria and Anaphylaxis, and in 2008 and since then, we have quality of life, has driven my Allergic Airways Disease), while been awarded the accolade of passion to be involved in research innovative modules allow you to World Allergy Organization Centres and education in allergy. I give drive your learning, such as our of Excellence, and been accredited my students the knowledge and Work Based Learning module where by the BSACI and recognised by skills to enable them to save lives students have developed innovative EAACI. and improve quality of life for patient education material, new Our students acknowledge thousands of people living with referral guidelines, staff training the impact of their learning at allergy worldwide. My vision is to days and more. The Dissertation Southampton. deliver a fit-for-purpose course module completes the MSc itself, Dr Carina Venter completed that prepares students to be the and over the years our students her PG Diploma Allergy with us future allergy leaders nationally have done some amazing projects in 2003. She said: “It is thanks to and internationally, improving that have really contributed to my training at Southampton that health care provision through clinical practice their ability to cascade education in all aspects of MSc Allergy students at Southampton learn practical skills to their institutions, colleagues, allergy. Look out including skin prick testing and inhaler techniques and are taught patients and their families. for our students how to assess the workforce for competency The unmet need for trained who regularly allergy professionals and leaders is present their work greater than ever, and postgraduate at the annual BSACI courses, such as our MSc Allergy conference. at the University of Southampton, I am passionate are an excellent way to obtain the about creating specialist knowledge and skills authentic, fit-for- required. One of the challenges of purpose learning choosing to combine working with experiences. Framing postgraduate study, is to find the a difficult subject right course for you that fulfils your such as immunology career needs and aspirations, and is using memorable flexible enough to give you choice. analogies like An MSc might feel like a very big ‘Bisto gravy’ for commitment, so at Southampton chemokines, ‘pick you can start on single modules, ‘n’ mix sweets’ 12
Education Allergy update BSACI SpR Training I am a world-leading dietitian in the field of allergic diseases, with over 100 publications to my name... I would suggest the University of Southampton to any medical Day professional who wish to enhance their career in allergy and increase The Allergy Department , The training day was their knowledge.” University Hospital Southampton, well attended by 13 trainees Dr Adam Fox completed his PG successfully hosted the BSACI in total - 6 Adult Allergy, 6 Diploma Allergy in 2004 and is Allergy Registrar training day on Paediatric Allergy trainees and 1 Consultant Children’s Allergist and 19th February 2018 . Immunology trainee. Clinical Lead Director of the very The venue was The Cherbourg The feedback received was successful Allergy Academy. He meeting room in the Southampton said: “I was very impressed with positive with all the trainees Novotel Hotel. This was carefully thoroughly enjoying the day. the University of Southampton. chosen keeping in mind the There are excellent networking They felt that the faculty convenience for delegates understood the needs of the opportunities. The University attending from all over the provides students with an excellent trainees faced by the speakers, country, given its proximity to grounding in the immunology and being able to change the focus the Southampton central railway clinical aspects of allergy from a of the lectures. The trainee station. world class faculty coupled with feedback also reflected on the This was well appreciated as was unrivalled support from course fact that the training day met evident from the trainee feedback. leaders.” their expectations. The teaching was organised Have I inspired you to find out For future BSACI training more about studying allergy as a on topics selected for various aspects of food allergy. These were days, there is a suggestion for a postgraduate student? As well as complex allergy case discussion my MSc Allergy at the University Food allergy in children, Inducing tolerance in Food Allergy, Food session, which would be useful of Southampton, there are other allergy – from a Dietary perspective, for all trainees. courses around the UK offering slightly different opportunities In vitro testing in T cell mediated for students, including the MSc drug allergy, Oral Food Challenge Dr Shalini Chandel Allergy at Imperial College, the (OFC) standards and Eosinophilic Allergy Registrar (ST5), MSc Immunology and Allergy at oesophagitis overview and update. University Hospital Southampton the University of Nottingham and the online Postgraduate Certificate in Clinical and Health Sciences with Allergy offered by Newcastle Joint RSM and BSACI University. Allergy SpR Training Day Links MSc Allergy, University of This February the Clinical Allergy discussion. Polly James shared Southampton and Immunology Section of the her experiences as one of the www.southampton.ac.uk/allergy, RSM and BSACI joined for a national only dedicated paediatric allergy follow us on twitter @mscallergy, allergy SpR training day. The focus psychologists in the country twitter.com/mscallergy of the day was the controversies while Tabi Leslie, spoke on itch, MSc Allergy, Imperial College in allergy and the juxtaposition of a symptom we all recognise https://www.imperial.ac.uk/study/pg/ the paediatric and adult allergy as difficult and frustrating medicine/allergy/ approach to certain disorders to treat. The day ended with MSc Immunology and Allergy, such as food allergy, urticaria and Lauri-Ann Van Der Poel and University of Nottingham angioedema. Our keynote speaker Chris Rutkowski talking about https://www.nottingham.ac.uk/ was visiting professor Jörg Kleine- the myths and potential pitfalls pgstudy/courses/molecular-medical- Tebbe, who spoke on advanced in managing drug allergy and sciences/immunology-and-allergy- test interpretation of component urticaria. The day was well msc.aspx resolved diagnostics. attended and the feedback was PGCert Clinical and Health Sciences Isabel Skypala continued with incredibly positive. with Allergy, Newcastle University https://www.ncl.ac.uk/postgraduate/ this theme and described the use courses/degrees/clinical-health- of CRDs in influencing the dietary Dr Erika Harnik sciences-allergy-pgcert/#profile intake in patients with food allergy Paediatric Allergy registrar, with both talks generating a lot of Royal London Hospital 13
Committee and Group News Allergy update Paediatric Group News Dr Adam Fox of constructive Consultant collaboration. Paediatric Whilst work Allergist and continues on the Deputy Medical Code of Conduct Director at Guys for the interaction and St Thomas’ between Healthcare Hospital. Chair Professionals and of the BSACI Industry in regard Paediatric Group to Products in Paediatrics Clinical Nutrition as well Since my last update, the as the Paediatric committee has continued to work Immunotherapy hard. I am particularly grateful to Registry, there has Dr Paul Turner for his continued also been focus on work around the successful change the concerns around deprescribing and we recently received a positive in legislation to allow schools to of hypoallergenic milk formulas. response from Jacquie Cornish, hold their own auto-injectors. The This has been raised by numerous National Clinical Director, Children, new Spare Pens in Schools website CCGs as part of consultations to Young People and Transition to (www.sparepensinschools.uk) reduce pharmacy spends. The Adulthood at NHSE to say this is has now successfully launched BSACI worked successfully in now on their agenda so we are and is looking great. It is very collaboration with Allergy UK and hoping for a more centralised comprehensive and has dedicated BDA (British Dietetic Association) response. areas for all the stakeholders with to prevent this from happening, This will be my last update, as a helpful focus on myth-busting. through lobbying and press I will be handing over the chair to It is endorsed not only by BSACI, attention, in Croydon but other Dr Mich Lajuenesse. I would like to but also the Department of Health, CCGs have since been raising this. wish him all the best for his term. RCPCH and the allergy charities We have lobbied RCPCH, who have and also to thank the committee and is an excellent example joined us in raising this with NHSE for all their efforts and support. Primary Care Committee update primary care group on the BSACI website so that interested GP’s recent activities: and primary care professionals can • We continue to recruit more directly reach out to someone local. GP’s with an interest in allergy We have upcoming allergy to our group training days with the Royal College • Allergy training days have Dr Helen Howells of General Practioners where several been arranged in London and GP, Southampton of our members are teaching. We Birmingham in the next few Chair of the Primary had an allergy stream at the PRIME months Care Committee conference in May, which was chaired • Further work planned to by us. As well as these, many more update the primary care section of BSACI webpage local training sessions continue to We have recruited several more educate those within primary care. GP’s from across the country to our We hope to work with Allergy UK issued with adrenaline autoinjectors. primary care group within BSACI. this year to provide all primary care Further updates are planned for the We have been using our What’s app surgeries with training packs for primary care webpage within BSACI. group to communicate regularly adrenaline autoinjectors. We hope Interested parties can contact us and keep each other up to date. this may combat the lack of training via Marie Gibbs at BSACI – Marie@ Work has begun to map out our given to patients when they are bsaci.org 14
Committee and Group News Allergy update Adult Allergy Group cover most of allergy services in allergy services. This was discussed England. at the national CRG special meeting, Professor Details of the networks can held at the Telford Conference Centre Hasan Arshad be found at the BSACI website during the annual meeting of the Allergy with a tab “Adult allergy network” British Society of Allergy & Clinical Consultant, under “Professionals”. The site Southampton Immunology. This information is is populated with information on General Hospital, required for future NHSE specialist existing allergy networks. There is Chair of the Adult commissioning and clinic coding. an option to contact each network Allergy Group Allergy CRG members will continue to for further information or to seek patient information leaflets/SOPS raise this matter at the CRG meetings. for local adaption. I am still looking for a successor. Adult allergy group is now in its 4th No further progress has been So if you are an allergist and have the year. The group has organised itself made with regards to the revision of enthusiasm and organisational skills through various regional allergy the criteria to define specialist versus to lead the group, please do contact networks. These networks now non-specialist case workload in our me through the BSACI. Food Allergy Specialist Group of the BDA once or twice a year. Many FASG dietitians have a high level of recent activities: Ms Tanya Wright expertise in the care of children and • We have collaborated with Dietitian, adults with food allergies. the BSACI PAG to produce Oxfordshire. Our members are also actively a guidance document for Dietetic Council involved in research projects within parents and healthcare Representative the field of food allergy presenting professionals for BSACI, this work in publications and at • Four new free resources are Member of national and international allergy now available FASG conferences. They are also active in the BSACI, EAACI, AAAAI and formula to extensively hydrolysed INDANA and FASG members are formula and home reintroduction chair of the Allied Healthcare We have collaborated with the guides for non-IgE mediated allergy Working Group, EAACI Executive BSACI PAG to produce a guidance to egg, soya and wheat. Committee, INDANA chair for US document for parents and We have also been focussing on and Europe. This work contributes healthcare professionals on “Allergy social media, in particular our Twitter significantly to the development prevention in infants at higher risk of practical approaches to the presence. Our followers are growing of food allergy”. This is under the diagnosis and management of in numbers every day (now almost final stages of review and will be food allergy. We have regular 400) and our regular tweets make available shortly. communications with our group 10-20,000 impressions per month. Four new resources are now members where we share allergy available free to all BDA member news, research, and educational Tanya has now stepped down as dietitians: home reintroduction events as well as allergy product FASG Representative on Council. of egg/ wheat/ soya for non-IgE information and queries about BSACI would like to thank Tanya for allergy, stepping down from amino complex cases. all her contributions. acid feeds. Further resources are During the last year, with Twitter: @BDA_FASG under final review: food-dependent the support of a grant from the Email: mary.feeney@kcl.ac.uk exercise-induced anaphylaxis and Anaphylaxis Campaign and the (FASG Secretary) three diet sheets for eosinophilic BDA, we have completed three oesophagitis. projects on complementary feeding Next FASG Food Allergy day: Our group has over 325 in infants at higher risk of allergy, 2nd July 2018 at St Mary’s members and holds meetings stepping down from amino acid Hospital, London 15
Committee and Group News Allergy update Clinical Immunology Committee The 6th National Audit Project on Perioperative Anaphylaxis recent activities: Dr Tariq (NAP6) received input and data • Subcommittee reviewed the El-Shanawany analysis from Bill Egner, member Consensus Document on 22q11 Consultant of the subcommittee. NAP6 was deletion syndrome Clinical launched at the Royal College • The 6th National Audit Project Immunologist, of Anaesthetists on 14th May, on Perioperative Anaphylaxis University and included presentations (NAP6) received input and Hospital, Wales, from anaesthetists, allergists, data analysis from Bill Egner, Cardiff immunologists and patient member of the subcommittee representatives. At the 2018 BSACI Annual the Immunology community and The subcommittee reviewed the Meeting there will be a joint encourage membership of the Consensus Document on 22q11 session with the British Society BSACI. Further information on the deletion syndrome by the Max of Immunology on Urticaria, Subcommittee’s activities can be Appeal with regards to co-badging angioedema and auto-inflammation. found at www.bsaci.org/about/ the document with the BSACI. We continue to engage with clinical-immunology. National Allergy Strategy Group down of Stephen McPartland MP election. Parliamentary activity and are very pleased to announce continues with a recent Westminster that Jon Cruddas MP has taken Hall debate on the subject of over as chair of the group. Jon Allergy Awareness in Schools and Ms Mandy East is a long-term supporter of our continuing Parliamentary Questions. National Allergy Strategy work along with his wife Anna, We are also pleased to report we Group (NASG) Baroness Healy of Primrose will be meeting with NHS England Parliamentary Hill and another long-term in May to discuss how to work Officer supporter of improvements to together on the recommendations allergy services Baroness Finlay in our forthcoming report. of Llandaff. In addition, we have For more information and to sign The NASG has recently reformed welcomed back Jo Swinson MP up for regular updates email mandy@ the All Party Parliamentary Group following her successful return nasguk.org or visit www.nasguk.org for Allergy following the stepping to the House in the last general We also tweet @AllergyCampaign Standards of Care Committee (SOCC) update we would value the membership’s Shayeghi, we have submitted our feedback on this document. updated guideline writing manual Dr Andrew Clark The Eczema guideline, led by to NICE for consideration of re- Chair of SOCC, Dr Helen Brough, is off the ground, accreditation. They are currently Consultant in Paediatric Allergy, with writing group meetings being assessing our compliance with their Addenbrooke’s organized and an assessment of the recommendations, so we hope for Hospital, literature is in progress. Questions good news soon. Cambridge for a pre-guideline national audit We will be meeting soon to are being prepared. finalise the primary care Adrenaline Prof Angela Simpson is leading Auto-Injector Guidline with our Three guidelines are currently being the Allergen Avoidance Guideline, and primary care colleagues. prepared. The Local Anaesthetic the writing group is being assembled We continue to support the Allergy guideline is about to be for their first planning meeting. nurses group, reviewing SOPs sent out for BSACI consultation and With a lot of help from Maryam before publication. 16
Committee and Group News Allergy update Nurses Specialising in Allergy Following on from the results of the AAI audit presented at the BSACI we are looking at adapting Ms Kathryn the BSACI children’s Powrie anaphylaxis action Chair of the plans for adults to BSACI Nurses provide continuity for Committee those transitioning into adult services and to support We have recently welcomed Jill and encourage Edmonds, senior immunology nurse professionals in both primary and professionals/nurses-specialising- specialist from Manchester onto secondary care who prescribe AAI’s in-allergies has resources for you to provide training for patients. to use, including competencies the committee and will be updating The group represents all aspects for staff training and SOP’s. We our webpage with short biographies of allergy nursing and we are welcome your ideas, questions and from each member. looking at issues around transition. comments and our e-mail group Continuing our work highlighting allows you to network with all the To begin with we would like to know allergy in nursing journals we have what arrangements are already in nurses in the UK who are BSACI recently published an article on the place for children reaching the point members in order to share ideas identification and management of of transition and plan to circulate or ask questions. If you would like drug allergy in the Nursing Standard a short questionnaire asking about an enquiry sent out to the group with further ones planned for your service. or have something you would their ‘How to’ series on the use of Our webpage, available via the like to share please send it to: adrenaline autoinjectors. BSACI website www.bsaci.org/ bsacinurses@gmail.com Junior Members Report with keynote speaker, Professor Jörg Kleine-Tebbe, flying in from recent activities: Berlin to speak on molecular • New BSACI national SpR diagnostics. training programme 2019 – Dr Erika Harnik The next training days will be on 2021 Junior Members’ paediatric allergy and transitional • Promoting allergy in medical Representative medicine at Imperial College schools Paediatric Allergy London in September and venom • Applications for a new Junior registrar, Royal allergy at the Royal Brompton Members Representative are London Hospital Hospital in November. We have also welcome finalised the training programme for 2019 – 2021 – in response to at the BSACI annual meeting this The excellent BSACI teaching trainee feedback we have included programme for allergy trainees year – please share with them your basic immunology and are asking has continued into this year, with experiences of working in allergy. facilitators to include more a study day in Southampton Sadly my time as junior paediatric allergy in the timetable. focusing on food allergy, with topics members’ representative will be We are continuing to focus on including tolerance induction, raising the profile of allergy as a coming to an end this autumn. An eosinophilic oesophagitis and career and have been in touch with email inviting applications for a dietary management. We were medical schools across the country new representative has been sent. fortunate to have an extra study to promote the specialty. As a result Please contact me if you would like day this year, held in conjunction we are hoping to welcome a larger any information about the post - with the Royal Society of Medicine, number of undergraduate delegates juniormembers@bsaci.org 17
Regional allergy networks Allergy update Guy’s Regional Allergy Network (GRAN) long term, attempt to deliver this. Expectations included education, research collaboration, assistance in service development, achieving Dr Rubaiyat accreditation, protocol sharing, Haque clinical fellowships and defining Consultant referral pathways. Allergist, Guys We currently have 46 individual and St Thomas’, members from across the country London – from the south coast, across to Cardiff and all the way up to East Yorkshire. We purposely did not limit On 22nd March, we held the the catchment area of membership to local geographic region (the inaugural meeting of the Guy’s ‘regional’ in our name was more Regional Allergy Network (GRAN) about producing a pleasing • London (GSTT, Brompton, at Guy’s Hospital in London. Setting acronym). Anybody happy to attend Homerton, KCL, Lewisham, up GRAN was the culmination of the occasional meeting in London is Luton, Medway & UCL) work that had been undertaken welcome to join. • Brighton for the BSACI Adult Allergy Group, Things have been a little quiet • Epsom/St Helier looking into the current state of since that first meeting – the day- • Southampton regional allergy networks in the UK. to-day challenges of clinical life • Cardiff Ten such networks were identified. leave little time to devote to such • Cambridge Many were informal with infrequent projects. However, we have some • Hull/East Yorkshire meetings. Some were well- exciting meetings planned for 2018. • Mid-Essex established and currently active. Topics to be covered will include • Manchester GRAN was devised to explore ‘Challenges of allergy accreditation’ • Salford what people really wanted from and ‘The future of allergy training in • Oxford an allergy network and, over the the UK’. General Data Key dates for your diaries.... Protection Regulation The countdown to the BSACI 2018 Meeting 2018 has begun! In preparation, we wanted to share with you some important deadlines You may be aware that a major change to data protection law came into force on so you don’t miss out! 25 May 2018. The General Data Protection Regulation (GDPR) which Late Breaking Abstract Submission affects all organisations and significantly Deadline 5pm on Monday 25th June tightens the processes when handling, storing and managing personal data. Applications for BSACI Travel Fellowships Monday 23rd July BSACI has drafted a Privacy Policy to help you understand what data we Early Bird Deadline collect, why we collect it and what we do with it. We hope you will take time to read Tuesday 31st July this on our website at www.bsaci.org. As always should you have any questions Should you have any questions regarding regarding any aspect of the meeting, please this please contact us at info@bsaci.org email the team at bsaci@medivents.co.uk 18
You can also read