The launch of the 6th National Audit Project - BSACI

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The launch of the 6th National Audit Project - BSACI
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
The launch of the 6th National Audit Project - BSACI
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
The launch of the 6th National Audit Project - BSACI
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
The launch of the 6th National Audit Project - BSACI
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
The launch of the 6th National Audit Project - BSACI
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

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                                                                                                             5
The launch of the 6th National Audit Project - BSACI
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
The launch of the 6th National Audit Project - BSACI
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
The launch of the 6th National Audit Project - BSACI
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
The launch of the 6th National Audit Project - BSACI
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
The launch of the 6th National Audit Project - BSACI
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

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