a gp and parent perspective on paediatric allergy the problema gp and parent perspective on...

11/10/16 1 A GP and Parent Perspective on Paediatric Allergy Dr Karen Barker The problem • Allergic disorders are becoming increasingly common in the UK, with serious and life threatening allergies on the increase (Burton 2009). • Allergies currently affect an estimated 30% of all children in Scotland (SMASAC 2009). • Allergic disorders account for more than 4% of GP consultations and 1.5% of hospital admissions (Anandan et al 2009). • Food is the most common trigger for anaphylactic reactions in children ( Akeson et al 2007). Most childhood allergies are not anaphylactic. Our Story • Anaphylaxis at 4.5 months to CMP • Psychological impact • Allergy focused history (vomiting baby, eczema from 6 weeks) • Family history 1st degree hayfever, feathers,asthma, 2 nd degree eczema, drug anaphylaxis • Three AAAs (Avoidance, Antihistamine, Adrenaline)

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11/10/16

A GP and Parent Perspective on Paediatric Allergy

Dr Karen Barker

Theproblem• AllergicdisordersarebecomingincreasinglycommonintheUK,withseriousandlifethreateningallergiesontheincrease(Burton2009).

• Allergiescurrentlyaffectanestimated30%ofallchildreninScotland(SMASAC2009).

• Allergicdisordersaccountformorethan4%ofGPconsultationsand1.5%ofhospitaladmissions(Anandan etal2009).

• Foodisthemostcommontriggerforanaphylacticreactionsinchildren(Akeson etal2007).Mostchildhoodallergiesarenotanaphylactic.

OurStory

• Anaphylaxisat4.5monthstoCMP• Psychologicalimpact• Allergyfocusedhistory(vomitingbaby,eczemafrom6weeks)• Familyhistory1stdegreehayfever,feathers,asthma,2nddegreeeczema,druganaphylaxis• ThreeAAAs(Avoidance,Antihistamine,Adrenaline)

Page 2: A GP and Parent Perspective on Paediatric Allergy The problemA GP and Parent Perspective on Paediatric Allergy Dr Karen Barker The problem • Allergic disorders are becoming increasingly

11/10/16

Howachildmightdescribeareactiontoafoodallergen…• Thisfoodistoospicy•Mytongueishot(orburning)• Itfeelslikesomethingispokingmytongue•Mytongue(ormouth)istingling(orburning)•Mytongueormouthaches

•Mytonguefeelslikethereisahaironit•Mymouthfeelsfunny• There’safroginmythroat• There’ssomethingstuckinmythroat•Mylipsfeelstight

Howachildmightdescribeareactiontoafoodallergen…•Mytonguefeelsfull(orheavy)• Itfeelsliketherearebugsinmyears•Mythroatfeelsthick• Itfeelslikethereisabumpinthebackofmytongue(throat)

Page 3: A GP and Parent Perspective on Paediatric Allergy The problemA GP and Parent Perspective on Paediatric Allergy Dr Karen Barker The problem • Allergic disorders are becoming increasingly

11/10/16

Impactonfamilylife• Foodiscentraltoourlives• Restrictionstokeepwell• Psychologicalimpacttraumaofsevereallergicreaction•Weaning• Shopping• Siblings• Socialeventseg parties• Eatingout• Nursery/school• Activities• Selfconfidence

Whichfoods?

• Allergicreactionstofoodusuallystartinearlychildhood• Topoffenders

• Cow’smilk(2- 2.5%ofallchildren)• Egg• Soya• Peanuts(1in50)• Treenuts• Gluten

• Fish• Molluscs• Crustaceans• Celery• Lupin• Sesame• Mustard• Sulphites

Page 4: A GP and Parent Perspective on Paediatric Allergy The problemA GP and Parent Perspective on Paediatric Allergy Dr Karen Barker The problem • Allergic disorders are becoming increasingly

11/10/16

Management

• MultipleHospitalvisits–explanation• Skinpricktests,IgE specificbloodtests• Daycasefoodchallenges• SchoolagegrownoutofCMPAandmajorityofreactiontoegg,residualnut• Selfawareness

Whathelpedintheallergyjourney?

• Dietetics• Specialistallergynurse• Healthvisitor• Communitypharmacist• FriendsandFamily• Ourgirl

ChallengesinGeneralPractice

• Commonpresentation• Resources• Lackofeducation• Selfdiagnosis• Patientexpectation“wantatest”• Allergyclinicwaitingtimes

Page 5: A GP and Parent Perspective on Paediatric Allergy The problemA GP and Parent Perspective on Paediatric Allergy Dr Karen Barker The problem • Allergic disorders are becoming increasingly

11/10/16

Improvingallergycareinpractice

• Audit• Allergymanagementguidelineforvision• Demoautoinjectors andcareplans• Educationalsessions- RCGP,localschool,GPs,PPG• Mailshot• Annotationofchildrens notesregardingweight• Regularmeetingschildhealthnurse

Pharmacyperspective

• Medicationreviews- repeats,dosages,overdueprescriptions• Indicationsthatpatientswithallergymayhavesuboptimalcontrolofasthma• Holisticinprescribing,daytodayandtravelling• Informingpatientsofexpectedsideeffects• Labellingsmallerbottlesforantihistamine• MHRAapprovalforlegislationchangeforprovisionofgenericautoinjectors