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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)

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

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

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

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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

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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

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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

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Resources

• NHSGIntranet• AnaphylaxisCampaign(anaphylaxis.org.uk)• BritishSocietyofAllergyandClinicalImmunology(bsaci.org)• AllergyUK(www.allergyuk.org)