NICE (national institute for health and clinical excellence) publishes new allergy guidance for children and young people
One of the most frequently encountered health problems in our nursery age children is providing care for children in nursery with allergy. We take great care to ensure children do not come into contact with foods they are allergic to, and our nursery staff are trained to provide emergency care for children who have allergic reactions.
NICE is a UK government organization, founded in 2004, whose aim is to bring together knowledge and guidance on ways of promoting good health and treating ill health. NICE provides the principles for helping people make healthier and more informed choices about their health. The new guidelines are intended to provide consistency in the way that food allergies are diagnosed by NHS health professionals.
Once NICE guidance is published, health professionals (and the organisations who employ them) are expected to take it fully into account when deciding what treatments to give people.
However, NICE guidance does not replace the knowledge and skills of individual health professionals who treat patients. It is still up to the health professionals to make decisions about a particular patient in consultation with the patient and/or their parent, guardian or carer when appropriate.
On 23rd February 2011 NICE published the first evidence-based guideline on the diagnosis and assessment of food allergy in children and young people. The guidance is designed to support GPs, nurses, healthcare professionals working in community/General Practices and patients. It gives clear recommendations on the diagnosis and assessment of children and young people with suspected food allergy. It warns against the use of some alternative and high street testing.
The new guidance to general practitioners (GPs) is to help them more effectively diagnose and treat childhood food allergies. Parents who suspect that their child is suffering from an allergy have complained that it is sometimes difficult to get their GP to take the matter seriously and that GPs do not always recommend effective treatments. They contain detailed guidance on the steps to follow when making a diagnosis and how to decide whether a child should be offered allergy testing.
The NICE guidelines state that there are currently only two effective methods of diagnosing food allergies: skin prick tests and immunoglobulin blood tests, ( RAST) both of which require a qualified medical doctor to administer. NICE hopes that the guidelines will help GPs diagnose food allergies more quickly and that National Health Service (NHS) treatments can, in future, be conducted without long waiting times for specialist appointments.
It is estimated that 5 per cent of children suffer from some form of food allergy but the cause of the rise in reported cases is unknown.
Hospital admissions in the UK for food allergies have increased five-fold since 1990.
In addition, a fifth of children who report an allergy also wrongly self-report diagnoses and avoid eating certain foods as a result, but do not have a confirmed diagnosis.
The guideline advises GPs to take an allergy-focused clinical history if allergy is suspected, including a physical examination. Diagnosis may include skin prick and/or blood tests for immunoglobulin antibodies, which can suggest particular allergic reactions.
The new guidelines also warn against the use of “alternative” test kits, available online and in some shops. NICE says there is little evidence that these work, some can leave children at risk of malnutrition from restricted diets, and that they are a waste of time and money.
Specialist help, from a paediatrician or paediatric allergist, should be considered if the child has ongoing problems including faltering growth or failure to thrive, vomiting, abdominal pain, loose or frequent stools, or constipation, in combination with other gastro intestinal symptoms.
what else does NICE advise for children with allergies?
The advice covers children and young people up to the age of 19 who have symptoms or signs that could suggest a food allergy. It also focuses on children and young people who have conditions that put them at greater risk of developing a food allergy, such as asthma or eczema. They may also have a parent, brother or sister with a food allergy or allergy-related condition.
The advice sets out a detailed “care pathway” for health professionals to follow when dealing with a possible food allergy. A food allergy should be considered as a possibility if a child has one or more of the following signs and symptoms:
- skin conditions, such as rash or eczema
- digestive problems, such as nausea or constipation
- respiratory complaints, such as shortness of breath or sneezing
- anaphylaxis, a rare and severe hyper-reaction
Food allergies should also be considered in children who have not responded to treatment for atopic eczema or certain digestive symptoms such as chronic constipation.
how do the new guidelines affect my child or me?
The guidelines also say that care for children with suspected food allergies should be "patient-centred" and that children, their parents and carers should be involved in discussions and make decisions about their care. For example:
- When a food allergy is suspected, health professionals should give parents adequate information about food allergies. If possible, the child should also be able to understand this information.
- Health professionals should always explain the tests for food allergy, covering the possible benefits and risks, and talk to parents and children about which test they would prefer.
- Parents and children should also be offered advice about how to start an elimination diet if appropriate, including information about food labelling, how to ensure they still have a healthy diet, and with consideration of whether their culture or religion affects the foods a child can or cannot eat. Families should be offered support from a dietitian if needed.
- Parents and children should also be given information about where to get support, including how to contact support groups.
where can I get more information?
NICE has produced information for parents and carers about the new guidelines:
National Institute for Health and Clinical Excellence. NICE advises against alternative testing for food allergy in children (press release) February 2011
National Institute for Health and Clinical Excellence. Food allergy in children and young people. February 2011
