Case Number 6602
Request Date 05/03/2019
Completion Date 01/04/2019

 

Details of the Request

The survey takes 30-45 minutes to complete. Please note the instructions to omit sections that don't apply to your paediatric allergy service. The expectation is that you will be able to answer the questions without having to seek additional information about your service.

In places, we ask you to prove an estimate for your response - absolute precision is not necessary.

 

Details of the Response

Paediatric allergy services

Q1) What level of paediatric allergy service are you providing?

Secondary only

 

Q2) What is the name of the trust you are responding on behalf of?

Ashford & St Peter’s Hospitals NHS Foundation Trust

 

Q3) Does your trust, provide paediatric allergy services in more than one hospital?

Yes

 

Q4) Please write the name of each hospital where paediatric allergy services are provided by your trust:

Ashford Hospital, Ashford, Surrey
St Peter’s Hospital, Chertsey, Surrey
Paediatric allergy services in primary care

 

Q5) Have you established paediatric allergy services in primary care?

No special link established

 

Medical Staffing

Q6) Which medical staff undertake clinics in your trust where paediatric allergy patients are seen?

Consultant General Paediatricians with a subspeciality interest (≥50% of time with paediatric allergy patients)

 

Associate Specialists

Q7) If your paediatric allergy service includes Consultant General Paediatricians with a subspeciality interest: What are the subspeciality interests of the Consultant General Paediatricians with a subspeciality interest involved in seeing paediatric allergy patients

Allergy & Respiratory Interest
Allergy Interest

 

Q8) If your paediatric allergy service includes Consultant Subspecialist Paediatricians:What are the subspeciality interests of the Consultant Paediatric Subspecialists involved in seeing paediatric allergy patients

N/A

 

Q9) What formal allergy training have consultants contributing to the service had?

MSc in Allergy:
2 out of 3

Other allergy training / experience:
1 out of 3

If other allergy training and/or experience:
Participating in respiratory and allergy clinics for many years in tertiary centres

 

Q10) Do you have a designated lead for your Paediatric Allergy Service?

Yes

 

Q11) How many consultants contribute to seeing paediatric allergy patients?

Consultants (number of individuals) = 3

Total (for all consultants) number of Whole Time Equivalents (WTE) of 2.4 time providing services to paediatric allergy patients = 50%

 

Q12) Do all consultant staff working in your paediatric allergy service have a minimum of 2 PA's in their job plan designated for paediatric allergy?

Yes

 

Q13) Are the staff involved in seeing paediatric allergy patients members of the BSACI?

3 out of 3

 

Junior Medical Staffing

Q14) Do specialist registrars and/or clinical research fellows regularly attend the clinics where paediatric allergy patients are seen?

Yes - they see patients independently

 

Nursing Staffing

Q15) How many nurses contribute to looking after paediatric allergy patients?

Nurses (number of nurses) = 4

 

Total (for all nurses) number of Whole Time Equivalents (WTE) of time providing services to paediatric allergy patients

This is a joint service with respiratory and 1.7 wte nurses look after both services

 

Q16) What band are the nurse/s who contribute to seeing paediatric patients?

Number who are Band 5 = 2

Number who are Band 6 = 1

Number who are Band 7 = 1

 

Q18) If you have any Band 8 nursing staff: What role do your Band 8 nursing staff hold?

N/A

 

Q19) Allergy training of the nurse/s in the paediatric allergy service

Some nurse/s have had formal training in allergy = Yes

All Skin prick test assessed and competency done

AAI training done

 

Q20) Do nursing staff undertake independent nurse led clinics seeing paediatric allergy patients?

Yes

 

Q21) If nursing staff are undertaking independent nurse led clinics: In independent nurse led clinics, what kinds of paediatric allergy patients are seen?

Follow up paediatric allergy appointments

Paediatric allergy patients referred to the nurse led clinic for allergy testing or training

 

Dietician support

Q22) How much dietician support does your paediatric allergy service have?

Dietician present at some paediatric allergy clinics and also have 1 general clinic where allergy patients can be referred into

 

Q23) How much dietician time do you think your paediatric allergy service has specifically for paediatric allergy patients? (in Whole Time Equivalents)

0.2 WTE but not adequate present amount as more clinics without dietician

 

Q24) Do dieticians undertake independent dietician led clinics seeing new paediatric allergy referrals?

Yes see note in Q22. There are also 4 slots per week available for seeing new paediatric allergy referrals by a paediatric allergy dietician

 

Paediatric Allergy Clinics

Q25) In what kind of clinic are paediatric allergy patients seen?

In general paediatric clinics amongst other paediatric patients = mostly

In clinics with exclusively paediatric allergy patients = occasionally

 

Q26) Approximately how many clinics does your paediatric allergy service undertake per week?

General clinics where paediatric allergy patients are seen amongst other paediatric patients? = 3

Paediatric allergy clinics with exclusively paediatric allergy patients = 5

 

Q27) Approximately what proportion (%) of the general paediatric clinic consultations, on average, would you say relate to paediatric allergy problems? (please give a percentage as an estimate)

30%

 

Q28) Approximately how many paediatric allergy patients does your service undertake outpatient consultations for per week?

New Outpatient appointments each week = 15

Follow Up appointments each week = 30

 

Q29) What is your best estimate of the waiting time for paediatric allergy patients new and follow up appointments?

New Outpatient appointment waiting time (months) = 2-3

Follow Up appointment waiting time (months) = 15-18

 

Joint Clinics

Q30) Does your paediatric allergy service undertake any joint clinics i.e. paediatric allergy with another speciality?

No

 

Q31) If your paediatric allergy service offers joint clinics: What joint clinics does your paediatric allergy service offer?

N/A

 

Paediatric Allergy Clinic Configuration

Q32) When do the clinics occur when paediatric allergy patients are seen?

Morning
Afternoon

 

Q33) For the relevant clinics: How long are the outpatient clinics in which paediatric allergy patients are seen?

Morning clinic (answer in hours please) = 3

Afternoon clinic (answer in hours please) = 4

 

Paediatric Allergy Consultation Duration

Q34) How long is the average appointment time for a NEW paediatric allergy consultation? (please answer in minutes)

New patient appointment duration with the Consultant = 30 min

New patient appointment duration with the Associate Specialist = 30 min

New patient appointment duration with the Allergy Nurse Specialist = 30 min

Average new patient appointment duration with the Specialist Registrar = 30 min

Average new patient appointment duration with the Dietician = 15 min

 

Q35) How long is the average appointment time for a FOLLOW UP paediatric allergy consultation? (please answer in minutes)

Follow up appointment duration with the Consultant = 20-30 min

Follow up appointment duration with the Associate Specialist = 20-30 min

Follow up appointment duration with the Allergy Nurse Specialist = 20-30 min

Follow up appointment duration with the Specialist Registrar = 20-30 min

Follow up appointment duration with the Dietician = 15 min

 

Q36) If you undertake morning paediatric allergy clinics: Please describe how your service templates general clinics where paediatric allergy patients are seen amongst other paediatric patient?

Morning clinic: Number of new patients = 2

Morning clinic: Number of follow up patients = 6

Afternoon clinic: Number of new patients = 3

Afternoon clinic: Number of follow up patients = 3-4

 

Q37) If you undertake afternoon paediatric allergy clinics: Please describe how your service templates clinics seeing exclusively paediatric allergy patients?

Morning clinic: Number of new patients = 2

Morning clinic: Number of follow up patients = 6

Afternoon clinic: Number of new patients = 3

Afternoon clinic: Number of follow up patients = 3-4

 

Q38) How is a paediatric allergy outpatient appointment in your paediatric allergy service coded?

As 317 Allergy

 

Q39) Do you know, even if only approximately, what your trust is reimbursed per patient for the paediatric allergy services it provides?

Yes

 

Q40) If known: How much does your trust get reimbursed for the following paediatric allergy services?

New patient consultation (£) = 373

Follow up consultation (£) = 373

Day case attendance (£)

 

Allergy Investigations

Q41) What diagnostic tests are offered in your paediatric allergy service? (please choose all that apply)

  • Blood tests (specific IgE/RAST tests)
  • Skin Prick tests
  • Component resolved diagnostic tests
  • ISAC ImmunoCAP test
  • Spirometry

 

Skin Prick Testing

Q42) Are skin prick tests usually undertaken on the same day or in a separate clinic on a different day?

Same day = Both

Different day = Both

 

Q43) Who regularly performs skin tests at your clinic

Nurse

 

Q44) Do you have resuscitation facilities immediately available for skin tests?

Yes

 

Q45) What do you undertake skin prick testing to?

  • Foods - commercial skin prick test solutions
  • Foods - using fresh whole foods
  • Aeroallergens
  • Latex

 

Q46) Which commercial skin prick solutions do you use?

  • Immunotek
  • Diagenics (Allergopharma)
  • Lofarma

 

Q47) If you use whole foods for testing: Which whole foods to you use for skin prick testing?

  • Tahini (sesame)
  • Fresh cow's milk
  • Raw egg white
  • Other food brought in by the patient
  • Nuts

 

If Nuts, please state which All as needed and judged safe and walnut

 

Q48) If you are using whole foods for testing: For the foods that you are using for skin prick testing, do you use them alone (instead of the commercial solution), or as well as the commercial solution

Variable

  • Sesame - mostly prick to prick
  • Fresh cow's milk and solution
  • Raw egg white and solution
  • Nuts if entered in Q47 Ground walnut

 

Q49) How does your service measure skin prick test wheal size?

Largest diameter of the wheal

 

Q50) Do you deduct the size of the negative control from the allergen responses, if the negative control response is positive?

Yes

 

Q51) What do you consider a positive skin prick test response to an allergen?

≥ 3 mm diameter

Yes

 

Any positive response

Is still taken into account

 

Q52) Do you include the diameter of psuedopods when measuring the largest diameter?

No

 

Q53) Do you have a threshold that the histamine positive control has to exceed to consider it valid and hence the tests to be interpretable?

Yes

 

If yes, what size does the histamine response have to be greater or equal to in millimetres?

2mm

 

Intradermal tests

N/A

 

Component testing

Q55) What do you undertake component testing to?

  • Peanut components = yes
  • Hazelnut components = yes
  • Birch components (Bet v1 and homologues) = occasionally
  • Other components = Casein and ovomucoid

 

Q56) If you undertake peanut component testing: Who do you measure peanut components on?

Specific children

 

Please describe what criteria determine who you chose to measure peanut components on

Suspicion of associated sensitisation to pollens

 

Q57) If you undertake peanut component testing: Which peanut components do you routinely measure, if you chose to measure them?

  • ara h1
  • ara h2
  • ara h3
  • ara h8
  • ara h9

 

Q58) If you undertake hazelnut component testing: Who do you measure hazelnut components on?

Specific children

 

Please describe what criteria determine who you chose to measure hazelnut components on

Associated sensitisation to air allergens

 

Q59) If you undertake hazelnut component testing: Which hazelnut components do you routinely measure, if you chose to measure them?

  • cor a1
  • cor a8
  • cor a9
  • cor a14

 

Challenge tests

Q60) Are food and/or drug challenges offered at your service?

Yes

 

Drug challenges

Q61) Who performs drug challenge tests at your clinic

  • Consultant
  • Associate specialist
  • Specialist registrar
  • Allergy Nurse specialist

 

Q62) What classes of drugs do you offer challenges to?

  • Analgesics - paracetamol
  • Analgesics - NSAIDs
  • Antibiotics - IV
  • Antibiotics – oral

 

Food challenges

Q63) What type of food challenges do you undertake?

  • Open food challenges
  • Supervised feeds
  • Blinded food challenges - only occasionally

 

Q64) Do you stratify your open food challenges into high risk and standard risk challenges?

Yes

 

Q65) Where do you undertake your challenges?

Paediatric day ward

 

Q66) Do you have resuscitation facilities immediately available for challenges?

Yes

 

Challenge service configuration

Q67) On average, how many challenges do you undertake per week in your service?

6-10

 

Q68) How many challenges are undertaken in one session?

6

 

Q69) How do you configure the challenges that are done in one session? 6 beds available, 6 challenges start at the same time

Please describe how this number of challenges is configured: all arrive at same time? Or staggered - please describe as per the example above.

 

Q70) How many challenges are supervised by each individual nurse or doctor?

  • Open food challenges = 2
  • Open food challenges - high risk = 1
  • Supervised feeds = 3

 

Q71) If some challenges are designated high risk: How does the challenge configuration differ for challenges designated high risk, compared to low/standard risk? Please explain

Use of 7 step challenge and increased observation

 

Challenge test staffing

Q72) Who performs food challenge tests at your service (please choose all that apply)

  • Consultant
  • Associate specialist
  • Specialist registrar
  • Allergy Nurse specialist
  • Paediatric Nurse

 

Q73) Does your service undertake nurse led challenges?

No

 

Q74) Is any specific cover arranged for nurse led challenges?

N/A

 

Challenge tests practice

Q75) Do you provide written information for parents and children about the challenge process?

Yes

 

Q76) Do you obtain written consent to undertake challenges?

Yes

 

Q77) Do you start your food challenges with a lip dose (rubbing a small amount on the inner part of the child's lips and then observing the child)?

Yes for certain high risk challenges

 

Q78) Do you offer challenges to the following foods?

  • Baked egg
  • Baked milk
  • Challenge tests outcomes

 

Q79) Do you maintain a database of children undergoing challenge procedures and their outcomes?

Yes

 

Q80) Do you record symptoms/signs during a challenge using a standardised protocol?

No - have own symptom/sign recording protocol

 

Q81) Approximately how many times has intramuscular adrenaline had to be administered to paediatric allergy patients in the last year?

3

 

Q82) Over the course of a year, please estimate what percentage of your challenges are positive?

  • Standard risk challenges: % positive = 20%
  • High risk challenges: % positive = 50%
  • Supervised feeds: % positive = 5%

 

Q83) How is an appointment for a challenge test coded in your service?

As a day case admission for procedure

 

Immunotherapy

Q84) Do you provide allergen specific immunotherapy for allergic rhinitis (pollen/HDM/pets)?

Yes

 

Q85) Which allergens do you offer immunotherapy to?

Grass

 

Q86) Is the number of people you provide immunotherapy to capped each year?

Yes

 

Q87) Approximately, how many new patients do you offer immunotherapy to each year?

4

 

Q88) What form of immunotherapy do you undertake?

Sub-lingual immunotherapy (SLIT)

 

Q89) If you undertake SLIT: Which products do you use for your sublingual immunotherapy (SLIT)?

Grazax (Manufacturer ALK)

 

Q90) If you undertake SCIT: Which products do you use for your subcutaneous immunotherapy (SCIT)?

N/A

 

Q91) How is an appointment for immunotherapy coded in your service?

N/A

 

Q92) If Other form of coding used for immunotherapy, please specify

N/A

 

Q93) Do you maintain a database of children undergoing immunotherapy?

No

 

Q94) Do you obtain written consent for patients undergoing immunotherapy?

Yes

 

Q95) If you use Grazax: Do you ask GPs to take over the funding of Grazax?

No

 

Omalizumab (Xolair)

Q96 Do you offer omalizumab (Xolair) therapy for severe urticaria in your clinic?

No

 

Reintroduction ladders

Q97) Do you use reintroduction ladders for the following foods?

  • Egg (e.g. BSACI guidelines for the management of egg allergy - egg ladder)
  • Milk (e.g. iMAP/MAP)

 

Q98) If you use reintroduction ladders:In what situation do you use the reintroduction ladder

  • Home introduction of well cooked (e.g. baked) egg
  • Non-IgE type allergy
  • Home introduction of lightly cooked egg (if tolerating well cooked egg)
  • Home introduction of dairy using
  • iMAP/MAP ladder

 

Desensitisation treatment / programs

Q99) Do you provide desensitisation treatment?

Desensitisation not provided

 

Q100) If you undertake desensitisation treatment to a food: For which foods do you provide desensitisation programs?

N/A

 

Allergy reaction management

Q101) Which adrenaline autoinjector device does your service issue?

  • EpiPen
  • JEXT
  • Emerade

 

Q102) Which antihistamine do you routinely prescribe for food allergic reactions?

Cetirizine

 

Q103) Where are your management plans for allergic reactions sourced from?

  • Locally designed
  • BSACI

 

Patient support and training

Q104) Where are your patient information sheets sourced from?

  • Locally designed
  • Allergy UK
  • Anaphylaxis Campaign
  • From other centres

 

Q105) Do you offer bespoke training to patients, parents and/or carers in the following in your clinic?

  • Training in the use of self injectable adrenaline
  • Inhaler use
  • Eczema management (use of emollients/steroids)
  • Nasal spray/drop use

 

Service clinical governance & audit

 

Q106) Are you aware of the following NICE Clinical Guidelines?

  • Food allergy in under 19s: assessment and diagnosis (CG116) = Yes - have read it but not implemented it
  • Anaphylaxis: assessment and referral after emergency treatment (CG134) = yes
  • Drug allergy: diagnosis and management (CG183) = yes

 

Q107) Do you have any comments you wish to make about the NICE Clinical Guidelines for food and drug allergy?

Yes

 

If Yes, please state comments

Not very practical

 

Q108) Are you aware of the RCPCH Allergy Care Pathways?

No

 

Q109) Do you have any comments you wish to make about the RCPCH Allergy Care Pathways?

No

 

Q110) Do you hold a Multi-Disciplinary Team (MDT) meeting?

Yes

 

Q111) If you undertake a MDT meeting: How frequently are your MDT meetings held?

Every two months

 

Q112) Is your service part of a Regional Paediatric Allergy Network?

No

 

Q113) Is your service formally linked to a tertiary Paediatric Allergy Centre

No

 

Q114) Do you offer paediatric allergy educational events?

  • For General Practitioners
  • For colleagues in your hospital

 

Q115) If you offer paediatric allergy educational events: How often do you offer paediatric allergy educational events

Every six months

 

Follow up arrangements in your service

Q116) Do you have a routine frequency of follow up for your paediatric allergy patients

Yes

 

Q117) What would your follow up policy be for the following patients in general (recognising that there will always be exceptions)

  • Isolated nut allergy = Annually / Every two years
  • Food allergy BUT NOT nut allergy = 1 Year
  • Nut and other food allergies = 1 Year
  • Pollen food/oral allergy syndrome only = 2 Years
  • Non-IgE type allergies (excluding FPIES) = 6-12 Months
  • FPIES = 6-12 Months
  • Complex allergy patients = 6-12 Months

 

Q118) It would be very helpful if you could describe in more detail your follow up policy, e.g. does your follow up policy vary according to patient age? If so, how?

A bit more often when younger

 

Q119) Do you run an adolescent only clinic?

No

 

Q120) Do you run a transition clinic?

No

 

Q121) Does your hospital offer an adult allergy service?

Yes

 

Q122) What do you do with your patients when exceed the age threshold for your paediatric allergy service?

Refer some of them to an adult allergy service

 

Q123) If you refer them on: What adult services do you refer your patients on to?

  • Adult allergy service
  • Adult dermatology service
  • Adult respiratory service

 

Q124) When our survey of all UK paediatric allergy services is complete would you like to receive a copy of the results?

Yes

 

If yes, please can you confirm your email address for us to send the survey results to:

This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Q125) Are you happy for your service to be identifiable by name for bench marking purposes?

Yes