Issue 38

Summer 2022

Issue 38

The official newsletter of the British Society for Allergy and Clinical Immunology

Professor Graham Roberts, BSACI President, Professor Bryan Martin and Dr George Gkimpas, Scientific Programme Co-Leads, Professor Motohiro Ebisawa, WAO President.

World Allergy Organization & BSACI 2022 UK Conference Page 10 Focus on BSACI Registries Page 6

National Allergy Strategy Page 9

Nurse-led allergy in Scotland Page 12

I n t en d ed f or UK h ea l t h ca r e p r of es s i on a l s on l y .

From the Platinum Partners April I n t en d ed fof orthe UKWAO h ea & l t hBSACI ca r e 2022 p r ofConference es s i on a l s on l y .2022, Edinburgh From the Platinum Partners of the WAO & BSACI 2022 Conference April 2022, Edinburgh

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Editorial

Allergy Update

I

am delighted to present the 2022 summer issue of Allergy Update. As you can see from the pages that follow, the Society has been incredibly productive in the last few months, and you can catch up with all the important updates as well as accessing useful links on our website

Dr Erika Harnik Consultant in Paediatric Allergy, Imperial College Healthcare NHS Trust

I hope you were able to attend our conference this year, which was held in partnership with the World Allergy Organisation in Edinburgh. Thanks go to George Gkimpas and his team for all their hard work, and you can read about the highlights from the conference.

We stay in Scotland for our service spotlight, which this issue features an innovative nurse-led allergy clinic, which was led by Margaret Kelman.

Following the report from the All Party Parliamentary Group for Allergy, “Meeting the Challenges of the National Allergy Crisis”, the National Allergy Strategy Group describe the next steps which are being taken to improve allergy care across the UK.

Contents President’s message

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Supporting BSACI through legacy giving

5

Focus on BSACI registries

6

NASG/Parliamentary roundtable

9

WAO & BSACI 2022 UK Conference round up

10

Primary Care Adrenaline Guidance

13

Service spotlight: Edinburgh

14

Group and committee reports 16

We have updates from the BSACI Registries – BRIT (immunotherapy), UK Anaphylaxis Registry (to report any unintended anaphylactic reactions), UKFAR (fatal anaphylaxis).

This is sadly my last issue as editor of Allergy Update - I hope you’ve enjoyed the issues. Thank you to all who have contributed, and a special thanks goes to the BSACI team for all their support and hard work. Please contact Fiona Rayner (fiona@bsaci.org) if you would be interested in becoming the next editor. I would thoroughly recommend the position - it has been such a pleasure and please don’t hesitate to contact me (erika.harnik@nhs.net) if you’d like to learn a little more about the post.

Contributions should be e-mailed to: info@bsaci.org Editor of Allergy Update Dr Erika Harnik Co-ordinator Louise Colonnese Layout INQ Design Ltd (020 7737 5775) BSACI Trustees BSACI President Professor Graham Roberts Past President Professor Adam Fox Secretary Dr Deb Marriage Treasurer Dr Susan Leech Co-Editors of Clinical and Experimental Allergy Dr Robert Boyle & Dr Mohamed Shamji

Elected Council Members Dr Steve Jenkins Dr. George Gkimpas, BSACI Meeting Scientific Programme Lead Mrs Lucy Common Dr Dinusha Chandratilleke Dr Louise Michaelis Dr Rubaiyat Haque Dr Sophie Farooque Representatives and Leads of Committees Dr Isabel Skypala – Co-Chair of BSACI Standards of Care Committee Dr Mich Lajeunesse – Chair of BRIT Registry Committee Dr Richard Pumphrey – Chair of Anaphylaxis Committee Mrs Hannah Kramer – Chair of Nurses Committee Dr Nick Makwana – Chair of Paediatric Allergy Committee Professor Paul Ciclitira/Dr Steve Jenkins – Co-Chairs of Adult Allergy Committee Dr David Luyt – Co-Chair of BSACI Standards of Care Committee Dr Tomaz Garcez – Chair of the Clinical Immunology Committee Dr Matt Doyle – Chair of Primary Care Committee Co-opted Members Dr Louise Savic – Expert Working Party lead for Improving the provision of care in perioperative allergy Professor M Thirumala Krishna – Equality Diversity & Inclusivity Group Lead Dr Rebecca Knibb – Psychology Working Group Lead Dr Andrew Whyte – Rep on the RCP Medical Specialties Board (MSB) Professor Michael Rudenko – EAACI Rep Professor Helen Smith – BSACI Ethics Champion Ms Hannah Hunter – Representative of the FASG of the British Dietetic Association Dr Neha Christian/Dr C Alviani – Junior Members Representatives Dr Elizabeth Griffiths – Chair of Allergy Specialist Advisory Committee Dr Pamela Ewan – Allergy Services Lead and Co-Chair of the NASG Professor Judith Holloway – Chair of BSACI Allergy Education Network

BSACI team

Chief Executive: Fiona Rayner fiona@bsaci.org Clinical Guidelines and Registry Manager: Dr Shifa Shaikh shifa@bsaci.org Finance & Administration Officer: Sandie Campbell sandie@bsaci.org Membership Officer: Melanie Parrianen melanie@bsaci.org Marketing & Communications Manager: Louise Colonnese louise@bsaci.org Training & Education Coordinator: Marie Gibbs marie@bsaci.org Managing Editor, Clinical & Experimental Allergy: Catherine Hyland catherine@bsaci.org BRIT Coordinator: Maria Smith maria.smith@bsaci.org BSACI Studio 16, Cloisters House 8 Battersea Park Road London SW8 4BG info@bsaci.org 0207 501 3910 0207 627 2599 www.bsaci.org Registered charity no: 1069199

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President’s message

Allergy Update

International conference success I

’m writing this after our very successful joint conference with the World Allergy Organisation. For most of us, this has been the first international conference we’ve been to in nearly three years! We had over 800 participants, more exhibitors then we had space for in the exhibition hall plus some excellent Edinburgh weather. Those of you who have been involved in these meetings Professor Graham Roberts will know just how much work goes into planning them. They are only President successful because of the dedication of many people. I would like to thank George Gkimpas for leading the scientific program committee helped by Nandinee Patel and Natasha Gunawardana. Also Tammy Rothenberg who expertly coordinated all the abstracts. Also our thanks needs to go to our WAO collaborators, particularly Motohiro Ebisawa and Bryan Martin and also to Medivents who again did a great job in organising the logistics behind the meeting. Lastly I’d like to thank the CEOs of both the BSACI and WAO, Fiona Rayner and Justin Dodge who expertly managed the whole conference.

We now have a bit of a break from conferences.

The next scheduled BSACI conference is not until autumn 2023. This seems rather a long way away and I’ve already been asked about whether we should put on a small event before then. We would you be interested in your thoughts.

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We are at one of those points in time when there is likely to be a massive change in service delivery. I know that many of you are wondering about how Palforzia can be incorporated into your clinical activity. We all need to take a deep breath, think about what is possible and which patients can benefit from peanut oral immunotherapy. As many of you know, there is a BSACI group working on guidance for our members. The aim is to have this published in October.

Last year’s National Allergy Strategy Group (NASG) Meeting the Challenges of the National Allergy Crisis report has helped establish an ongoing dialogue with government on the provision of allergy services. Recently there has been a question in Parliament on research into

We had over 800 participants, more exhibitors then we had space for in the exhibition hall plus some excellent Edinburgh weather. allergy and the launch of the Allergy UK allergy patient charter. We all need to support the NASG group as they continue these discussions.

It’s good to be talking about something other than the pandemic! Hopefully the warmer weather will allow us all to catch up with our waiting lists.

I hope you manage to have a good summer break.

News

Allergy Update

Supporting BSACI through legacy giving

T

hank you to everyone who completed the recent survey about gifts in wills. Your responses are already proving useful for shaping our future plans.

The number of people living with allergies in the UK is growing by 5% a year, and worryingly, A & E departments are seeing a rise in Fiona Rayner anaphylaxis admissions. As part of Chief Executive the NASG we spoke to Gillian Keegan Minister of State for Care at the Department of Health and Social Care about the three mains aims:

• To appoint a national

lead for allergy.

Given the major cost to patients and the NHS over so many years, this requires leadership with a national clinical director to implement a national strategy and improve primary care and specialist services.

• Upskill and grow the NHS workforce

in allergy, to cover primary care and specialists (in adult and paediatric allergy).

• Improve allergy awareness/knowledge

in primary care. This will be a component in developing an integrated care model for allergy. Allergy needs to be brought into the mainstream of education for GPs in training, and for qualified GPs.

The survey showed that 17% of people say they have or would consider remembering BSACI with a gift in their will. Many of those who responded positively were particularly passionate about allergy care, with the majority of those having personal experience of allergy themselves or through a loved one. They were also particularly likely to feel a sense of personal connection to BSACI, and to be more trusting of the Society.

However, regardless of interest in gifts in wills, respondents were united in their desire to provide high quality care and improve the quality of life for people with allergies. The research programme is currently ongoing with some members having kindly offered to take part in in-depth interviews to explore their experiences more deeply. We hope to share more information in the next issue of Allergy Update.

Primary Care training days B • SACI is keen to improve allergy knowledge and competency in primary care, and part of this initiative involves organising Allergy Training Days for Primary Care Health Professionals.

The events are proposed by BSACI local allergy services (allergy clinics) and funded by BSACI. This funding is made possible by an education grant from ALK Abello and Thermo Fisher. Successful applications will receive an exclusive Education Grant of up to £3000 (up to £500 for a virtual event).

BSACI has so far funded 77 training days, training around 3300 primary care practitioners. Events have taken place all over the UK including one event in Stornaway!

Selection Process Applications are considered by a panel selected by BSACI and comprise of GPs and allergy specialists in both primary and secondary care. The decision will be

based on the following criteria: Producing a Primary care focused programme with both adult and paediatric components

• Priority will be given to centres with limited exposure to allergy training

• Priority will be given to centres with limited

funding opportunities to hold a similar event.

The feedback we have received from primary care practitioners who have attended an allergy training day has been that the training days are proving to be extremely beneficial in the day-to-day allergy management of patients in their practices.

To apply for funding for an allergy training day for primary care practitioners, please send an email to marie@bsaci.org. All applications will be assessed by the committee and notified by email of the outcome of each application.

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Registries

Allergy Update

Focus on BSACI Registries E ach BSACI registry is used to evaluate and improve outcomes for patients.

deaths in the UK. Gathering information from each of these cases is crucial.

Registry for Immunotherapy (BRIT) is a web-based patient registry that records immunotherapy treatment of patients under the care of BSACI consultants practicing in the UK. To find out more visit www. b s a c i .o rg /p rofe s s i o n a lresources/bsaci-registries/ immunotherapy-registry/

UKFAR data aims to helps develop better understanding of the risks and causes of fatal anaphylaxis with the intention of reducing the risk of future deaths from anaphylactic reactions.

UKFAR has received a grant from the Food Standards Agency (FSA) to continue its important work.

BSACI is working with Imperial College to support the UK Anaphylaxis Registry which has been set up to collect data relating to unintended allergic reactions. The Registry is fully integrated into the existing European Anaphylaxis Registry Network for Online Registration of Anaphylaxis (NORA). To find out more visit www.bsaci.org/ professional-resources/bsaci-registries/ukanaphylaxis-registry/ UK Fatal Anaphylaxis Registry (UKFAR) analyses suspected cases of fatal anaphylaxis from any cause. Each year there are between 20-50 such

UKFAR encourages the submission of suspected cases on mft.fatal.anaphylaxis@nhs.net.

Team can provide advice on the investigation of cases.

Early involvement of UKFAR in the assessment of suspected fatal anaphylactic events is beneficial in the identification of contributing factors and to guide or focus post-mortem assessment. For further information please visit www.bsaci.org/professional-resources/ukfar To find out more about BSACI Registries and how to sign up to help us with our evaluations visit www.bsaci.org/professional-resources/bsaciregistries/

UK Fatal Anaphylaxis Registry

UKFAR analyses suspected cases of fatal anaphylaxis from any cause

U

K FAR seeks to assemble details of every fatality in the UK since 1992 for which anaphylaxis is considered a possible cause of death. Nearfatal reactions with subsequent death due to brain damage or other resuscitation sequelae are included. The registry, founded by Richard Pumphrey in the early 1990s, aims to collect detailed information about every case, typically 20-40 each year. The data in the registry has improved our understanding of fatal anaphylaxis and the clinical circumstances leading to fatalities.

This important work is funded by the Food Standards Agency (FSA) and enables analysis of fatal anaphylaxis cases. The data from the registry informs trends and helps develop better understanding of the risks and causes of fatal anaphylaxis, which will ultimately provide knowledge to reduce the risk of future deaths.

Continuing to collect this data in the UK is important to allow comparison with data in other

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countries, add to the overall understanding on fatal anaphylaxis. Enhanced understanding will enable us to improve the advice on avoidance strategies and management of anaphylaxis to reduce fatalities. This approach is particularly important considering the reported increase in prevalence of allergy in the UK population.

We are looking for BSACI members to support UKFAR. To register a case visit www.bsaci.org/ professional-resources/bsaci-registries/ukfar/ uk-far-contact-us/ We wish to look at any information that can be shared with us on fatal cases of anaphylaxis which people are directly involved with as this would be incredibly helpful. Additionally, for any on-going evaluations, people can request involvement of the registry team directly with the Coroner. Direct involvement of the registry team with the Coroner, investigation of cases gives the richest possible information.

Registries

Allergy Update

Exciting changes to the BRIT Registry Improving our patient experience and the dawn of recording peanut immunotherapy

W

e saw in the New Year by welcoming our new administrator, Maria Smith. She is working with us three days a week and has taken over new registrations. She can help you get set up in the registry and troubleshoot any problems you might have.

Our poster at the WAO & BSACI conference Dr Mich showed that about Lajeunesse 50% of BSACI services Consultant in are now registered Paediatric Allergy with BRIT. We would & Immunology like to make it as Southampton simple as possible Children’s for you to get started, Hospital and we’ve made some developments that will really help. Firstly, we combined our consent forms into a single document to make the consent process simpler and more intuitive. There is just one consent form, regardless of what form of immunotherapy you administer. We have one for children under 16 and one for adults.

We have made changes to our patient related outcome measures because of poor return rate. Patients can now receive a text message instead of an email. We’ve realised that a lot of the registry emails go into junk folders or get overlooked.

Because you will need patients’ consent to collect their phone numbers, we have created a onepage text message consent form so that you don’t have to completely reconsent existing patients. We’re also moving toward having monthly PROM questionnaires that focus on adherence, side effects, and realworld effectiveness. A

few simple questions that will take two minutes to complete.

Peanut immunotherapy was licensed by NICE in February and the registry is now able to include your peanut immunotherapy patients. It is designed for children on Palforzia, but you can add any patients Maria Smith receiving peanut OIT as long as they are not currently part of a clinical trial. This includes children receiving dietary peanut as treatment for peanut allergy. As with the other parts of the registry, we are tracking adherence, safety, and effectiveness by looking at reactions to peanut and anaphylaxis whilst on treatment.

If you are interested in learning more, visit the www.bsaci.org/professional-resources/ bsaci-registries/immunotherapy-registry/ to watch the recorded BRIT webinar from March, download our new forms, or contact Maria for advice at BRIT@BSACI.org.

We have redesigned our landing and registration pages (see below) to be clearer and more accessible.

Visit BRIT to view the changes and register now.

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Registries

Allergy Update

Sign up to the UK Anaphylaxis Registry and help evaluate and improve outcomes for patients B

Paul Turner Reader in paediatric allergy and immunology, Imperial College London

SACI is working with Imperial College London to establish a prospective UK Anaphylaxis Registry, supported by UK Food Standards Agency (FSA) and Food Standards Scotland (FSS), to collect data relating to unintended allergic reactions. The Registry is fully integrated into the existing European Anaphylaxis Registry Network for Online Registration of Anaphylaxis (NORA).

The UK Anaphylaxis Registry serves as a platform for clinicians to record details of all anaphylaxis incidents and will enable us to collate data from across the UK to help provide a better picture of the type of reactions - food and non-food related - that take place as well as their frequency and geographic spread. Understanding more about accidental allergic reactions to food, such as the specific food causing a reaction, will help us better protect those with food allergies.

The Registry works with a two-step data collection process. The first is a case report form for completion by the health care professional where anonymous data relating to the allergic reaction is collected. The second step is a patient questionnaire which will collect additional information relating to symptoms and possible risk factors in an anonymous way from the patient after verbal consent is obtained by the healthcare professional and consequent electronic informed consent then obtained.

The UK Anaphylaxis Registry serves as a platform for clinicians to record details of all anaphylaxis incidents.

Since the registry launched in October 2021, 37 individuals have signed up to the registry, but we need many more contributors to help us understand more about accidental allergic reactions to food, such as the specific food causing a reaction, to help us better protect those with food allergies. We are encouraging BSACI members and other health care professionals to register for access to the online platform, and

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then submit data relating to unintended allergic reactions occurring in adults and children, to both food and non-food triggers.

• To register as a contributor, visit bit.ly/uk-anaphylaxis

• If you are already registered and want to

report a case, visit www.anaphylaxie.net/ survey/admin/authentication/sa/login

• Free short tutorial video explaining how to use the platform and the Case Report Survey can be found at https://www.anaphylaxie.net/en/ educational-video/

Once your account has been approved, you will receive an email with your User ID and password which will give you access to the online platform.

If you have any questions, please email Dr Alessia Baseggio Conrado at anaphylaxis.registry@ imperial.ac.uk

Become a UK Anaphylaxis Registry champion The UK Anaphylaxis Registry and BSACI are looking for healthcare professionals across a range of settings including hospitals, primary care, general practice, and emergency department who will act as champions and promote participation of their colleagues and report allergic events in the UK Anaphylaxis Registry. The champion should be a consultant or specialist nurse (band 7 upwards).

The registry also has the functionality to set up a centre-based account for the champion. This shared account aims to give the champion the opportunity to share their account details with their colleagues to facilitate the reporting of allergic events into the NORA platform. To activate the centre-based account you must select this option in the e-request (https://bit.ly/ukanaphylaxis). Centre User ID and a password will then be created. Sharing these account details will be at the champion’s discretion.

News

Allergy Update

NASG/Parliamentary round table F ollowing the launch in October 2021 of Meeting the Challenges of the National Allergy Crisis in conjunction with the All-Party Parliamentary Group for Allergy, members of the NASG met with the Minister of State for Care and Health, Gillian Keegan MP and members of her team for a round table meeting and laid out the key areas for improvement as follows:

Ms Mandy East National Allergy Strategy Group (NASG) Parliamentary Officer

• The creation of a National Lead – an Allergy Champion

• Increase in the number of specialist posts

• Improvements in primary care education

The Minister was very open to the discussions and showed a keen interest in the subject with a promise to take each ask forward for further discussion. As a result, we have now had a meeting to discuss the creation of an Allergy Champion and are working on how this role should look; have one scheduled to outline improvements in workforce and will be booking a date shortly to start a dialogue on improvements in primary care.

As always, the National Allergy Strategy Group

works as a coalition with its strength being the coming together of the BSACI with the patient groups Allergy UK and the Anaphylaxis Campaign. The group continues to receive support from the All Party Parliamentary Group for Allergy chaired by Jon Cruddas MP and will shortly be holding the AGM for the group to maintain it’s position within Westminster for another year.

At the end of June the chair of the NASG will pass from Dr Pam Ewan to Professor Adam Fox. We would like to take this opportunity to thank Dr Ewan for many years of dedicated work to improve NHS allergy services and the lives for those living with allergic disease. Dr Ewan was a founding member of the NASG 20 years ago and has steered the group through the many reports and inquiries over the last two decades and been at the forefront of our campaigning including speaking at all our Parliamentary receptions and leading the publication of Meeting the Challenges of the National Allergy Crisis. Dr Ewan will continue to be part of the NASG and give her time and experience to the group as the work continues; Professor Fox will take on the role of chair from the start of July, and we wish him all the best for the future of the group.

New website content Patient information BSACI has produced patient information in line with current published BSACI management guidelines. To help patients understand more about Anaphylaxis, we have developed a new patient information leaflet. The publication includes key information on the nature of the condition, its management and treatment. This is a BSACI members-only resource, produced primarily for clinicians to provide to patients during consultation. Access to the resource can be found at www.bsaci.org/professional-resources/publications/patient-information Allergy Management The Allergy Management section of the website has been developed to provide health care professionals with a valuable resource for specific allergic conditions.

BSACI approached specialists with expert knowledge in each of the conditions to provide the content.

The information - Food Allergy, Drug Allergy, Skin Allergy, Urticaria and Immunotherapy, has been divided into sub sections to make the navigation of the topic seamless. Take a look at www.bsaci.org/professional-resources/allergy-management

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WAO & BSACI 2022 UK Conference

Allergy Update

WAO & BSACI Conference 2022:

Four decades in the making A

Dr George Gkimpas Consultant Allergist, Royal Preston Hospital WAO & BSACI 2022 Conference Scientific Program Co-Lead

s we leave the WAO & BSACI 2022 UK conference behind us, we can now reflect on what has been a highly successful event, taking place not long after the epicentre of the COVID pandemic. It was a challenging task to deliver the first WAO conference in the United Kingdom after four decades, and looking back we are delighted that it was, indeed, an experience to remember.

The conference highlighted the allergy field on a global scale and endorsed innovation. It also focused on the effect of the environment and climate on allergy, as the new decade presents us with several global challenges from these viewpoints. As it was fitting for a WAO conference, we focused on collaborations and joint sessions with international societies, opening with the European Academy of Allergy and Clinical Immunology (EAACI), continuing with the American Academy of Allergy Asthma and Immunology (AAAAI), and closing with the Japanese Society of Allergology (JSA). We further highlighted the importance of input from all parts of society by offering a platform to key UK charities, the Anaphylaxis Campaign, Allergy UK and the Natasha Allergy Research Foundation (NARF), to discuss updates in informing and protecting the allergic public. There were also several informative workshops where practical

The exhibition area was well attended

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issues of our everyday practice were highlighted in an engaging, hands-on environment.

The conference, as expected for any BSACI event, provided a platform to British and international speakers of global calibre to deliver high-quality talks for all issues around Allergy & Immunology. In the opening plenary, Professor Graham Roberts, BSACI President, Professor Motohiro Ebisawa, WAO President and Professor Nikolaos Papadopoulos, EAACI Past President, set the stage with comprehensive talks. The program featured throughout several sessions that highlighted the effect of environment on allergy, culminating in the ‘Plenary of Environmental Exposures’ where Professor Sir Stephen Holgate and Professor Jurgen Schwarze delivered influential keynote lectures on the effect of pollution, the climate, helminths and viruses on allergy. The conference closed with a ‘Year in Review’ session supported by WAO, BSACI, and our sister societies, which celebrated the strong bonds that bind us. In what was a once-in-a-lifetime session, current, past and elect Presidents of WAO, BSACI, EAACI, AAAAI and JSA joined together to Chair and speak on this year’s advances and breakthroughs in the field.

The combined expertise of BSACI and WAO alongside the support of our sister societies, empowered us to deliver a conference that was one of the scientific highlights of 2022, as also demonstrated by the highly positive feedback we The conference was attended by 840 delegates, speakers and exhibitors from all around the globe

WAO & BSACI 2022 UK Conference

Allergy Update

Delegates from all over the world attended the event

Allergy testing at the conference

received from our delegates. The program, which featured several exciting sessions for clinicians, scientists and allied health professionals alike, was highly appreciated by those in attendance.

The exhibition area was very well-attended during breaks, and the ‘Speakers’ Corner’ talks received fantastic feedback and captured the interest of delegates in-between sessions. Medivents, who organised the conference, delivered an immaculate event in the face of several challenges. But over and above everything else, it was the delegates from all over the world that made this event a success, and it is our hope that they all travelled back home with great memories that will stay with them for years to come. Historic Edinburgh welcomed people from hundreds of countries, and we are hopeful that, alongside attending the sessions, everybody took the opportunity to tour the famous Edinburgh Castle, take in the sights of the city, or play a round of golf!

As we now move forward, I am delighted to leave the preparation of the next BSACI 2023 conference in the capable hands of Dr Nandinee Patel and Dr Natasha Gunawardana, who take over as Scientific Programme co-leads, and who will no doubt deliver a remarkable event that will push even further the boundaries of what we can expect as a society from our Annual Conference. I wish them all the best with this challenging but highly rewarding task. I want to thank everybody in the BSACI and WAO teams for their fantastic support in this journey through the last two events; I am hoping to see each and every one of you face-to-face at BSACI 2023!

Professor Graham Roberts and Dr Pamela Ewan who was recognised for her serivce to UK Allergy

“I’m Alina Pokryshko, pediatric allergist from Ukraine. First and foremost, I want to thank you for the great opportunity to attend the WAO & BSACI 2022 UK Conference. WAO & BSACI are ready to support young medical practitioners if they are in a difficult situation. Due to Russian invasion in Ukraine, I was financially unable to join the conference. WAO & BSACI accepted me as a junior member, and even provided funding to pay for the costs relating to attending the conference, for which I can’t thank them enough!

The WAO & BSACI 2022 UK Conference was an amazing event with precious insights and impeccable organization. Participants of the event brought valuable professional experience, new connections and refreshed friendships. I will return to Ukraine with a practical knowledge and skills to use in the clinic I work in. It was a great honor for me to meet with highly professional allergists. That really inspired me to continue growing and developing as an allergy specialist further. Many thanks to the team for putting in all this effort, no event can be so successful without people dedicating their resources and time to make sure everything is faultless. Thank you very much for this experience, I highly appreciate it!”

Alina Pokryshko, Pediatric Allergist

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WAO & BSACI 2022 UK Conference

Allergy Update

First joint UK conference in 40 years a great success I t was a pleasure to host the WAO & BSACI UK Conference in the beautiful historic city of Edinburgh.

The UK last hosted a World Allergy Organization (WAO) conference in 1982, so the conference was a key opportunity to meet and learn from colleagues from all around the world.

knowledge base and lead to improved quality of life for allergy patients around the world. WAO was delighted to be able to give financial support to 8 international delegates through the Abstract Award Scheme to help with travel, registration and accommodation costs to attend the WAO & BSACI UK Conference.

WAO was proud to host its first in-person international conference since the pandemic began as a partnership with BSACI. WAO international conferences are at the heart of the organization’s mission to be a global resource and advocate in the field of allergy, advancing excellence in clinical care through education, research and training. As a result of this successful collaboration, global experts in allergy and other related fields gathered in the charming city of Edinburgh to exchange ideas and present new research that will deepen the professions

We would like to thank delegates for traveling across the globe to join us. We hope everyone who attended found the conference a rewarding experience and enjoyed the opportunity to network with colleagues from around the world. On behalf of WAO, I would like to thank and congratulate BSACI. We look forward to working together in the future.

Professor Motohiro Ebisawa President, World Allergy Organization

BSACI Medical Scholarships Scheme 2022

D

ue to the increasing prevalence of allergy within the UK population and the shortage of allergy expertise to treat the increasing allergic population, BSACI offers Medical Scholarships to encourage medical students and foundation doctors to consider this diverse and growing specialty as a career. We were pleased to offer financial support to medical scholars by providing funding to pay for costs relating to attendance at the WAO & BSACI joint 2022 conference. The interest in medical scholarships this year was huge with 22 scholarships awarded! The Medical Scholarships Scheme is open to FY2 doctors, IMT and paediatric ST1-3 trainees in the UK, to encourage those who have an interest in a career in allergic diseases to apply. It is a fantastic opportunity for junior doctors to see what a career in Allergy and Clinical Immunology looks like and how rewarding being a member of the UK allergy community can be.

“I was fortunate to participate in BSACI Medical Scholarship Scheme as an Internal Medicine Trainee in 2021. This scheme enabled me

to attend the BSACI Annual Conference in Harrogate, where I enjoyed excellent talks and connected with like-minded colleagues. I would definitely recommend it to any other interested trainees!” Dr Joseph Jayasundera Medical Scholarship recipient 2021 “Becoming a medical scholar has proved invaluable to my developing career in allergy and clinical immunology. It provided a huge boost to my specialty training application, and introduced me to many wonderful colleagues with whom I am proud to work with to this day. I now eagerly look forward to the annual BSACI conference as a highlight of my professional calendar.“ Robbie Yellan, Medical Scholarship recipient 2019

BSACI will be offering Medical Scholarships for our 2023 conference. If you know of any medical trainees that are interested in a career in allergy please spread the word. Details will be sent to members closer to the time.

WAO & BSACI Abstract Award Scheme 2022

B

SACI and WAO were pleased to offer the Abstract Award Scheme this year. The Abstract Award Scheme gives delegates who submit abstracts the opportunity of applying for support for travel, registration and accommodation for the conference. There were two categories for applying, either UK or international (including Europe). There were 16 UK awards and 8 international awards. For UK awards, allocation in this category was restricted to accepted abstracts from trainees, undergraduate students, nurses and allied

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health professionals and awards allocated on the grounds of those perceived to be in most financial need or having incurred the greatest expense to attend the conference. International awards were open to Junior members of a WAO Member Society working in the field of allergy/clinical immunology, under 35 years of age or within 5 years of a training program in allergy, asthma, clinical immunology or related field. Awards were allocated based on the quality of the abstract, location and perceived need of the applicant.

News

Allergy Update

Primary Care Adrenaline Guideline A

Deepa Choudhury GP with a special interest in Allergy, Bedfordshire

s Primary care health professionals, we have realised the difficulties we face on a day to day basis when it comes to prescribing auto-injectors. Challenges have ranged from supply issues, training for the correct device, knowing how to respond to patients requesting multiple auto-injectors and the conundrum of whether a patient really needs the auto-injector. The list is endless but we thought we would strive towards creating a document that can help us all with being equipped with the knowledge and practical information around

of hospital settings.

It includes :

• an A4 summary (can be printed off and used on office notice boards if needed)

• an Algorithm to assess suitability and decision making

• Service delivery pathway that provides a full cycle overview

• Auto-injector tables with dosages • FAQ section covering most common

questions relevant to clinical practice

• Illustrative case examples covering

common case scenarios that are faced with in primary care setting

this topic.

The primary care guidance for auto-injector prescription in adults and children is a document we finally achieved after many years of team effort. This has involved meticulous appraisals and discussions with various stakeholder groups and we are extremely grateful to them and members of SOCC for accomplishing this guidance.

• Link to GP Referral Template – that can

be integrated into systemone, Emisweb or other IT systems if required. This can be used by any health professional in the primary care setting faced with a patient requiring an auto-injector

In this guidance, we have tried to summarise simplify and elucidate the specific aspects around prescribing auto-injectors. This was mainly to help and unify information that is relevant to health professionals working in the community and out

Our vision and aims for this guidance was to help simplify the understanding and practice of prescribing Auto-injectors in the community at present and in the future. It is our hope that this would in turn smoothen the process for patients and primary care health professionals involved.

Resources will be available on the BSACI website summer 2022 AAI prescription guidance in primary care (for adults and children)

1. Inspect

2. Empower

DIAGNOSIS

Is this anaphylaxis?

Anaphylaxis is defined as a severe life-threatening systemic hypersensitivity reaction. It is characterised by being rapid onset with involvement of the airway, breathing or circulatory problems. It is usually (but not always) associated with skin and mucosal changes.

Airway

Breathing

Common in adults

Adolescents and young adults

Common in children Milk Peanuts Tree nuts Fish Egg

Avoid risk factors

A

Register devices

NEVER forget to carry the devices everywhere

N

Alcohol Acute illness

Patient is empowered by selfmanagement and self-efficacy

symptoms

Act early

Order trainer pens

?

Exercise Stress Lack of sleep Premenstral states

Recognise

PRESCRIBE

Check date of expiry

ge rs

Common allergic triggers

Read labels

2 pens carried at all times

common a llerg ic t r ig

Peanuts Tree nuts Fish and shellfish Insect stings Medicines NSAIDs Penicillin/Antibiotics

Patients with poorly controlled asthma

R

Training can be done by competent health professionals

Training video links

TRIGGERS

Wh

Exposure

High-risk patients include:

T

Roles

Technique

t are the

SESSMENT K AS k patients?

RISo are high-ris

on time

W ha

Disability

Renew devices Trainer pens

Circulation

Asthma control

Weight appropriate dosing (especially important in children)

optimisation

Inform about patient organisations Allergy UK Anaphalaxis Campaign Patient peer support groups

I

3. Refer Patient discharged back to the community with discharge

Patient’s primary care referral

+

letter with ongoing advice on allergy

2 pens prescribed + training as per device prescribed Allergen avoidance advice

Referral letter

Patient given advice, training and support with devices

3. Refer

Anaphylaxis care plan

Patient awaits assessment whilst safety-netted

Tailored anaphylaxis care plan Medic alert

Patient assessed in allergy clinic

Focussed allergen avoidance advice Device training at clinic

Patient enters primary care

(secondary/tertiary)

Oral challenge (where

Specific IgE blood test

appropriate)

and others

Review of history

Skin prick tests

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Service spotlight

Allergy Update

Development and implementation of a pilot nurse led allergy clinic in Edinburgh I

Margaret Kelman Specialist Allergy Nurse

n a mixed methods feasibility pilot study, a Nurse-led allergy clinic ran for 3 years between 2017 and 2021, hosted by the University of Edinburgh and NHS Lothian and funded by Allergy UK. This novel clinic was initiated within the South East and South West area of Edinburgh, Scotland, to assess the feasibility of setting up an intermediary service in primary care, look at filling gaps in allergy service provision within Scotland and to measure the acceptability of the service to the patients, their families

and health care professionals who used it.

We explored a variety of clinic models and chose the hub and spoke model as the best fit for delivery of the clinical service within primary care.

In this model the Specialist Nurse is based within one primary care practice (hub) and all practices (spokes) within the cluster locality refer into the hub.

The two specialist nurses, supported by local

14

hospital specialists, were required to diagnose, carrying out investigations where necessary, and manage allergic conditions, prescribe and provide follow-up for patients/parents. Referrals into the clinic were accepted, provided they fulfilled the inclusion criteria (see Box 1), by secure NHS email via an electronic proforma from all primary care practitioners within the cluster locality. The patient or parent was offered an initial consultation and

This novel nurse-led feasibility study has demonstrated that within the pilot area (NHS Lothian) the clinic was well received by the patients, families and health care professionals who engaged with the clinic. followed up with a review appointment 6–12 weeks later. Participants were asked to complete a consent form and quality of life questionnaire at each consultation and a satisfaction survey at the review, as well as being offered the opportunity

Service spotlight to be interviewed. The clinic started out offering face to face consultations with a phone review, but this was adapted to remote consultation as a result of the COVID-19 pandemic during 2020.

A total of 506 patients were referred, of these, 426 patients were considered to fit the criteria to be seen in the clinic, with 332 patients reviewed and discharged with complete paperwork. 35 out of 37 practices within the cluster locality were regularly referring patients into the nurse-led allergy clinic, with a waiting time of4-6 weeks on average. Of the health care professional referrals received into the clinic, the majority (52%) were over 16 years old. This was the largest patient group seen in the clinic and is probably due to the fact there is no comparable adult allergy or transition allergy service available within NHS Lothian or within the SE of Scotland.

Of the 52% of patients over 16 years referred for anaphylaxis or suspected anaphylaxis only 47% had a clinical diagnosis of anaphylaxis after being seen in the clinic. Infants under 36 months with suspected food allergy were the second largest patient group (34%) referred. Referring health care professionals stated that 90% of patients would have been referred to secondary care had the nurse led clinic not been available. However a large percentage stated they had no service to refer to, indicating these patients would potentially have remained within primary care.

It is Important to note, of those seen in the clinic, the allergy nurse only referred 5% onwards to secondary care specialities. The most commonly used method for follow up was via phone call (57%), with face to face appointments offered for 33% with a DNA rate of 10%.

To conclude, this novel nurse-led feasibility study has demonstrated that within the pilot area (NHS Lothian) the clinic was well received by the patients, families and health care professionals who engaged with the clinic. The high number of referrals (n=506) patients seen (n=426) and number of spoke practices (35/37) engaging with the clinic within the 30 month period reflects this. Patient and health care professional feedback from satisfaction surveys and interviews were also very positive

Allergy Update

Box 1: Eligibility criteria Inclusion criteria: • Children aged <36 months with suspected food allergy.

• Children aged <36 months with moderate-to-severe atopic eczema not responding to standard treatment.

• Children and young people up to 16 years of age with suspected allergic rhinitis symptoms not responsive to a combination of oral antihistamines and nasal steroids.

• Young people and adults (from 16 years of age) with a history of anaphylaxis or suspected anaphylaxis.

• Able to give informed consent/assent for children under 16 years.

Exclusion criteria: • Children aged <36 months with suspected or confirmed non-IgEmediated food allergy presenting primarily with gastrointestinal symptoms.

• Single urticarial reactions without obvious triggers.

• Non-allergic chronic urticaria.

• Drug allergy.

• Well-controlled allergic rhinitis, asthma or atopic eczema.

• Mild-to-moderate atopic eczema without any obvious allergic trigger.

• Localised insect sting reactions.

• Unable to give informed consent/ assent. about the service provided.

The full protocol article is available Development and implementation of a nurse-led allergy clinic model in primary care: feasibility trial protocol PubMed (nih.gov) , and the full results of the study have been submitted for publication

Online training and events for members

Over the last two years we have been hosting regular online webinars for all our members.

Covering a host of topics including Urticaria and the Registry for Immunotherapy (BRIT), the webinars have been organised by BSACI Council offering high quality, conveniently accessible education on key allergy topics. The speakers are all experts in their field and the webinars have been a huge success.

The BSACI Paediatric Allergy Committee (PAC) runs monthly educational opportunity for allergists

throughout the UK and Ireland. Each session begins with an interactive journal club followed by case presentations including Q&A session.

As part of your membership you can attend the live webinars and Grand Rounds or access them afterwards at www.bsaci.org/account/ Thank you to ALK Abello and Thermo Fisher for supporting BSACI webinars and grand rounds.

15

Committee and group news

Allergy Update

Junior members

W

e are delighted to have taken over the Junior Members Representative role from October 2021. It’s been a busy period of settling into the role, and we both feel that having a joint approach, with a representative from both the Adult and the Paediatric trainees cohort, is highly beneficial. One of the biggest challenges we face is Cherry Alviani (pictured) the merging of the adult allergy and Paediatric Allergy Immunology Curricula, and how our Registrar, training days can adapt to this. The University Hospital training programme outline for 2022Southampton 2024 has been now finalized, whilst and Neha the next iteration of the training Christian programme will more fundamentally Adult Allergy reflect the change to the curriculum.

Registrar, For the time being the training days Guy’s and St continue to remain virtual, which has Thomas’ NHS Foundation Trust; really maximised attendance. Going forward, we’d love to see a return to Junior Members some face to face training meetings Representatives and perhaps we will be able to adopt

RECENT ACTIVITIES: • Online networking through Basecamp • Exciting programme of webinars and virtual events • New online learning modules under development a hybrid model. We are also looking into organizing evening teaching session with special focus on immunology which will help adult allergy trainees to better integrate into the new curriculum.

The Medical Scholars programme has been extremely successful this year, with over 30 applicants and 21 scholarships awarded. The aim of this programme is to help promote an interest in a career in Allergy and Immunology, and it’s great to see such positive uptake. We have just launched a survey of the previous Scholars to determine whether they have progressed onto a career in Allergy and look forward to sharing these results for you in due course.

Nurses in Allergy Commitee W

Hannah Kramer Paediatric Allergy Nurse Specialist (London) and Chair of the Nurses in Allergy Committee

e offer a warm welcome to our new nurse committee members Shauna McKibben (Primary Care Representative), James Gardner (Vice Chair) and Sarah Burrell (Secretary). In March we were able to hold our first face to face committee meeting since the pandemic began. It was lovely to be back together again and to be able to meet new members in the flesh!

We said goodbye to our previous Chair, Lucy Common, back in November. We thank her for her hard work over her term. Lucy has led us through a challenging few years, but remained positive and passionate about nursing careers, enabling us to offer support to our colleagues across the country via virtual sessions during the pandemic.

Our most recent meeting was a productive one, setting out our goals and objectives for the coming year. Our first objective is to establish an ‘Annual Allergy Update’ study day for BSACI

16

nursing members. We are aiming for this to be a virtual day in October 2022, free for members and offering sessions suitable for both adult and paediatric nurses. Watch this space. We aim to begin advertising the programme and further details in the summer.

Our second goal for this year is to update our ‘Allergy Nurse Competencies’ education document. We hope to expand the content to be more representative of the skills and knowledge we use in practice, incorporating intra-dermal testing and research sections. We will of course be reaching out to our nurse members first though via a short survey to welcome feedback on the current document so that we can be sure that all needs are met by the updated version.

We organised an informal social meet for those of you who attended the WAO & BSACI conference in Edinburgh. This was a great opportunity to meet colleagues from across the British Isles.

As always, we welcome any communication via our email address nurses@bsaci.org please do get in touch if there is anything we can support with. Or indeed you can follow us on Twitter @BSACInurses

Committee and group news

Allergy Update

Standards of Care Committee

T

Dr David Luyt Consultant in Paediatric Allergy, University Hospitals of Leicester; Chair of the Standards of Care Committee

his update brings news of further changes in the membership of SOCC. We said goodbye to Helen Fisher who was our nursing representative on the committee; and welcome to Kerrie Kirk who was appointed after interview in a strong competitive field. I know Kerrie well having worked with her in the Children’s Allergy service in Leicester (for more years that we both care to remember) where she is our lead specialist paediatric allergy nurse.

We are also in a transition period of handover of our guideline manager. Colleagues will recall that we welcomed Erinn Gallagher this time last year. Erinn decided to move

back home to Australia at the end of last year and continued in her role remotely. However, I am pleased to announce that Dr Shifa Shaikh has recently been appointed as the new Clinical Guidelines and Registry Manager. We look forward to working with her.

There has also been progress with guideline production with both the ‘Adrenaline autoinjectors (AAI) prescription for anaphylaxis in adults and children: guidance for primary care’ and ‘BSACI guideline for the diagnosis and management of Pollen Food Syndrome/ Oral Allergy Syndrome’ submitted to Clinical Experimental Allergy. In addition, through meetings via ‘Zoom/Teams’ members are striving to work on the proposed guidelines on NSAID hypersensitivity and urticaria.

Primary Care Committee D

Dr Amir Esteki GP, Wheatfield Surgery, Luton; Chair of the Primary Care Committee

uring the last two years of pandemic there has been extremely difficult times for Primary Care from the perspective of workload not to forget the delivery of the unprecedented and historic number of immunisations to the majority of the country while facing unprecedented pressure and yet at the same time dwindling workforce.

The Primary Care Committee met several times and set priorities for the coming 3 years that includes the following: 1. Engaging primary care by increasing need to engage with other AHPs in Primary Care (e.g., pharmacists, ANP, Dieticians etc.).

2. The group is aware there is an increased need to expand our presence by increased engagement of the allied group including advanced Nurse practitioners and pharmacists. We are also aware that the RCGP is currently unable to support further educations. Therefore, we aim for a wider engagement with allied professional where we could increase regular online training sessions

offered to these groups. We hope to deliver such online educational training 3-4 times annually.

We are also hoping that these groups can help us to deliver targeted educational webinars and lectures to expand the knowledge within the primary care team nationally. We hope the BSACI could support us to fulfil this objective by the possible appointment of a lay member and a pharmacist in particular to fulfil this objective.

3. We are restructuring our primary care online presence with commencement of a new WhatsApp group of the members only but are implementing structures for other allied professionals to be added to the group based on the need and competency framework assessment.

4. The PCC has reached out to RCGP to endorse the GP with Extended Reach (GPWER) in Allergy competencies. We have been asked by RCGPs to make a few alterations to this after which time we are hoping this will be endorsed by the RCGP.

17

Committee and group news

Allergy Update

Food Allergy Specialist Group

O

ur Food Allergy Specialist Group (FASG) of the BDA has around 400 dietitian members. We continue to share news, clinical queries and updates through the Basecamp platform.

Hannah Hunter Specialist Dietitian in Allergy, Guy’s Hospital, London; BSACI Dietetic Representative

We have continued our programme of webinars and in July are hosting a BSACI webinar on FPIES. Our 31 diet sheets continue to be open access to all BDA dietitians and are regularly updated. The newest addition is our FPIES weaning leaflet.

Work is progressing on our online learning module “taking an allergy focussed diet history” which supports the aim to improve allergy education for allied health professionals. We have appointed a dietitian to complete this project, which is funded by the British Dietetic Association (BDA).

An international group of dietitians and

RECENT ACTIVITIES: • Online networking through Basecamp • New online learning module under development

clinicians working in food allergy led by Isabel Skypala formed last year with the aim of improving the dietary management of food allergy. This is supported by the EAACI Research and Outreach Committee and INDANA. There are three sections: prevention, exclusion and treatment of food allergy.

Potential outputs will be position papers, videos and information sheets in multiple languages.

Twitter: @BDA_FASG

Clinical Immunology Committee Headlines: T Dr Tomaz Garcez Consultant Immunologist, Manchester University NHS Foundation Trust; Chair of the Clinical Immunology Committee

he focus of the BSACI CIC is education and training across clinical immunology and allergy. The committee is supporting a trainee led education subcommittee (with stakeholders at trainee level from all of the involved organisations) to look at the delivery of training across clinical immunology and allergy and to see if there are any gaps (or duplicated efforts) that could be minimised by joint working. This group has met a few times and is making good progress on defining high standards of allergy/ immunology training.

In line with engagement with the clinical immunology scientific community the committee invited a healthcare scientist to the CIC meeting to discuss views on joint working, particularly in, but not limited to, the area of education. The group has invited self-nominations from the scientific community for healthcare scientists to join the committee.

We have received several nominations and will be appointing scientific representatives in the

18

• Education and training subcommittee • Recruit Healthcare Scientist • Collaborative working between Allergy and Clinical Immunology

near future to help support the working of the committee.

With the new GMC approved medical curriculum there is a need to enhance the joint working with the immunology professional organisations. The CIC is well placed to be involved in and support these discussions. There are plans for BSACI to work with the British Society for Immunology (BSI) on forthcoming conferences, which will help to align some of the organisational priorities. The United Kingdom Primary Immunodeficiency Network (UKPIN) is in advanced discussions on the formation of a new Clinical Immunology Network with the BSI and it will be important for BSACI to engage with the newly formed network and identify any joint working opportunities.

Committee and group news

Allergy Update

Paediatric Allergy Committee

I

Dr Niten Makwana Consultant Paediatrician, Sandwell and West Birmingham NHS Trust

t is great to be writing this report on behalf of the Paediatric Allergy committee as the new Chair. Over the last few months we have reviewed our committee membership and have appointed new members, including a new role of Paediatric Education Representative, which also links with the BSACI Allergy Education Network (BAEN). The group have had two meetings since the beginning of the year and are very excited to be working on a number of projects over the next 12-24 months. These include: • Continuation of the virtual grand rounds, which were implemented during the

pandemic, recognising the loss of training opportunities during this time. These have been very successful with over 1000 attendees over the course of the sessions and over 300 views of the recordings.

Centres across the UK contributed and gave great insight into case management and also journal club review of articles –

combining evidence with experience • Work on best practice guidance for the use of Palforzia has commenced. We are aware of the NICE approval of Palforzia, but this came without guidance on how to implement this practically. The paediatric allergy community felt we needed some clarity on this to prevent inequalities in access and delivery. The guidance will focus on eligibility and equity of access, safety of delivery, and follow on arrangements after completing the recommended course of Palforzia.

• National Paediatric Allergy Service Standards to be produced jointly with BSACI and RCPCH. This work had begun but stalled during the pandemic. The aim is to allow services to benchmark across agreed standards and move towards accreditation of services in accordance with level of allergy service provided in the future. It will also allow peer to peer assessment of services which is already done in other tertiary level paediatric specialities.

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SAVE THE DATE

SAVE5th -THE DATE 7th October 2023 Annual Conference

SAVE THE DATE

2023 Annual Conference 2023 Annual Conference - 7th October October 5th -5th7th

BRITISH SOC IET Y

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GY & C Annual Conference LLER LIN A R IC 2023 UK e U K

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NOLOGY MU IM

bsaci og ate5th - 7th October ntr e og Convention C r t r

BRITISH SOC IET Y

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Annual Conference 5th - 7th October 2023

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5th - 7th October

UK

Annual Conference 2023

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