Issue 40

througheducation,training and research

Allergy Update Spring 08 copy apped d Allergy Update Spring 0 d 08 0 age

specialisttraineesacrossEurope,detailsofthe greatstridesmadeintheallergyspecialist trainingprogrammeandcoverageofthehighly laudableplansofthePrimaryCareAllergy Grouptodevelopallergyeducationinprimary care.Whilstprogressisbeingmadeforfuture tertiaryallergistsandGPs,aren’tweforgetting somebodyhere?AsaPaediatricAllergistIam oftenstruckbythelackofopportunitiesto developtheveritablearmyofgeneraland specialistpaediatricians, dermatologists,E surgeonsandadultimmunologistswhoare responsibleforseeingalargeproportionof allergicchildreninsecondarycareyetwould havereceivedverylittletrainingoutsideoftheir ownspecificspecialistarea.Athirstfor knowledgeisclearlypresentasevidencedby thelargeturnoutsfromthesegroupsatthesmall numberofavailablestudydaysandI understandthesamedemandexistsfromthis groupintheareaofadultallergy. Potentialroleforspecialistcentres Unfortunately,withfewallergyconsultantsand thecurrenthighpatientburden,thereislittle AdamFoxregularlyteachesonpostgraduatecoursesandhas receivedtraininginmedicaleducation.Hegiveshisvisionfor thefutureofeducationinallergyforsecondarycarespecialists. Continuedonpage8

Winter 2017 Issue 30 BSACI launches new drug allergy management resource section on website BSACI Rhinitis Guideline Page 7 Allergy teaching for medical students Page 6 BSACI Annual Meeting 2017 review Page 10 The official newsletter of the British Society for Allergy and Clinical Immunology New BSACI website unveiled 5

Commissioning – allergy services progress 6

Exploring new frontiers in Allergy 12-13

AllergyUpdate

TheNewsletteroftheBritishSocietyforAllergy&ClinicalImmunology

Continuedonpage2

Issue10 Autumn2007 Inthisissue... ● HouseofLordsreport Editorial DrPamelaEwanCBE BSACIThinkTank ● HotnewsforAllergy trainees BSACI Annual Meeting2007 EAACISummer School,Oxford ● Bookreview–FastFacts:Rhinitis ClinicalImmunology Sub-Committee PaediatricAllergy Group:BSACI-PAG ● BDA FoodAllergy& IntoleranceSpecialist Group PrimaryCareAllergy Group ● EAACI2007Congress, Sweden ● AllchangeatBSACI Office Diarydates www.bsaci.org 3rdindependentnationalreport: Lordsendorsethesamemessage DrPamelaEwanawardedCBE PamEwanattendsBuckinghamPalacetoreceiveherhonourforservicestomedicine. Turntopage3 Allergy Update Autumn 07.qxd:Allergy Update Spring 07.qxd 23/11/07 12:29 Page 1 Summer 2022 Issue 38 National Allergy Strategy Page 9 Nurse-led allergy in Scotland Page 12 Focus on BSACI Registries Page 6 The official newsletter of the British Society for Allergy and Clinical Immunology Page 10 World Allergy Organization & BSACI 2022 UK Conference Professor Graham Roberts, BSACI President, Professor Bryan Martin and Dr George Gkimpas, Scientific Programme Co-Leads, Professor Motohiro Ebisawa, WAO President. Summer 2017 Issue 29 BSACI Nut Allergy Autumn 2011 The Newsletter of the British Society for Allergy & Clinical Immunology Allergy update Issue 18 Autumn 2011 The Newsletter of the British Society for Allergy & Clinical Immunology Allergy update Issue 18 The official newsletter of the British Society for Allergy and Clinical Immunology CELEBRATING75 SRAEY Celebrating 75 years of BSACI

New Council member’s visions 10-11 BSACI launches its new website Autumn 2012 Issue 20 Winter 2021 Issue 37 Meeting the challenges of the National Allergy Crisis UK Fatal Anaphylaxis Registry Page 15 New egg allergy guideline Page 11 Allergy education strategy launched Page 8 The official newsletter of the British Society for Allergy and Clinical Immunology Page 6 througheducation,training and research Winter 2018 Issue 32 In memory of: Professor Anthony Frew 1955-2018 TTechnologyCommitteeReporton Allergy,chairedbyBaronessFinlayand publishedinSeptember,waswideranginginits brief.Howeverthecommitteewassostruckby theevidenceofinadequateservicesforpatients thatthisbecameamajorfocusoftheinquiry.The Reportidentifiesthe‘severeshortageofallergy specialistsintheUK’andthat‘clinicalservices lagfarbehind’mostofEurope.TheReport rgyand inadequateprovisionacrosstheNHS,inhospital servicesandinprimarycare: Thekeyrecommendationisthatanallergy centreshouldbecreatedineachStrategicHealth Authority,headedbyafulltimeallergyspecialist –astheessentialsteptobegintoimprovecareat boththehospitalandprimarycarelevel.These

Dr Shauna McKibben

Allergy & Asthma Clinical Nurse Specialist, St Mary’s Hospital, London

Welcome to this special edition of Allergy Update Summer 2023 celebrating 75 years of BSACI and what a journey it has been. From the British Association of Allergists first meeting at St Mary’s Hospital in 1948 with over 40 people in attendance, to a now thriving Society with a diverse membership of multidisciplinary professionals across a variety of healthcare sectors.

In this edition it is a privilege to have BSACI stalwarts share their memories and reflections of the Society over the years. With thanks to dedicated members and strong leadership, BSACI continues to provide support and direction for healthcare professionals caring for people living with an allergy.

Looking forward, a new organisational structure and an expansion of working groups and specialist interest groups shows a Society that is reflective and responsive to its member’s needs. I’m excited by the British Allergy

Education Network’s commitment to driving allergy competencies, curriculum and education for all healthcare professions and look forward to seeing this work progress. Nowhere is the strength of BSACI better showcased than at the Annual Conference in Harrogate in October and with a second Global Allergy Online Symposium planned for January 2024, there is much to look forward to.

As well as celebrating this 75th milestone for BSACI, it is also the 75th anniversary of one of the UK’s greatest institutions, the NHS. We are no doubt working in challenging times, but I am confident the sense of community and shared purpose of members will enable BSACI to steer the way for the allergy community.

I hope you enjoy this edition and I look forward to seeing you in Harrogate. Here’s to the next 75 years.

If you would like to get in touch, my email address is: s.mckibben@nhs.net.

Contributions should be e-mailed to: info@bsaci.org

Editor of Allergy Update

Dr Shauna McKibben

Managing Editor

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, Joint Chair - Transition Working Group

Mrs Lucy Common

Dr Dinusha Chandratilleke

Dr Louise Michaelis

Representatives and Leads of Committees

Dr Isabel Skypala – Chair of BSACI Standards of Care Committee

Dr Mich Lajeunesse – Chair of BRIT Registry Committee

Professor Graham Roberts – Chair of Anaphylaxis Committee

Mrs Hannah Kramer – Chair of Nurses Committee

Dr Nick Makwana – Chair of Paediatric Allergy Committee

Dr Steve Jenkins/Professor Paul Ciclitira – Co-Chairs of Adult Allergy Committee

Dr Tomaz Garcez – Chair of the Clinical Immunology Committee

Dr Matt Doyle – Chair of Primary Care Committee

Co-opted Members

Dr Claudia Gore - Joint Chair Transition Working Group

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 – Junior Member Representative

Professor Adam Fox - Chair of the National Allergy Strategy Group

Professor Judith Holloway – Chair of BSACI Allergy Education Network

BSACI team

Chief Executive: Fiona Rayner fiona@bsaci.org

Chief Operating Officer: Vivine Smith vivine@bsaci.org

Chief Scientific Officer: Dr Shifa Shaikh shifa@bsaci.org

Finance & Administration Officer: Sandie Campbell sandie@bsaci.org

Membership Officer: Melanie Parrianen melanie@bsaci.org

louise@bsaci.org

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 www.bsaci.org

Registered charity no: 1069199

Half-way through - time flies!

Iam now over halfway through my three-year presidential term. It’s great to see how all the BSACI groups have responded to the challenge to generate and start to deliver a threeyear strategy. A lot of things have already emerged from across the Society.

Professor Graham Roberts President

The GP with Extended Role (GPwER) in allergy framework has now been completed and endorsed by Royal College of General Practice. The document contains the key competency elements for GPs

working in Allergy and is based on both the prior Respiratory and current Dermatology GPwER frameworks. The document was led by Dr Liz Angier and builds on the group’s success in getting allergy into the GP training curriculum.

Dr David Luyt has decided to step back from his role as Chair of SOCC with his pending retirement. David was a core member of SOCC before taking over as Chair in 2020. Under his leadership the group has published guidelines for the management of egg allergy, penicillin allergy de-labelling and pollen food syndrome in the UK. He has also overseen the commencement of a number of other guidelines that will be published over the next few years.

It’s time to renew the senior leadership of the BSACI. We are inviting expressions of interest

for a president elect, a treasurer and three vice presidents. It would be great to see applicants from outside the south-east, particularly from Wales, Scotland and Northern Ireland. I’d also like to encourage non-medical members to apply. There are an exciting range of vice president positions with responsibility for key strategic areas for the society. I, Fiona or one of the other current leadership team be very happy to talk about these with anyone.

Finally, an update on our BSACI re-structuring project. This aims to strengthen the leadership of the Society, streamline our processes and align them with the legal framework governing the Society. We have lots of helpful feedback. The

The BSACI re-structuring project aims to strengthen the leadership of the Society, streamline our processes and align them with the legal framework governing the Society.

current proposed structure is illustrated in the figure on page 17. We would be grateful for any additional feedback over the summer. The new structure will be formally presented at the BSACI Annual General Meeting in October.

I hope you all have a great summer. I look forward to seeing you all at our BSACI Annual Conference in Harrogate in October.

Ways to support BSACI

As a registered charity, there are lots of ways to support BSACI including making donations online, leaving a legacy, and corporate and industry support. You can now make a single donation or set up a regular donation by credit card or Paypal. When you donate online you can choose to leave a message and information about your donation but this is optional.

To find out more visit www.bsaci. org/about-bsaci/ways-to-supportbsaci/

Celebrating 75 years!

The British Allergy Society was formed 75 years ago in 1948, but did not have a constitution until it was written in 1951, at which time there were 40-50 members. At the same time the Royal Society of Medicine section of Clinical Immunology and Allergy was started up in 1965, by which time the British Allergy Society had 150 members. The Antibody Club was later incorporated to the British Allergy Society, thus being the roots of the British Society for Allergy & Clinical Immunology. Vera Walker was the first President in 1948. To mark this special occasion, we are celebrating our significant milestones and achievements over the years.

Past BSACI Presidents

Professor Graham Roberts

2018 – 2021 – Adam Fox

To me, the outstanding feature of BSACI is bringing together British allergy scientists which extends their ability to work together and produce results that they could not produce alone. Certainly, I made friends all over the country through BSACI.

One of my outstanding moments in BSACI is chairing a symposium to celebrate 100 years since the discovery of histamine.

Martin Church, BSACI member and Secretary from 1991 to 1994

Current President

Milestones and achievements over the past 75 years

BSACI is 75 years old, and since its inception many changes and achievements have occurred in the field of allergy. A timeline of these are listed below.

1948 - 1950

1948 The first meeting of the society took place on 24th January 1948 at St Marys Hospital, London. Over 40 people attended, and the British Association of Allergists was formed. Dr William Frankland was Secretary.

1961 - 1970

1969 The journal, Clinical Allergy was started with Professor Jack Pepys as editor which became Clinical and Experimental Allergy in 1989

1969 The society’s name changed to the British Society for Allergy & Clinical Immunology

1962 The Association changed its name to the British Allergy Society and became recognised as a charity

1981 - 1990

1951 - 1960

1959 The society hosted the 4th European Congress of Allergy in London

1957 Blair Macaulay became President

1954 Bruce Pearson became President

1953 At a two-day meeting at St Mary’s Hospital, London, there was a clinical pathological discussion on a case of asthma

1951 D A Williams became President

1971 - 1980

1975 The society arranged a European Congress of Allergy in London

1975 Dr Monica McAllen became President and introduced the first 3 day meeting which took place in Manchester

1990 Stephen Holgate took over President in 1990 and the first Jack Pepys Lecture was given by Professor R Coombs

1990 Led by Robert Davies, Barry Kay and Stephen Holgate there was a scientific meeting over three days in Edinburgh with abstracts published in Clinical and Experimental Allergy (CEA)

1989 Meeting in Edinburgh

1989 The format and name of the journal was changed and the newly named Clinical and Experimental Allergy included editorials, reports of meetings, review articles and scientific abstracts

1988 Robert Davies and John Warner planned the meeting which took place in Montpellier, linked with the French equivalent Society

1987 Robert Davies was made President and a joint meeting was held with the French Allergy Society in Montpellier

Stephen Holgate and Barry Kay in 1989

Dr William Frankland

1991 - 2000

2000 Annual Meeting in Nottingham

1999 Joint meeting with BSI in Harrogate

1998 BSACI became a registered charity

1998 BSACI/EAACI joint meeting in Birmingham

1997 Meeting in Nottingham

1994 Meeting in London

1993 Meeting in Nottingham

1990 Meeting in Glasgow

UK Fatal Anaphylaxis Registry (UK FAR) was founded by Richard Pumphrey in the early 1990s

2011 - 2020

2001 - 2010

June 2010 EAACI and BSACI conference at Excel London with over 8,000 delgates (one of the largest allergy conferences to take place)

2009 BSACI published Anaphylaxis during General Anaesthesia guideline

2009 BSACI published Drug Allergy guideline

2004-2008 Annual Meetings held in Loughborough

2001-2003 Annual Meetings held in Nottingham

2003 first issue of Allergy Update published

2002 BSI/BSACI Joint Conference in Harrogate

2001 Annual Meeting in Nottingham

2020 BSACI Annual Meeting took place online during the pandemic

2019 BSACI Registry for Immunotherapy (BRIT) was launched

2018 Spare Pens in Schools Website launched in partnership with Allergy UK, Anaphylaxis UK, RCPCH and Department of Health & Social Care

2017 BSACI Allergy Actions Plans for children were launched and an update published on the Immunotherapy for Allergic Rhinitis 2017 guideline

2017 BSACI published Peanut and Tree Nut Allergy guideline

2016 BSACI published Adrenaline Auto-Injector guideline

2014 BSACI published Cow’s Milk Allergy guideline

2015 BSACI published Beta-lactam / Penicillin Allergy guideline

2015 BSACI published Chronic Urticaria and Angioedema guideline

2011-2019 Annual Meetings held in Telford

2011 BSACI published Venom Allergy guideline

The BSACI has been a stalwart over the 30 years of my career. Their continually raising of standards and position papers has brought science based guidelines that one can be measured against. In addition, this professional network allows us to gain teaching, advice and appraisal by trusted colleagues. I thoroughly enjoyed submitting research, being a speaker particularly to the Allied Health groups and chairing at conference. All good experiences. We are very fortunate to have such a body as the BSACI. Retired BSACI member

2021 - present

Planning is underway for the next BSACI Global Allergy Online Symposium taking place in January 2024

Registration is open for the next BSACI Annual Conference in Harrogate in October 2023

2023 BSACI published the primary care Adrenaline Auto Injector Guidance

2023 The first BSACI Global Allergy Online Symposium took place

2022 BSACI published Pollen Food Syndrome/Oral Allergy guideline

2022 BSACI published the guideline Set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting

2022 WAO & BSACI UK Conference took place in Edinburgh

BSACI published the updated Egg Allergy guideline

2021 the National Allergy Education Strategy was launched

2021 the National Allergy Strategy Group (NASG) launched a report on Meeting the Challenges of the National Allergy Crisis at the Department of Health, Victoria

2021 BSACI Annual Conference took place in Harrogate

To read more about BSACI achievements over the decades, visit:www.bsaci.org/celebrating-75-years/ milestones-and-achievements-over-the-past-75-years/

Read the top cited articles in Clinical & Experimental Allergy, the official journal of BSACI: https://onlinelibrary.wiley.com/doi/toc/10.1111/(ISSN)1365-2222.top-cited-articles

Personal recollections of BSACI over the years

Andy Wardlaw BSACI member; President 2002-2006

Ifirst became aware of the BSACI in 1984 when I joined Barry Kay’s laboratory. At that time it appeared little more than an informal collection of asthma and allergy scientists. In 1990 led by Robert Davies, Barry and Stephen Holgate the profile of the society was raised with an AAAAI style scientific meeting over three days in Edinburgh with abstracts published in Clinical and Experimental Allergy (CEA). Initially a success the meeting flagged when in 1996 an attempt was made to go into partnership with the much larger BSI which overshadowed our small society at the time. However the experience gained in running a high-quality meeting allowed us to successfully host the EAACI Congress in Birmingham in 1998 which was a scientific and financial triumph providing the fiscal platform for a more professionally run society in later years. Up to the millennium the BSACI had given little thought to allergy services despite increasing awareness of the ‘allergy epidemic’. Dr Ewan prioritised lobbying of the Royal College of Physicians and the Department of Health to expand the number of trainees within the recently created speciality of Allergy.

By 2002 the society had a no permanent administration or office and a limited income. It needed a revamp. We were rescued by Jack Barnes a recently retired senior civil servant who took pity on us. Jack rented highquality office space from the British Thoracic Society and recruited Fiona Rayner to run the society. This was an inspired appointment as the success of the BSACI over the last two decades has been largely down to her excellent management. We wrote a new constitution which has stood the test of time establishing a number of sub-committees of Council including the very successful

Standards of Care Committee and a paediatric sub-committee to represent the burgeoning growth of the discipline. We also encouraged participation of Allied Health specialists. Chris Corrigan set about repairing the annual meeting by returning to the template established by Professor Davies which set the course for two decades of increasingly successful events. CEA continued to provide an international window for the society as well as underpinning its finances.

The BSACI has enriched my professional life, providing a wealth of friends and colleagues. It has transformed itself over the last four decades from an amateur club into a highly professional outfit with a growing membership and a contemporary outlook, although I still regret the passing of the old logo. Blessed with a steady stream of hard-working volunteers its promotion of allergy services has been of considerable benefit to the speciality and wider society. Not least amongst those stalwarts was Tony Frew whom I had known since we were undergraduates together in Cambridge. He exemplified the loyalty, commitment, selflessness, companionship and good sense that has guided the society so effectively over the years. Many others have put their heart and soul into the BSACI which has every reason to be proud of its achievements.

Deborah Marriage

Former Chair of BSACI Nurses Committee and BSACI Secretary

Istruggle to remember a time now before I became a member of the BSACI. I do remember a work colleague, Dr Joe Unsworth saying to me in clinic one afternoon in about 2008 ‘I’m not sure what your career ambitions are but the BSACI could do with some more nursing input. You’d be good, you should join’. I have no recollection at all of the order of these following events but I have two early memories; attending a conference, and joining the Nurses Group. My first

We asked retired and long-standing members to review their personal memories of BSACI and how it has changed over the years.

The BSACI has enriched my professional life, providing a wealth of friends and colleagues.

Andy Wardlaw

annual conference was in Nottingham and was a much smaller affair that it is today. My accommodation was a damp room with breakfast in a bag left outside the door each morning, and conference rooms were smaller and fairly crowded. My take home message came from a talk on FPIES (which I had never heard of and thought I would never see) but lo and behold, the very same year I was able to make our first departmental diagnosis. I also attended EAACI in 2010, where in an attempt to meet people I made the mistake of getting on the German bus for dinner which was a definite challenge to my linguistic skills.

who met in Regent’s Park. As allergy became more prevalent and more scientific the society gradually grew and the Annual Meetings did so too. We moved to Derby, then Nottingham for a few years, followed by Loughborough, Telford and finally Harrogate. Membership increased into four figures, evolving to include not only adult physicians, but paediatricians, dermatologists, nurses, chest physicians, dietitians, ENT surgeons and immunologists. Primary care membership was encouraged, particularly during the presidency of Steve Durham, when the realisation that the burden of allergy was so great that it needed to be dealt with much more widely.

Deborah Marriage

I then spotted a call for Nurses’ Group members. I was desperate for collaboration and, despite being employed as an asthma CNS, was keen to evolve my role to include the allergy work I had enjoyed when working with Gideon Lack at St Mary’s. Being involved in the Nurses’ Group was so valuable (thanks Joe for the tip off), allowing me to get properly involved in the BSACI and to meet new work colleagues who are now friends. The group inspired me. I became Chair of the Nurses’ group alongside fantastic colleagues and we were proud to be part of a collaborative national BSACI nurses’ audit on the use of Adrenaline Autoinjectors , given the Barry Kay award in 2017. BSACI has given me many things over the years which include knowledge, and confidence in my work. Currently, I am involved with SOCC, the BRIT Registry, and am a Trustee.

Glenis Scadding

BSACI President 2009-2012 1947 was a very good year. It saw the inception of the NHS and the BSACI, plus the arrival of Windrush and me. In that year Vera Walker, an ophthalmologist, contacted John Freeman about initiating an allergy society. The resulting British Association of Allergists (now BSACI) first met in 1948, the speakers being Sir Henry Dale and Dr Freeman. Dr A W (Bill) Frankland was the first Secretary, over 50 members joined. .

By the time I had taken up Allergy as my specialty, the BSACI was still a small organisation run by Sue Duff part-time in her spare bedroom. The Annual Meeting consisted of a few (mainly adult) allergists

The BSACI is now a wonderfully broad church and all the better for it. Some of our most successful meetings have been in conjunction with other societies: the BSI, EAACI and the WAO. A memorable one for me was in Glasgow when we first joined with EAACI. The opening ceremony involved Barry Kay and Robert Davies wearing kilts and, I think, attempting toss the caber. My concentration and therefore memory, was a little diluted by the worry of having arrived plus husband and 3 children and finding that we had nowhere to stay. Fortunately we found a family room in the attic of the very central Railway Hotel. The most memorable was the next time we collaborated with EAACI in London in 2010, when I had the honour of being BSACI President. Tony Frew devised a wonderful spoof of James Bond for the opening ceremony in which I was M. The video included the chase along the Thames, absolutely appropriate, since the meeting was in the riverside Excel centre. The massive opening ceremony audience had been given flags to wave and this they did with gay abandon, especially to the strains of Land of Hope and Glory. It was Allergy meets the Last Night of the Proms. A close second in memorability was the sight of Shuaib Nasser driving a delighted centenarian Bill Frankland round and round on the dodgems in Telford. Bill, whose trial was the first to prove efficacy of allergen immunotherapy and Harry Morrow Brown, another elder statesman who did great work in showing that eosinophils in sputum predict corticosteroid responsiveness, are much missed, as is Barry Kay, who demonstrated the inflammatory nature of asthma and co-edited the journal Clinical and Experimental Allergy for many years. All are remembered by named lectures and prizes at BSACI meetings.

The BSACI is now a wonderfully broad church and all the better for it. Some of our most successful meetings have been in conjunction with other societies: the BSI, EAACI and the WAO.

Glenis Scadding

BSACI has given me many things over the years which include knowledge, and confidence in my work.

Integration also happened with patient organisations such as Allergy UK and the Anaphylaxis UK, thus widening the ability to get messages out, not only to medical staff but also directly to those affected by allergies. This linkage has been successful over many years thanks to stalwarts such as David Reading, then Lynne Regent at Anaphylaxis UK (Formerly Anaphylaxis Campaign); Muriel Simmons and then Carla Jones at Allergy UK. Recently the Harrogate auditorium was the scene of a very moving opening session on the death of Natasha EdnanLaperouse with brave contributions from her parents.

My presidency was marked by getting the BSACI into a home of its own. This was necessary as the always excellent Fiona and her staff had coped valiantly with 3 moves from various rented business premises in 18 months, which was extremely disruptive. Fiona, Richard Powell (then Treasurer) and I visited several possible locations, but were very taken with the space and light at the top of the current building in what became very fashionable Battersea. I hope that the staff are still happy there, although I understand that the roof did need expensive repairs. Sadly, my suggested solar panels never came to fruition. However, I suspect and hope that the BSACI will remain a beacon of good allergy practice and of good collaboration, cooperation and friendship in future years and I wish it well for its centenary.

John Warner

Former Chair of BSACI Paediatric Committee

My path into allergy started at a very early age because my mother had eczema, asthma and hay fever which improved dramatically after she received pollen allergen immunotherapy in the 1950’s. This was, of course, due to Bill Frankland’s publication describing the world’s first double-blind trial demonstrating the efficacy of pollen immunotherapy.

It was, therefore inevitable once I commenced research into the pattern of asthmatic responses to house dust mite challenge and the impact of allergen immunotherapy, that I would seek membership of BSACI. Having the opportunity to meet, amongst many others, Bill Frankland, Jack Pepys, and Roger Altounyan was very compelling. My initial memories were of friendly and supportive twice yearly 1-day scientific meetings which led to many research collaborations and life-long friendships. However, coming from paediatrics, I found myself in a minority group with meetings dominated by allergists from adult medicine. How things have changed!!

After an intense discussion with Roger Altounyan about my research during a meeting he asked me about my next career step which was to complete clinical training. He was concerned that I should extend my research. Two months later he phoned me and said he had fixed an appointment for me to work with Freddie Hargreave (1938-2011) in Hamilton Ontario. While in the end I did not takeup the offer it is a fine example of the support evolving from membership.

During the International Congress of Allergy and Clinical Immunology (ICACI) triennial meeting held in London in 1982 and organised by BSACI I was tasked by Robert Davies (the co-chair with Jack Pepys) to be the press secretary. The meeting was a great success and was followed by IAACI evolving into the World Allergy Organisation.

Subsequently I became the secretary of BSACI during the period when Robert Davies was the president. He and I planned the first annual 2-3day meeting. He and I also linked with the French equivalent Society and we arranged a joint meeting in Montpellier in 1988 through Jean Bousquet and Professor FB Michel. I decided to hire a plane to transport BSACI members to Montpellier thereby reducing costs of the flight. We gathered at Gatwick in the early morning and were taken to an elderly Dan Air plane sometimes known as a flying coffin. Several of our members elected to not proceed but the majority were persuaded to continue with my offer of champagne which I rapidly purchased from duty-free. The flight to Montpellier was uneventful and was fondly known as “Allergy 1”. However, the return created a memorable experience. On reaching cruising altitude a highpitched whistling sound caused alarm. It was attributed to a leak around a door seal and the crew attempted to stuff Jiffy cloths into the seal without success. The rest of the flight was at low altitude to reduce the air leak. Gavin Boyd, the then treasurer of the BSACI, observed that it was interesting to fly through rather than over the Alps. Following our safe return, I complained to Dan Air which refunded part of the costs to the benefit of the society.

The BSACI has gone from strength to strength.

It is gratifying to see the large numbers of paediatricians who have not only become members and presented high quality research but also now have leading roles guiding its future.

John Warner

From my perspective, it is gratifying to see the large numbers of paediatricians who have not only becoming members and presented high quality research, but also now have leading roles guiding its future.

Isabel Skypala Chair of BSACI Standards of Care Committee

Ihave worked in adult allergy for over 30 years, encouraged and enabled by my mentor, Professor Stephen Durham. In 2000, I set up the food allergy specialist group of the British Dietetic Association and was keen for more dietetic involvement in the BSACI since I had become a member. I went to meet the then President Andrew Wardlaw to discuss this and he co-opted me onto Council. This enabled me to lobby for a reduced meeting fee and membership fee for dietitians, and because I was on the programme committee, I could also help to promote food allergy to be included in conferences. The BSACI then was a small close-knit community and although it is much larger now it still has a very close and collegiate approach. I feel that the BSACI has promoted and supported dietitians in the UK to become very specialized and able to work at a high level. I cannot now remember the exact date of my first BSACI conference, but it was during Andrew Wardlaw’s presidency, and was held in Loughborough. It was very exciting, meeting and mixing with likeminded people, and I was made to feel very welcome and valued. The meeting and subsequent involvement in the BSACI paved the way for some great and lasting friendships.

Chris Corrigan Former BSACI Honorary Officer

Little did I know, when I first tapped on the office door of a certain Professor Barry Kay at the National Heart & Lung Institute at the Brompton Hospital back in the early 80s hoping to be given a research registrar post, that with his help I would embark on a long, fulfilling and, I trust, productive relationship with all of the BSACI colleagues that I have met and worked with since. At that time, Allergy was a medical speciality in the throes of birth, with help offered to a few patients in major centres and pioneered by visionaries such as Jack Pepys and

Bill Frankland. Jack Pepys was already well known for his work at that time: the picture below, from the front cover of the September 2001 issue of Journal of Allergy and Clinical Immunology, shows one of the many simulated occupational challenges he developed at the Brompton Hospital during the 1960s. With Barry Kay’s foresight, and alongside people like Jack and Steve Durham, Allergy pioneers all, I was inspired to devote my research career to the pathogenesis and management of asthma, and my clinical career to the management of adult allergy.

At that time, the speciality of adult Allergy had no training curriculum or trainees; those entering the profession inevitably did so after training in related specialities such as Clinical Immunology. After establishing my career with Barry, who was President of the BSACI between 1993 and 1996, I moved on to Guy’s Hospital and King’s College London to work with another lifelong friend and colleague, Tak Lee, who succeeded Barry as BSACI President between 1996 and 1999. At that time our research nurses, under the supervision of Tak, myself and other colleagues such as Lawrence Youlten performed allergen immunotherapy for pollen-induced allergic rhinitis and our Allergy service began to take shape. Still no specialist trainees, though, so one day I decided to bite the bullet and compose a training curriculum for Allergy specialist trainees which was eventually acknowledged and ratified by the Joint Committee on Higher Medical training at the Royal College of Physicians. Allergy training and assessment was born, and with the support of the Trust I was able to recruit our first ever adult Allergy trainee, Sophie Farooque. Sophie was the first of very many trainees who have become my dear friends and colleagues and who have enhanced and enlarged the reputation, solidarity and database of the BSACI and gone on to become trainers themselves. Many, such as Leonard Siew, Prathap Pillai and Joanna Lukawska have also undertaken basic research under my guidance, broadening and enhancing expertise and resources for the diagnosis and management of Allergic diseases. The BSACI has remained pivotal in this process as a central hub of expertise, innovation and encouragement, bringing experts together at annual meetings, promoting research through grants and rewarding innovation through many initiatives such as the Barry Kay Award, travel fellowships, a Paediatric Group, a Primary Care Committee, a Standards of Care Committee, a Nurses in Allergy Committee and a National Allergy Strategy Group, to name but a few, and the continuing expansion of its journal, Clinical and Experimental Allergy, a forum for the progress of Allergy research and management. I was fortunate to be nominated for two other beacon initiatives of the BSACI, the Jack Pepys Lecture, a spotlight for outstanding basic research in the field of

asthma and Allergy, and the William Frankland Award for the forwarding of Allergy care, both presented at the BSACI annual meeting. The second attached picture is from the BSACI Annual general meeting report in 2013, held in Telford. This was the year when I received a trophy for delivering the Jack Pepys lecture, presented to me by Sir Mark Pepys, and my great friend and colleague Adnan Custovic received the William Frankland Award, presented by Bill Frankland himself.

I served the BSACI Organising Committee as secretary for the allotted time span, but was also famous (or perhaps infamous) for another duty I inherited and performed for many years at the Annual BSACI Meeting: that of responding to the President’s After Dinner Speech. Many of my colleagues will recall my loud and sometimes lascivious ramblings which, to be fair, frequently left the participants in stitches. One firm favourite was the story of the patient who visited his Allergist: ”Doc, doc, every time I drink a cup of coffee with milk I get this terrible pain in my nose. Is it an allergy?” To which his Allergist replied: “I don’t know. Have you tried taking the spoon out of the cup?”

Carla Jones Chief Executive Office, Allergy UK

It has been a privilege to be CEO of Allergy UK over the last 8 years. There have been challenges along this journey, but many positive achievements I am proud of too.

We’ve focused on developing the charity’s credibility and excellence, which has only been possible with Amena Warner, our Head of Clinical, alongside. Our Dietitian Service - launched following a need we identified through our Helpline calls - has improved the quality of life for over 1600 families living with

food allergy. Our successful Masterclasses for primary care, have provided allergy education for thousands of healthcare professionals.

We’ve raised the profile of the lived experience of allergy through our Allergy Hero Awards, where the public are invited to nominate ‘heroes’ who have supported people living with allergy, our national Allergy Awareness Weeks, and our wide range of excellent education and advice resources. This includes leading on the European School Allergy Awareness programme, which received an award from EAACI, and since then our Model Schools’ Policy in collaboration with the BSACI and Anaphylaxis UK.

We continue to be involved in national, European, and international guideline development, research and consultation, and have held roles as Co-Chair of the National Allergy Strategy Group and been CoChair of the EAACI Patient Organisation Committee (2018 to 2022). I was privileged to be elected President of the European Federation of Allergy and Airways Diseases Patient Organisations’ Associations (2021 to 2023) representing 45 patient organisations across 26 countries Europe-wide at European Parliament.

We will continue to work to ensure those affected by all allergies receive the support and care they need. Research projects such as the Allergy Nurse in primary care research, led by the University of Edinburgh and funded by Allergy UK, our 2021 survey on attitudes and perceptions of allergy among the UK population, and our patient and clinician focus groups culminated in the creation of our “Patient Charter for People Living with Allergic Disease”, launched in Westminster in May 2022. The Patient Charter vision of The Right to A Quality Standard of Care, The Right to Accurate Information and Education and The Right to Equality in Society will continue to inform our advocacy campaigning, such as recent Westminster debates on the unmet need of allergy.

Only by joining together can we achieve our collective goal to improve the lives for all living with allergy in the UK. Thank you for your support during my leadership.

Looking back... 75 years of BSACI

Left: Tony Frew and Shuaib Nasser

Right: Tony Frew, Isabel Skypala and Bill Frankland,

Right: Country dancing at BSACI Conference 2017

Below: Silent disco at Annual Meeting 2018

Above: Adam Fox and William Frankland

Above: Annual Meeting 2015

Left: WAO & BSACI Conference 2022

Above: Annual Meeting 2015

Below: Annual Meeting 2016

Below: Motohiro Ebisawa, WAO President and colleagues

Above: Tak Lee receiving his CBE

Right and below: Professor Jack Pepys and his laboratory, circa 1930

Above: Pam Ewan and Fiona Rayner WAO & BSACI Conference 2022

Right: BSACI Nurses’ Group, Annual Meeting in Telford

Below: Annual meeting 2005

Below: Annual Meeting in Loughborough

Left: William Frankland

Above: Annual Meeting 2017

Right: Chris Corrigan as auctioneer

Above: Annual Meeting 2019 Right:Annual Meeting 2013

Looking back... 75 years of BSACI

Above: 1998 BSACI/EAACI joint meeting in Birmingham

Left: Pam Ewan awarded CBE for services to medicine.

Right: Annual Meeting 2021

Our new organisational structure that will strengthen the society in the future!

Fiona Rayner Chief Executive

BSACI developed an ambitious three-year strategy when Professor Graham Roberts took up the role of president, however to be able to deliver it, we needed to have the right structure in place. During Adam Fox’s presidency it was agreed to widen the structure to include in total four Vice President positions. Each one would have their own portfolio and would all be trustee positions, as our

governing rules state we can have up to seven trustees. Currently we are appointing for three Vice President positions, a fourth (we hope) will be ratified at the AGM in October.

Council had grown over the years to over 30 members, therefore we felt it was time to review its structure also to ensure it was a fully representative body of those who serve the allergy community. In December 2022 we met with Council and brainstormed ideas on how we could achieve this. We also appointed an external consultancy who helped advise us through the process by providing sensible advice when we needed it.

Going forward it was agreed there will be a defined board of eight trustees who will be overall responsible for the society. Council will be a consultative body where discussions take place maxi-mizing the voices of those whom council represent. The seven Sub- Committees have been re-designated as Special Interest Groups, the Chairs of which will sit on council, along with the

Neha Christian, BSACI Junior member

Like many others, I happened to chance upon the nuance field of Allergy. With increasing prevalence of allergic conditions, no out-of-hours work, scopes of research activities and excellent work life balance, allergy seemed fit to pursue as a speciality. Practising allergy is a skill acquired by experience and hence is an art with an allergist being a skilled artist armed with scientific evidence-based knowledge. Interesting and challenging cases never stop to surprise you and each case requires fresh thinking. You learn to think as an allergist, which

four Chairs of the Standing Committees and eight members of the Board of Trustees.

The BSACI also have a number of working groups, which are set up to address a specific area of need with a view to completing their tasks within a set period of time (usually 1 to 3 years). Each have their own ToRs and a clearly defined goal. As we start to move into the implementation stage I would like to thank everyone on Council who has worked hard in developing this new framework and to say there are exciting times ahead!

is the most satisfying part as a clinician. New research is revolutionising the management of food and drug allergies, making it an exciting speciality to be a part of. As a trainee, BSACI has been instrumental in helping me acquire the skills and knowledge I require as a trainee.

They have diligently organised high-quality allergy education and invested heavily in the education and training of all healthcare professionals. BSACI has supported trainees with feedback received well and changes made where necessary. I look forward to being a BSACI member for many years to come.

An organogram showing the proposed new sructure of BSACI

BSACI members greatly missed by friends and colleagues

Harry Morrow Brown 1917-2013

Dr Harry Morrow Brown pioneered the use of inhaled steroids in the 1970s, leading to the development of beclomethasone (Becotide). Dr Morrow Brown remained an active participant at the BSACI Meetings throughout his working life and during his retirement and passed away in 2013. He left the society a bequest in his will to establish an international or national paediatric focused lectureship with emphasis on the practical application of scientific research to clinical practice, bridging the gap between the laboratory and the clinic.

William Frankland 1912-2020

Dr Alfred William Frankland, the “grandfather” of clinical allergy in the UK, died at the age of 108. He was respected worldwide for his contributions to allergy

and particularly for his pioneering work on allergenspecific immunotherapy which has improved the quality of life of patients with severe hay fever and other allergic diseases. He received many honours over his lifetime, the highest one was in 2015 when Bill was recognised in the Queen’s Birthday honours list and awarded an MBE by HRH The Duke of Cambridge. The allergy unit at St Mary’s Hospital was named after him and in recognition of his accomplishments, BSACI named an award in his honour ‘The William Frankland Award’ which has been presented each year at the BSACI Annual Meeting since 1999 to those who have provided outstanding services to clinical allergy in the UK. Rarely can a single figure have been so influential in an institution and the fostering of a clinical discipline to the extent that Bill Frankland was. He was a legend in his own lifetime and many allergists of several generations have benefitted greatly from his wisdom and experience, not to mention his admirers from all over the world, including patients and colleagues.

Anthony J Frew 1955-2018

Professor Tony Frew was one of the leading members of the UK allergy community. He oversaw and expanded an active clinical practice in acute general internal medicine, respiratory medicine and clinical allergy. He served on the BSACI Council from 1993 until September 2018, including two terms as Treasurer and three years as Secretary and became BSACI President in 2012. In 2016, in recognition of his outstanding contribution to UK clinical allergy, he was chosen by the BSACI membership to receive the William Frankland Award and in the following year elected by the membership to deliver the prestigious Jack Pepys Lecture at the BSACI Annual Conference

William Frankland and Dr Claudia Gore in October 2018

Looking Tributesback...

in 2017. This award is presented to those who have made outstanding contributions to the science of allergy and clinical immunology internationally. Tony is one of the few people to have received both of the highest honours bestowed by the Society.

Barry Kay 1939-2020

international contributions to the field of allergy and asthma. The award is presented each year at the BSACI Annual Conference to those whose abstract has been judged outstanding in the category submitted.

Tak Lee 1951–2022

Professor Lee studied Medicine at King’s, graduating in 1975. He had a pioneering career in medicine across three continents, and is remembered for his breakthroughs on treating allergies and dedication to his patients. His commitment led to a number of awards and accolades, including a CBE appointed by the late Queen Elizabeth II in her Birthday Honours List of 2012. Tak was BSACI President from 1996 -1999. He was a great friend to BSACI members and an inspiration to so many and is greatly missed.

Professor Barry Kay died in 2020 after a long illness. Barry was Head of the Department of Allergy and Clinical Immunology, National Heart & Lung Institute, Imperial College London and the Royal Brompton Hospital Allergy Clinic from 1980 to 2004. Latterly he was Professor Emeritus at Imperial. He was a past President of the BSACI (1993-96) as well as a past President of EAACI. His professional achievements in the field of Allergy and Asthma were considerable. Each year delegates are invited to submit an abstract to be considered for the Barry Kay Award which recognises Professor Barry Kay’s national and

It is just over five years from the time I invited Prof Jörg Kleine Tebbe to London with a series of lectures.

As a part of his visit he met and interviewed Dr William Frankland the last person who worked with the fathers of immunotherapy Dr Leonhard Noon and Dr John Freeman. That interview served as a symbolic link of generations of allergists.

Unfortunately both colleagues are no longer with us, we will keep their legacy and remember them. We thank them for the contribution they made to the allergy science, medicine as well as to health of many thousands of allergy sufferers.

Professor Michael Rudenko

Dr William Frankland and Prof Jörg Kleine Tebbe

Allergy in the military

The UK military has relatively strict requirements which ensure that recruits and serving personnel are medically fit to meet the diverse challenges involved in military service, including unpredictable and substantial physical and psychological stress often at short notice and away from easy access to medical care in an emergency. Consequently they are very careful in their assessment of people reporting certain medical conditions and there is a Joint Service Manual of Medical Fitness (JFP 950 6-7-7) to provide guidance in which conditions are acceptable, which are not, and which might be in certain circumstances.

Unsurprisingly many young people wishing to join the military

report allergic disease, either currently or earlier in their life. Many of these may obviously be suitable or unsuitable for military service according to JFP 950 6-7-7 (https://data.parliament.uk/ DepositedPapers/Files/DEP2019-0604/Joint_ Service_Manual_of_Medical_Fitness.pdf), but some require specialist allergy assessment to confirm the diagnosis, establish whether it is ongoing or resolved, what treatments might be required (and what the consequences would be of treatment being unavailable), and some discussion of the risk of exacerbation might be and what factors would influence it.

A working group has been assembled to develop guidance to help standardise the approach to these individuals between allergy services around the country. A document is under development to provide some guidance for allergists. An important focus will be on what the military requires from an allergy assessment – we often think of straightforward factors such as the requirement for adrenaline autoinjectors, but in fact a more detailed discussion of risks is more helpful. There are also ethical considerations –should we perform oral food challenges in people with significant sensitisation but mild reactions previously? Ordinarily we might suggest avoidance but are occupational implications sufficient to justify a higher-risk challenge? Is this balance different between aspiring recruits and existing service personnel?

We hope the final document will facilitate standardisation of allergy assessment between allergists and centres to provide confidence to allergists and to provide the military with assurance that assessment from any allergist will be of equivalent value in making decisions regarding recruitment, retention, and deployment.

Finally we are very grateful to Tony Frew who began the discussion of these issues some years ago.

The BSACI webinar in March 2023 covered some of these issues in more detail, and it can be found at www.bsaci.org/education-and-events/ webinars/2023-webinars/

Andrew Whyte Consultant in Allergy and Immunology, University Hospitals Plymouth NHS Trust; Chair of Allergy in the Military Working Group.

Primary Care

GP with Extended Role (GPWER) framework

We are pleased to announce the successful completion of the GP With Extended Role (GPwER) framework which has now been endorsed by the Royal College of General Practitioners (RCGP). The document contains key elements of competencies for GPs working in Allergy and is based upon both the prior Respiratory and current Dermatology GPwER frameworks. The document will be available on the BSACI website in Autumn 2023.

The document was led by Dr Liz Angier who, along with other colleagues, led work which resulted in the inclusion of Allergy into the RCGP

curriculum. The framework refers to resources such as the EAACI competencies for health care professionals and has been reviewed by Primary Care and Specialist BSACI members before submission.

For the scheme to be successful we will need Specialist colleagues with an interest in education to support GPs undertaking accreditation. The current Dermatology framework involves an accreditation scheme run by the British Association of Dermatology; we aim to trial this approach with a couple of pilot GPs through the project towards the end of the year. The document may also be of interest to GPs more generally and is likely to be advertised by the RCGP who have already included reference to it on their main website.

Resources such as the recent adrenaline prescribing guidance, signposts to other guidelines of relevance to Primary Care, and frequently asked questions will be available on the BSACI website.

We hope to create a UK map of GPwERs and link them to the Paediatric and Adult networks

New GP guidance

to encourage networking and shared care where necessary. Integrated care systems will be looking at system-wide delivery of health care. Primary care networks, often seen as the frontline delivery units of the system, may want to consider employing GPwERs or looking at dual employment between practices and hospital clinics for shared learning. Models of care may vary across the country with some GPs working remotely from home, some in clinics, and some in the community.

We are not aware of another framework of this kind in place throughout Europe, so this may be of interest to other healthcare systems. We are aware that we have good examples of GPs being supported in hospital clinics and other areas, however, there have also been some GPs who have completed further training such as diplomas and MScs who have struggled to find a place to work or units to link to. We hope this process may help facilitate such linkages, the sharing of good practice, and lessening of the isolation that colleagues in the community may feel.

There will be a BSACI webinar in November which will cover this new accreditation process alongside details on the IQAS accreditation system. We see this new GPwER accreditation as a companion to IQAS. Increasingly, GP colleagues look to work in specialist fields and this document creates a pathway to enter working in Allergy with clear governance and demonstration of learning and competencies. We anticipate an increase in GPs taking up such work which will assist the workforce crisis in Allergy.

Dr Matt Doyle, who will be one of the first GPs to undergo the accreditation, said “this is an important step in improving the governance for Primary Care colleagues who wish to develop a specialist interest in Allergy and I welcome the opportunity to take part”.

The Adrenaline auto-injector prescription for patients at risk of anaphylaxis: BSACI guidance for primary care is available on our website at www.bsaci.org/guidelines/ primary-care-guidelines/

The guidance has been written for a primary care healthcare professional managing a patient who has either experienced anaphylaxis or a milder allergic reaction where they may be at risk of anaphylaxis in the future. To view the letter in Clinical & Experimental Allergy visit https://onlinelibrary.wiley.com/doi/10.1111/cea.14325

Liz Angier

Portfolio GP, NHS Hampshire, Southampton and Isle of Wight CCG

Supporting your Society now and in the future!

My lawyer daughter, Rosie, who once worked briefly in the BSACI office, tells me that it is a crime to die intestate. Confronting one’s own mortality is rarely pleasant, but is necessary for the benefit of those left behind. Making a will is best done early, with expert advice.

Glenis Scadding Honorary Associate Professor, Department of Infection and Immunity at University College London

Leaving bequests to charities is a good way to be happily remembered and is tax efficient. The gift itself is taxfree and charitable gifts can reduce inheritance tax payable on the rest of your estate. If you give at least 10% of your taxable estate to charity, the inheritance tax rate for the remainder falls from 40 to 36%.

As a charity, the BSACI receives no money from government but relies on the support of members and sponsors in order to carry out our

objectives to improve allergy care via education, training and research. Having grown from a small organisation run by Sue Duff part-time in her spare bedroom – we now have our own office, over 1000 members, an excellent journal, meetings and guidelines which are highly respected worldwide. Our staff now number 9 and soon to be 10 and all are working hard. We need to build on this firm base: producing further guidelines, increasing the size of our meeting whilst maintaining its scientific

and clinical validity, continuing to educate allergy and immunology trainees and primary care practitioners and helping to support the National Allergy Strategy Group. In order to accomplish all this, we need guaranteed future funding.

Previous legacies have enabled us to have named lectures, these not only educate, but also remind us of our history and of old friends.

With this in mind, I would like to make an appeal for your help. If you have thought about leaving money to a charity in your will, perhaps you might consider a legacy to the BSACI? A pledge of your continuing support would safeguard the Society’s aims and help us to plan for the future with confidence.

Please email fiona@bsaci.org for more details about leaving a legacy to BSACI. Whatever type of legacy you may decide to leave to the BSACI, it would be very gratefully received.

Online learning and development

Webinars and Grand Rounds

Our webinars are organised by the BSACI Council with the aim of offering high quality, conveniently accessible education on key allergy topics for our members. The speakers are all experts in their respective fields. Webinars take place every two months, usually on the last Monday at 5pm. If you have any ideas for future topics, would like to deliver a session or have any feedback about previous sessions, please get in touch with Dinusha Chandratilleke on info@bsaci.org

Grand Rounds are organised by the BSACI Paediatric Allergy Committee (PAC) and are held every month. Each session will begin with an interactive journal club followed by case presentations including Q&A session.

BSACI members can attend the live Webinars and Grand Rounds or access the recordings after the event. To do this, log in to your BSACI account at www.bsaci.org/account/ - click on Education and Events and select Webinars or Grand Rounds from the dropdown menu.

Welcoming you back to Harrogate...

Dr Nandinee Patel

BSACI Scientific Joint Programme Lead

We are excited to welcome you back to Harrogate for this year’s annual conference on 5th7th October. As we are celebrating 75 years of the BSACI we will be celebrating significant milestones throughout the conference programme. The planning committee has put together an exciting programme which you can view on the Annual Conference website www. bsaciconference.org

Dr Natasha Gunawardana BSACI Scientific Joint Programme Lead

Highlights include Speakers Corners - the most influential figures in UK Allergy taking us through the breakthroughs that have been made in allergy over the past 75 years; introducing a number of ‘10 minute rapid fire’ sessions; more practical workshops than ever before; poster walks; showcasing education projects and celebrating ‘Excellence in Allergy

Care and Research.’ There will be plenty of opportunity to network with allergy experts from across the globe and social occasions including a

Welcome Reception and a unique Gala Dinner. Thank you to our planning committee, patient charities, industry partners and all those who are contributing to making our conference successful. We look forward to seeing many of you in Harrogate. If you haven’t done so already, please register at www.bsaciconference.org

Follow us on Twitter @BSACI_Allergy #BSACI2023

Early Bird registration closes Monday 31st July – register now!

www.bsaciconference.org/registration

Book your tickets for the Welcome Reception and Gala Dinner

www.bsaciconference.org/meetinginformation/

Our first Global Allergy Online Symposium is a huge success!

On Friday 10th February, BSACI hosted a Global Collaborative Online Symposium to celebrate our 75th Anniversary. The unique symposium was supported by our international partner organisations WAO, EAACI and AAAAI, covering ‘CLINICAL ALLERGY: STATE OF THE ART 2023’. The programme included a WAO session on Drug Allergy, EAACI session on Environmental Impact on Allergy, BSACI session on Challenges in Allergy and AAAAI session on Immunotherapy.

In the Keynote lecture, Professor Sir Stephen Holgate discussed effective interventions on the environmental causes of allergy and what we can do as an allergy community, based on a recent landmark global workshop hosted by King Charles III in Scotland.

Attracting delegates from all over the world, we

were delighted to work with our global partners to develop an exciting programme and build closer collaborative initiatives, to share world class knowledge for the benefit of the global allergy community. Registration included access to the talks on demand for a month after the event.

We shall be working collaboratively with our global partners again to deliver a Global Online Symposium on Friday 26 January 2024. DON’T MISS IT!

THE EVOLUTION OF ASTHMA MANAGEMENT: A BRIEF OVERVIEW

Dr Shuaib Nasser, Consultant in Allergy and Asthma, Cambridge University Hospitals NHS Foundation Trust, UK

Over the last 100 years asthma management has evolved considerably, thanks to increased understanding of the mechanism of disease and identification of new treatment targets. Here, we explore some of the key milestones that have shaped our understanding of asthma pathogenesis and the evolution of our approach to disease management in patients, from adrenergic bronchodilators to a new era of precision therapy.¹

“Prescientific” era [Pre 1930] First descriptions of asthma were recorded

With thanks to Prof Ian Pavord & Dr Simon Couillard for the original work of which this was adapted from.

1.

Asthma diagnosis and management were initially based on patient symptoms alone, as observed by the first description of asthma from Aretaeus of Cappadocia, a Greek physician. He described asthma as chest heaviness, difficulty breathing, tiredness and cough symptoms.2 Later, Sir William Osler further identified asthma as a spasm of the bronchial tubes and swelling of bronchial mucus membranes, closely related to hay fever. Asthma was also identified as disease beginning in childhood, with a possible genetic component.3 In the early 1900s, intrinsic and extrinsic asthma, now known as non-allergic and allergic asthma, were also described.4 Treatments during this era were focused on tackling symptoms rather than underlying disease. Direct adrenergic bronchodilators were one of the first treatments introduced for relief of asthma attacks.1

“Physiological” era [1930–1970]

Asthma diagnosis moved away from symptoms alone

Scientists gained improved understanding of how asthma affects the bronchial tubes and focused research on treatments that delivered bronchodilation for patients. Nebulised epinephrine was one of the first treatments to demonstrate effective bronchodilation for patients with asthma and emphysema.5 The role of eosinophils in asthma and immunoglobulin E (IgE) in mast cell activation were also discovered during this time.6,7 Once activated, mast cells were found to produce histamine which has a role in the asthmatic response.6 Short-acting ß2-agonists (SABAs) were recommended as an initial treatment for mild asthma.8,9

“Immunological” era [1970–2000]

Development in understanding of asthma inflammatory pathways

Further understanding of eosinophils and interleukin-5 (IL-5) led to a better understanding of patient responses to corticosteroid treatment, with eosinophilic and non-eosinophilic asthma described.6,10 These two inflammatory phenotypes were further characterised to identify different structural, physiological and clinical characteristics for each group.11 Systemic corticosteroids were the standard therapy for the treatment and prevention of asthma exacerbations.1 Inhaled corticosteroids (ICS) were first launched in 1978 and were found to reduce airway eosinophils, mast cells and inflammation.3,9 Leukotriene receptor antagonists (LTRAs) are approved for treating chronic asthma.12,13

“Phenotypes” era [2000–2010] Definition of asthma phenotypes

The phenotypes era saw the clustering of clinical phenotypes of asthma based on genetic and environmental factors.14 Antileukotriene and anti-IgE treatments specific to known endotypes of asthma were developed.1 In 2003, the first biologic therapy targeting IgE was approved as an add-on therapy for adults and children ≥6 years old with moderate-to-severe allergic asthma.15

“Endotypes” era [2010–2020]

Evolution of asthma endotypes

Asthma was classified by endotypes based on mechanisms that drive the disease phenotype. These included early onset allergic, late onset eosinophilic, exercise-induced, obesity-related, and neutrophilic asthma.16,17 Blood eosinophil counts were identified as predictive biomarkers for asthma exacerbations and responsiveness to ICS18, and precision medicine management approaches driven by patient phenotypes and endotypes were proposed.19 Clinical studies highlighted a clearer understanding of the role of eosinophils in the pathogenesis of severe exacerbations of asthma, and the role of thymic stromal lymphopoietin (TSLP) in asthma was first investigated.20,21 Anti-eosinophil agents such as IL-5 receptor and prostaglandin D2 receptor antagonists were found to reduce sputum eosinophilia.17 Short- or long-acting muscarinic antagonists (SAMAs/LAMAs) recommended as an alternative or add-on controller.8,22

“Epithelial” era [2010–Present]

New understanding of epithelial science

There is a growing understanding of the airway epithelium and epithelial cytokines. Associations between epithelial cytokine polymorphisms and asthma have been identified23–25, in addition to establishing the different components of type 2 inflammation from biomarkers26 to fractional exhaled nitric oxide (FeNO) and blood eosinophil counts.27,28 This precision treatment era has seen the more targeted treatments, including short- and long-acting ß2-agonists (SABAs/LABAs), used in combination with ICS, to relieve bronchoconstriction, improve asthma control, and prevent exacerbations. In the 2018 Global Initiative for Asthma (GINA) guidelines, ICS/LABAs are considered the first choice maintenance therapy for patients with moderate-to-severe asthma.8 More recently, therapies targeting TSLP are being developed due to the potential to treat more diverse phenotypes and endotypes of asthma.29,30

Am J Respir Crit Care Med. 2005; 171:1202–1208;

History of asthma (part 1). 2017. https://asthma.net/living/history-of-asthma-part-one-in-the-beginning [Accessed June 2023];

Allergy Asthma Immunol Res. 2010;2(3):165–171;

FM. Arch Intern Med. 1918;12:517; 5. Kouri A, et al. Eur Respir Rev. 2021;30:210081; 6. Diamant Z, et al. Respir Med. 2007;101(3):378–388; 7. Brown HM. Lancet. 1958;272(7059):1245–1247; 8. Larsson K, et al. NPJ Prim Care Respir Med. 2020;30:25; 9. Tanaka A. Journal of General and Family Medicine. 2015;16(3):158–169; 10. Pavord ID, et al. Lancet. 1999;353:2213–2214; 11. Wenzel SE, et al. Am J Respir Crit Care Med.1999;160(3):1001–8; 12. Wermuth HR, Badri T, Takov V. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. 2023 Mar 22; 13. Ekhart C, et al. BMJ. 2022;376:e067554; 14. Haldar P, et al. Am J Respir Crit Care Med. 2008;178(3):218–224; 15. Dragonieri S and Carpagnano GE. Asthma Res Pract. 2021;7:12; 16. Porpodis K, et al. J Pers Med. 2022;12:1093; 17. Wenzel SE. Nat Med. 2012;18(5):716–725; 18. Price DB, et al. Lancet Respir Med. 2015;3(11):849–858; 19. Pavord ID, et al. Lancet. 2017;391(10118):350–400; 20. Haldar P, et al. N Engl J Med. 2009;360:973-84; 21. West EE, et al. Drug Discov Today Dis Mech. 2012;9(34):10.1016/j.ddmec.2012.09.003; 22. National Asthma Education and Prevention Program. Recommendations for the use of long-acting muscarinic antagonists for asthma. 2020. https://www.nhlbi.nih.gov/resources/2020-focused-updates-asthma-management-guidelines. [Accessed June 2023]; 23. Hunninghake GM, et al. Allergy. 2010; 65:1566–1575; 24. Moffatt MF, et al. N Engl J Med. 2010; 363:1211–1221; 25. Torgerson DG, et al. Nat Genet. 2011;43:887–892; 26. Couillard S, et al. Am J Respir Crit Care Med. 2021;204:731–4; 27. Couillard S, et al. ERJ Open Res. 2021;8(1):00570-2021; 28. Couillard S, et al. Thorax. 2022;77(2):199-202; 29. Parnes JR, et al. J Asthma Allergy. 2022;15:749–765; 30. Matera MG, et al. Drugs. 2020;80(5):449458.

©AstraZeneca 2023. All rights reserved, GB-45948 Date of preparation: June 2023.

Chu EK and Drazen JM.

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3. Holgate ST.

4. Rackemann

BRIT Registry - update

2023 is a big year for the BRIT registry, which is wrapping up its second phase. There are currently over 2100 immunotherapy patients registered across 160 consultants, and the numbers keep growing.

For the first time, in preparation for our second 3-year report, we have hired a small team of statisticians for analysis and modelling of all the registry’s data. To make the most of this, we have begun a data cleaning process across the registry. We have determined key variables within the patient data, which include:

• Date of consent

• Gender

• Country of Residence

• Type of Immunotherapy

• Immunotherapy Prescribed

We will soon be reaching out to individual users to help them fill these gaps in their current data. All our users will be credited as co-authors on the

final report, so it is important that the data be as clean and thorough as possible.

To help motivate our users to keep their data current, we have finally launched our user dashboard. The dashboard will feature a series of useful infographs specific to each service and will allow users to collect at-a-glance summaries of all their data and how it compares to the rest of the registry.

If you are interested in learning more about the registry, visit the BSACI website (BRIT SITE LINK) or contact BRIT Coordinator Maria Smith (brit@ bsaci.org). To sign up, visit the registry.

If you are providing an immunotherapy service in the UK and would like to know more about BRIT, visit www.bsaci.org/professionalresources/bsaci-registries/immunotherapyregistry/ or email maria.smith@bsaci.org

Register here: https://brit.e-dendrite.com/ registerme.html

Dr Mich Lajeunesse Consultant in Paediatric Allergy & Immunology Southampton Children’s Hospital

Maria Smith, BRIT Co-ordinator

A unique collaboration with Education for Health and Respiratory Futures

Fiona Rayner Chief Executive

BSACI held its first ever collaborative webinar on ‘How to Successfully Manage Adults with Asthma and Allergies’. This was a partnership between the British Society for Allergy & Clinical Immunology (BSACI), Education for Health EfH) and Respiratory Futures. This took

place on Monday 26th June 2023 at 5pm. Over 700 people registered for the webinar which was expertly chaired by Dr Kathryn Prior, Respiratory Consultant with an interest in asthma and airways and our very own President Professor Graham Roberts.

BSACI would like to thank all the speakers for their excellent presentations if you didn’t get to see if you can watch it at www.bsaci.org/educationand-events/webinars/2023webinars/. On 16th October BSACI, Respiratory Futures and Education for Health will be hosting the ‘Allergies and Asthma’ webinar for primary care colleagues.

FREE Joint Webinar with presentations

5pm – 6:30pm Monday 26th June, 2023

A partnership between British Society for Allergy and Clinical Immunology (BSACI), Education for Health( EfH) and Respiratory Futures Chairs: Dr Kathryn Prior, Respiratory Consultant with an interest in asthma and airways and Professor Graham Roberts, Paediatric allergy & Respiratory Consultant, University of Southampton.

Learning outcomes

1. Understand why co-existing rhinitis can led to poor asthma control

2. To be able to identify chronic rhinosinusitis with and without nasal polyps

3. To gain an understanding of the managing of sinonasal disease in people with asthma: including allergen avoidance, first line medications, surgical options and biologics

Speaker: Mr Annakan Navaratnam – Rhinology Consultant, Royal National ENT Hospital, University College London NHS Hospitals Trust

Learning outcomes

1. To understand the indications and outcomes of using immunotherapy in people with asthma and allergies

2. To understand the indications and outcomes of using biologics in people with severe asthma and allergies

Speaker:

William Frankland Memorial Service

Family members, friends and many colleagues attended the Bill Frankland memorial Service at St Michael’s Cornhill, in the City of London on 17th May 2023 to celebrate the life of the man that was referred to as the ‘Grandfather of Allergy’! Bill died at the age of 108 in April 2020. Three years on we reflected on his life by sharing our stories and celebrating the life of a man who will go down in history for the significant contributions he made to allergy.

Left to right: Lynne Regent, Glenis Scadding, Chris Corrigan, Cecilia Trigg, Graham Roberts, Helen Smith, Adnan Custovic and Samantha Walker

BSACI Allergy Education Network

Dr Erika Harnik Consultant in Paediatric Allergy, Imperial College Healthcare

The British Allergy Education Network continue with their tireless efforts to improve the allergy education and allergy competencies of all healthcare professionals in the UK. We have three core subgroups focusing on competencies, curriculum and education resources. Current projects which are underway include mapping existing educational resources to key learning outcomes in allergy, and reviewing educational curricula in specific healthcare professional groups such as Foundation medical doctors.

As some of you will have seen, detailed surveys have been sent out to

the membership, specifically dietitians and nurses working in allergy across the country, and we are really grateful for all your responses – with your help we have been able to gather valuable information, which will help inform our educational strategy.

We are keen to continue the focus on quality education and there was a BSACI Paediatric Allergy Grand Round on the 17th May run by the

University of Southampton MSc Allergy team. They demonstrated a teaching model they have developed, which could be helpful in teaching patients, families, students and other healthcare professionals. For those of you who were not able to join the meeting, the recording is available here https://www.bsaci.org/education-and-events/ paediatric-grand-round/2023-grand-rounds/

We are also delighted to have our second dedicated session to showcase allergy education at the BSACI 2023 Conference – join us on Saturday 7th October in Harrogate.

We are indebted to our network who have been working on this huge project whilst juggling their clinical and non-clinical commitments. In order to help keep up this momentum, the BSACI are funding a part-time Allergy Education Fellow post.

We would warmly welcome any other members who would be interested in joining our Education Network – please contact Vivine Smith at vivine@ bsaci.org

https://www.bsaci.org/education-andevents/bsaci-national-allergy-educationstrategy/

National Allergy Strategy Group

Professor Adam Fox Chair – National Allergy Strategy Group (NASG)

The past few months have been exciting ones for the NASG. Since a change of leadership over the summer, we took the opportunity to update the Terms of Reference, as this had not changed since the inception of the NASG in 2001 and needed to reflect the current issues impacting allergy sufferers – whilst previously the focus for lobbying was exclusively around NHS service provision this needed to expand across a range of areas such as food labelling, allergy management in school as well as key areas such as primary care education.

We have successfully completed this role, which also open the doors for potential new core member organisations to join us in our work and this is an area we can now actively explore. We have worked closely with partners such as the Natasha Allergy Research Foundation, producing a joint briefing for MPs in advance of the

Parliamentary debates on food labelling and allergy leadership in government that took place on 15th May. Full details of these can be found https://www.youtube. com/watch?v=PNo_jUdF4X8 Read the transcript https://hansard.parliament.uk/ commons/2023-05-15/debates/56CD8E04F2BC-41CA-ADE5-943A63CE7ECE/ FoodLabellingAndAllergies

We have been making important progress during our regular meetings with DHSC and our proposal for an Expert Advisory Group on Allergy, co-chaired by NASG and DHSC has been well received. We are also exploring fundraising options to support the development of a National Allergy Strategy. Please do let me know if you would like to be more involved in our work.

NHS Trust

Psychology Working Group

Dr Rebecca Knibb Associate Professor in Health Psychology, Ashton University; Psychology Working Group Lead

The Psychology Working Group is chaired by Dr Rebecca Knibb, an Associate Professor in Health Psychology, aims to promote the psychological care and wellbeing of patients with allergies and their families. The group has eight further members from research and clinical practice, spanning paediatric and adult allergy. This year the group have been working to promote awareness of the impact of allergy and the effectiveness of psychological interventions. They held a BSACI grand round webinar on the 22nd May with talks from Drs Rebecca Knibb, Chrissie Jones and Mary Halsey covering latest research on psychological support for patients and families and practical strategies for non-Psychologists. The group

had great feedback from this session and plan to run another webinar in the next round. The group is currently compiling a set of resources they feel

will be helpful for health care professionals when working with patients and families. These will be uploaded to the Psychology working group webpage that is being developed on the BSACI website.

Members of the group have been involved in various research activities to gather data on the unmet need for psychological services and evidence for effective psychological interventions for patients and families. The results of a UK survey and a global survey on unmet need and a systematic review on psychological interventions are expected to be published this year. The Psychology Working Group will be using this information to work with the BSACI Standards of Care Committee regarding the development of best practice guidelines for psychological services for food allergy.

The working group will be doing a meet and greet at the BSACI stand at the conference in Harrogate, alongside other working group and special interest groups. If you would like to hear more about the Psychology Working Group, please come and talk to us. We will be available during the morning coffee break on the Friday of the conference.

Clinical Immunology Committee

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

The focus of the BSACI Clinical Immunology Committee remains firmly set in training and education. We are advancing our work with our health care scientist members and are in the process of developing evidence based cross organisation guidance on appropriate use of laboratory allergy testing. We continue to support a trainee led group looking at the potential opportunities posed by the revised GMC curricula in Allergy and Clinical Immunology (ACI). We are working with partner organisations to minimise duplication and enhance service development where possible..

Since our last update we have commenced a project looking at the use of laboratory allergy testing. We are working with the Royal College of Pathologists and the Clinical

Immunology Professional Network to provide guidance and recommendations on the use of laboratory allergy testing in primary care settings.

This guidance is based on published evidence to improve testing and reduce unnecessary testing by providing clinical advice at the point of test requesting.

The trainee group continues to grow in strength and has representatives from all the major ACI organisations. The health care scientist members of the CIC contribute to the trainee group.

We are in the process of initiating discussion with the British Society for Immunology (BSI) Clinical Immunology Professional Network (CIPN). This is a newly formed professional network based on the United Kingdom Primary Immunodeficiency Network (UKPIN). The BSACI CIC is well positioned to enter discussion with the CIPN to reduce any duplication of work and to ensure collaborative approaches to the delivery and development of ACI Services and training in the UK.

The overall aim of the BSACI CIC is to standardise care, reduce duplication and to ensure training is fit for purpose for future ACI training.

Standards of Care Committee

The Standards of Care Committee (SOCC) has had a busy few months. The BSACI guidelines on Pollen Food Syndrome (led by Dr Isabel Skypala) and Penicillin Allergy (led by Dr Louise Savic) were published in Clinical & Experimental Allergy in 2022. s

Isabel Skypala Consultant Allergy Dietician, Royal Brompton Hospital; Co-Chair of Standards of Care Committee

A working group for a new guideline on allergy to Non-Steroidal Anti-Inflammatory Drugs (NSAID) has been established and led by Dr Rita Mirakian. The guideline has been written and is currently being reviewed. Working groups for two new guidelines have also been set up; these are on Idiopathic Anaphylaxis, led by Dr Andrew White, and Emerging Food Allergens, led by Dr Isabel

Skypala. The latter guideline includes stakeholders from the British Dietetic Association and the Food Standards Agency. In addition to guidelines, SOCC has developed a plan to write some short Clinical Practice Statements. The first two will cover oral food challenge and Lipid Transfer Protein allergy and working groups are being established for both of these. The committee has also changed the way it reviews outputs from other groups, with two or three members providing feedback, followed by SOCC approval and this will be the model going forwards. All SOCC members have provided excellent support and feedback for all projects. The Committee is indebted to Dr Shifa Shaikh, the Chief Scientific Officer of the BSACI for her invaluable assistance and also to Dr David Luyt, SOCC co-chair who stepped down from the role in May 2023.

Nurses in Allergy Commitee

We are very pleased to report that our first Annual Nurses study day went ahead in April. We had 80 attendees and are very grateful to all of our 11 speakers. Our sessions aimed to update practice and we covered areas such as food allergy, drug allergy, asthma, apps/ technology, and allergic rhinitis. We have had some positive feedback which we hope to build into our offering for next year.

The next project in the pipeline for us was to update the ‘Allergy Nurse Competency Document’. However this project will now be taken on by the British Allergy Education Network

(BAEN), a multi-disciplinary group with a broader perspective of education and competency needs across the UK. We look forward to supporting them with this project where we can, and have passed on your questionnaire responses from last year.

This means our next task will now be to begin updating some of the information leaflets/SOP’s available on the BSACI website, starting with ‘how to use a nasal spray’ and ‘nasal douching’. We hope to modernise their appearance and review the content. Please get in touch if you have any comments or suggestions on changes you’d find useful.

As always we welcome any and all communication via nurses@bsaci.org and invite you to follow us on Twitter @BSACInurses

Hannah Kramer Paediatric Allergy Nurse Specialist (Evelina London); Chair of Nurses in Allergy Committee

Paediatric Allergy Committee

Summer is here and we were pleased to have had our recent meeting in hybrid fashion, with a number of us meeting in ‘3D’ after a long time. It was wonderful to spend some time together in Birmingham discussing our current projects, but also taking some time to chat over lunch and see some of the local sights.

We continue to engage with a number of projects. Most recently we completed an Allergy Action plan for FPIES which will be available on the BSACI website soon. This has been reviewed and endorsed by FPIES UK. The best practice guidance for delivery of Palforzia ® is nearly complete, with a final set of statements in review.

Our plan for developing a national set of paediatric allergy service standards stalled during the pandemic, but we now have a timeline for getting these produced. Our first step will be to prioritise key outcomes that are relevant and

measurable. We really want to hear from our paediatric members, so look out for the online survey to let us know which outcomes matter to you.

Transition is a key part of our work and we work closely with the transition working group. Claudia Gore and myself met with patient engagement officers from RCPCH and RCP who are keen to engage with us to collaborate to develop a robust transition process for the young people we look after. Our plans include development of UK specific, BSACI badged healthcare transition material and to advance a pragmatic pathway for healthcare transition in allergy.

Finally, the statement to highlight the impact of the cost of living crisis on patients with allergy was completed and released to BSACI members. This included some template letters to assist patients in getting additional support for health needs.

Once again thanks to all our members who continue to contribute to ensure that the care of children and young people with allergic disease is the best it can be.

Dr Niten Makwana Consultant

Paediatrician, Sandwell and West Birmingham NHS Trust; Chair of the Paediatric Allergy Committee

Paediatric Allergy Committee meeting: (left to right) Anjali Rampersand, Claudia Gore, Sian Ludman, Kate Swann, Sue Leech, Nick Makwana

Perioperative Allergy Network

This is a multidisciplinary network created by BSACI, the Association of Anaesthetists and the British Society for Immunology Clinical Immunology Professional Network (CIPN). We are also endorsed by the Royal Colleges of Anaesthetists, Pathology and Physicians. The network officially launched on 29th March 2023 and has already demonstrated its reach and impact with two key outputs.

The first is a statement in response to the MRHA withdrawal of pholcodine-containing products due to the risk of neuromuscular blocking agent (NMBA) allergy during anaesthesia. The recommendation that patients be screened for prior pholcodine use had unintended consequences, generating concern

that NMBAs should be avoided in patients who have used pholcodine. Our statement, endorsed by the Association and Royal College of Anaesthetists, BSACI and CIPN, clarified that screening was not required and is of no practical benefit. In conjunction with this statement, the network codesigned a patient leaflet with Anaphylaxis-UK to provide patients with information and reassurance

about their allergy risk during anaesthesia.

The second output is an addendum to the recently updated Resus Council UK guidelines on management of anaphylaxis. These guidelines steer away from the use of intravenous epinephrine and recommend the intramuscular route. Whilst this is appropriate for the vast majority of patients, this is not the case in the perioperative setting. Here, patients have intravenous access, are fully monitored, and are under the care of an anaesthetist trained in the administration of intravenous epinephrine. In such circumstances, low dose, incremental dosing of epinephrine represents ideal management, allowing much smaller doses to be administered with more rapid effect. This addendum is under stakeholder review and will be published later in the year.

In other news, the network held its first multidisciplinary seminar on May 25th. This event sold out and will be the first of many such opportunities for anaesthetists, allergists and immunologists to share experience and learnings, in order to improve care for patients who suffer perioperative anaphylaxis.

To find out more about the network and join up, visit our www.bsaci.org/about-bsaci/bsacicouncil-and-executive/bsaci-subcommittees/ perioperative-allergy-network/ today!

Adult Allergy Commitee

The Adult Allergy committee is now meeting regularly after a hiatus during the covid era. Trainee representation has increased, and there have been discussions on the impact of the new curriculum. Overall the feedback from trainees is positive, although results of a detailed survey are awaited. .

The committee is hoping to publish a detailed report later this year looking at access to adult allergy

services. There has been consultation across the whole of UK with excellent engagement.

This will build on existing sources of data, including a detailed survey of post-covid service provision undertaken in 2021. It is clear that there are considerable geographic variations in access to care, and we hope to provide accurate data to identify this, and then discuss solutions.

We have engaged closely with the IQAS team to ensure that all members are encouraged to engage with the accreditation process. The difficulties faced by smaller centres, in relation to the administrative burden of IQAS application, have been discussed.

The Allergy in the Military working group has continued its work looking to provide clear guidance for clinicians seeing patients with allergy issues applying to join the armed forces. Overall principles have been agreed, and a draft guidance with case-based scenarios will hopefully be available soon.

We will also be working closely with the new Transition working group, to provide an adult perspective, and hopefully with time to provide a directory of adult services with a clear transition pathway. This will be a challenge because the number of adult services is considerably less than those offering paediatric allergy.

Consultant Anaesthetist, Leeds Teaching Hospitals NHS Trust; Chair of Perioperative Allergy Network Steering Committee

Dr Steve Jenkins Consultant, Broomfield Hospital; and Co-Chair of Adult Allergy Committee

Food Allergy Specialist Group

Our group of 400 dietitians with an interest in allergy continues to share news, clinical queries and updates through the Basecamp platform.

RECENT ACTIVITIES:

• Diet sheet development

• Programme of webinars

Hannah Hunter Specialist

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

We now have 34 diet sheets available to members, the newest of which is on Alpha-Gal allergy. These continue to be regularly updated by our expert dietitians and new diet sheets will be developed in consultation with our members.

One of our main priorities is integrating dietitians into BSACI including both membership and key activities of the society.

We are supporting 5 dietitians

to attend the BSACI conference this year with grants of £400. In March we hosted a webinar for dietitians on how to write an abstract and present

Junior members

• Integrating dietitians into BSACI and supporting conference attendance

at conferences. Our May webinar was Anaphylaxis training for dietitians and the programme will continue throughout 2023 including a joint BSACI webinar in September.

Twitter: @BDA_FASG

Dr Neha Christian Adult Allergy Registrar, Guy’s and St Thomas’ NHS Foundation Trust; Trainee Representative

IThe BSACI training days continue to be received well. I would encourage everyone to register for BSACI 2023 conference to be held in Harrogate. The programme includes engrossing sessions like ‘Rapid Review sessions’, joint session with British Association of Dermatologists and an expert-led discussion of ‘Tricky cases’. There’s also an amazing opportunity to submit any particularly interesting or challenging case in BSACI “Case Rounds” sessions. Medical Scholarship to attend BSACI conference continues to help encourage medical students and junior doctors to consider this

diverse and growing speciality. BSACI monthly grand rounds are a great source of learning and I would strongly encourage participating in them. The recorded sessions are later available on the website to watch. Our next training day will be held in September by Manchester University NHS Foundation trust on anaphylaxis, new developments in allergy and psychology in allergy. The details of the programme will follow soon. For any queries/communication, please contact us at juniormembers@bsaci.org.

Primary Care Committee

Dr Matt Doyle GP, Jersey; Chair of Primary care Committee

We are pleased to announce the successful completion of the GP With Extended Role (GPWER) framework, which has now been endorsed by the Royal College of General Practitioners (RCGP). The document contains key elements of competencies for GPs with this role and is based upon both the prior Respiratory and current Dermatology frameworks.

The document was led by Dr Liz Angier who also led efforts to include Allergy in the GP curriculum, supported by members of the Primary Care Committee, the BSACI and NASG.

Dr Angier and Dr Doyle have been engaging with the main medical education companies for GP Education with a podcast already recorded and released by NB Medical Education and reviews having taken place of the existing Allergy content for Red Whale.