Helping your patients live in harmony with creatures great and small
Ryaltris is indicated in adults and adolescents 12 years of age and older for the treatment of moderate to severe nasal symptoms associated with allergic rhinitis (AR).1
Ryaltris® is the only fixed-dose combination intranasal spray for first-line treatment of moderate to severe nasal symptoms associated with allergic rhinitis1 – and can bring symptom relief within 10-15 minutes. 2-4*
*Findings from one environmental exposure chamber study and two large randomised controlled trials.2-4
Ryaltris is generally well tolerated; the most commonly reported adverse reactions are dysgeusia, epistaxis and nasal discomfort.1,2,5
Click here to learn more at www.ryaltris.co.uk
Prescribing information
Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk. Adverse events should also be reported to Glenmark Pharmaceuticals Europe Ltd medical_information@glenmarkpharma.com or call 0800 458 0383
References: 1. Ryaltris Summary of Product Characteristics. 2. Gross GN, et al. Ann Allergy Asthma Immunol 2019;122:630–638. 3. Patel P, et al. Ann Allergy Asthma Immunol 2019;122(2):160–166. 4. Hampel FC, et al. Allergy Asthma Proc 2019;40(4):261–272. 5. Segall N, et al. Allergy Asthma Proc 2019;40:301−310.
Ryaltris® is a registered trademark of Glenmark Speciality S.A.
© 2024 Glenmark Pharmaceuticals Europe Ltd. All rights reserved.
Date of preparation: May 2024 PP-UK-RYAL-0431 V1
Dr Shauna
McKibben
Allergy & Asthma
Clinical Nurse Specialist, St Mary’s Hospital, London
Farewell... and welcome
Welcome to the Summer edition of Allergy Update and my final as editor. It’s been a great two years and I’ve thoroughly enjoyed the experience. I now hand over to Dr Deb Marriage, Consultant Nurse in Allergy & Asthma at Bristol Children’s Hospital (below). I wish Deb all the very best in the role.
It’s been another busy six months for the Society with promising progress in the development of a National Allergy Strategy, another successful Global Online Allergy Symposium, not to mention all the hard work being undertaken by committees, specialist
interest groups and the BRIT registry team.
There is much to look forward to including the Annual Conference, with increased representation from nurse/AHPs, further national and international collaborations, and BAENs National Allergy Capability Framework of particular interest.
A big thank you to everyone who has taken the time and effort to contribute to the newsletter during my tenure as editor.
Dr Deb Marriage, Consultant Nurse in Allergy & Asthma
Editor of Allergy Update
Dr Shauna McKibben
Managing Editor
Louise Colonnese
Layout
INQ Design Ltd (020 7737 5775)
Honorary Officers
BSACI President
Professor
Graham Roberts
President Elect
Dr Robin Gore
Secretary
Dr Deb Marriage
Treasurer
Dr Runa Ali
Vice Presidents
Vice President of Education and Training – Professor Gillian Vance
Vice President of Workforce – Mrs Lucy Common
Vice President of Services – Dr Louise Michaelis
Vice President for Science and Research – Professor Jürgen Schwarze
Elected Members
Dr Steve Jenkins
Dr George Gkimpas
Dr Dinusha Chandratilleke
Standing Committees and Representatives
Co-Chair, Standards of Care Committee (SOCC) – Dr Isabel Skypala
Co-Chair, Standards of Care Committee (SOCC) – Dr Susan Leech
Co-Chair, BSACI Conference Committee – Dr Natasha Gunawardana
Co-Chair, BSACI Conference Committee – Dr Nandinee Patel
Chair of Ethics, Equality, Diversity, and Inclusion Committee – Mrs Cathryn Melchior
Chair of BSACI Allergy Education Network (BAEN) – Dr Jennie Gane
Clinical Immunology Professional Network Representative (CIPN)
– Dr Tomaz Garcez
Special Interest Groups (SIGs)
Chair of Paediatric Allergy Committee – Dr Nick Makwana
Chair of Nurses Committee – Mr James Gardner
Trainees Representative – Dr Neha Christian
Co-Chair of Adult Allergy Committee – Dr Steve Jenkins
Co-Chair of Adult Allergy Committee – Professor Paul Ciclitira
Dietetic Strategic Group – Joint Leads: Ms Hannah Hunter/ Mrs Karen Wright/Mrs Justine Dempsey/Dr Isabel Skypala
Psychology Lead – Dr Rebecca Knibb
Chair of Anaphylaxis Committee – Professor Graham Roberts
Chair of BSACI Registry for Immunotherapy (BRIT) Committee – Dr Mich Lajeunesse
Co-Chair, Paediatric - Dr Claudia Gore
Co-Chair, Adult - Vacant
Co-Chair, Transition Group – Dr Claudia Gore
Chair, Allergy in the Military Group – Dr Andrew Whyte
Co-Editors of Clinical and Experimental Allergy Dr Robert Boyle & Dr Mohamed Shamji
Chief Executive: Fiona Rayner fiona@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
Marketing & Communications Manager: Louise Colonnese louise@bsaci.org
Training & Membership Support Officer: Tamara Reid tamara@bsaci.org
Education Fellow: Margaret Kelman margaret@bsaci.org
Managing Editor, Clinical & Experimental Allergy: Catherine Hyland catherine@bsaci.org
BRIT Coordinator: Maria Smith maria.smith@bsaci.org
BSACI
Studio 16, Cloisters House 8 Battersea Park Road London SW8 4BG info@bsaci.org 0207 501 3910
www.bsaci.org
Registered charity no: 1069199
Another Azelair™ moment
A steroid-free option to effectively treat allergic rhinitis1 Azelair
PRESCRIBING INFORMATION. AZELAIR 0.15% NASAL SPRAY. Please refer to Summary of Product Characteristics (SmPC) before prescribing. Indication: Symptomatic treatment of allergic rhinitis in adults, adolescents and children 6 years and older. Presentation: Nasal pump spray containing 1.5 mg/ml azelastine hydrochloride solution. The delivered dose per actuation (0.14 ml) contains 0.21 mg azelastine hydrochloride equivalent to 0.19 mg azelastine. Dosage and administration: Adults and adolescents 12 years and older: 2 sprays in each nostril once a day. In some cases, 2 sprays in each nostril twice a day may be required. The maximum daily dose is 2 sprays in each nostril twice daily. Children 6 to 11 years: 1 spray in each nostril twice daily. Use longer than 4 weeks is not recommended in children 6-11 years due to lack of clinical data. Contraindications: Hypersensitivity to the active substance azelastine hydrochloride or to any of the excipients listed in section 6.1 of the SmPC. Warning and precautions: Nothing relevant. Interaction with other medicinal products: No specific interaction studies with azelastine nasal spray have been performed. Interaction studies at high oral doses have been performed. However, they bear no relevance to Azelair as systemic levels after administration reach no more than 1/5 of the levels that were well tolerated after oral administration. Pregnancy, lactation and fertility: There are no or limited amount
of data from the use of azelastine in pregnant women. At high oral doses reproductive toxicity has been seen in animals (see section 5.3 of SmPC). Therefore, caution should be exercised when using Azelair during pregnancy. It is unknown whether azelastine/ metabolites are excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when azelastine is administered to a nursing woman. Effects on fertility were seen in animal studies at oral doses greater than 3.0 mg/kg/ day. Effects on ability to drive and use machines: Azelair has minor influence on the ability to drive and use machines. Rarely, the patient may experience fatigue, weariness, exhaustion, dizziness or weakness due to the disease itself, or when using Azelair. In these cases, the ability to drive and use machines may be impaired. Special attention should be paid to the fact that alcohol may enhance these effects. Undesirable effects: Common (≥ 1/100 to < 1/10): dysgeusia (unpleasant taste). A substance-specific unpleasant taste may be experienced after administration (often due to incorrect method of application, namely tilting the head too far backwards during administration) which, in rare cases, may lead to nausea. Uncommon (≥ 1/1,000 to < 1/100): nasal discomfort (stinging, itching), sneezing, epistaxis. Please refer to SmPC for details of rare and very rare adverse events. Legal Category: POM. Marketing Authorisation Number: PL 46302/0085.
MAH: Mylan Products Ltd., Station Close, Potters Bar, Hertfordshire, EN6 1TL, UK. NHS Price: £9.90 for 20 ml bottle. Date of preparation: 04/2023. AZR-2023-0016.
The SmPC for this product, including adverse reactions, precautions, contra-indications, and method of use can be found at: http://www.mhra.gov.uk/Safetyinformation/ Medicinesinformation/SPCandPILs/index.htm and from Mylan Medical Information, Building 4, Trident Place, Hatfield Business Park, Mosquito Way, Hatfield, Hertfordshire, AL10 9UL, phone no. 01707 853000, Email: info.uk@viatris.com
Please continue to report suspected adverse drug reactions with any medicine or vaccine to the MHRA through the Yellow Card Scheme. It is easiest and quickest to report adverse drug reactions online via the Yellow Card Scheme website: https://yellowcard.mhra.gov.uk/ or search for MHRA Yellow Card in the Google Play or Apple App Store. Alternatively, you can report via some clinical IT systems (EMIS/SystemOne/Vision/MiDatabank) or by calling the Commission on Human Medicines (CHM) free phone line: 0800-731-6789. Adverse reactions/ events should also be reported to MAH at e-mail address: pv.uk@viatris.com
Looking back over the last three years
IPresident
t is hard to believe it is three years since I took over from Adam Fox as president of the British Society of Allergy and Clinical Immunology. Then we were just starting to emerge from the pandemic and there were still rather a lot of restrictions. So perhaps it is a good time to look back at what we have achieved as a society. As you will remember I set the BSACI Council a challenge to come up with a list of objectives for the three-year period.
Let’s start with education. The BSACI allergy education strategy had been developed under the leadership of Jude Holloway and then more recently Jennie Gane. We have appointed an education fellow, Margaret Kelman. This has helped to start implementing the strategy. This is absolutely key to the future of allergy services. The only way that we can close the gap in allergy care is to upscale more healthcare professionals to manage allergy across the health system.
The UK fatal anaphylaxis registry is now back on track. We have received funding from Viatris, PF Charitble Trust and Food Standards Agengy. Vibha Sharma and her colleagues have been and continue to strengthen their inter-agency collaboration. The aim of the registry is to accurately identify and register all deaths from anaphylaxis.
Our Standards of Care Committee has published three guidelines. The penicillin allergy delabelling guideline should be invaluable in tackling the over labelling of antibiotic allergy. Then the pollen food syndrome guideline should be a great resource for healthcare professionals across the system to recognise and manage this presentation, lastly the adrenaline auto injector guideline for primary care healthcare professionals was finalised.
A transition working group has been formed under the leadership of Claudia Gore and George
The only way that we can close the gap in allergy care is to upscale more healthcare professionals to manage allergy across the health system.
Gkimpas. Adolescents and young adults are an underserved group in our health system. The group is developing resources to support transition across the UK building on the work published by the European task force. A new psychology special interest group has also now been formed, led by Rebecca Knibb. The group is creating resources that can be used by psychologist and non-psychology healthcare professionals across allergy services. Again, another major gap that is being addressed.
The paediatric allergy committee have led a working group which has developed guidance for using Palforzia. You can find it at https://onlinelibrary.wiley.com/doi/10.1111/ cea.14491 . Adult Allergy have been undertaking a review of allergy services which has been an extensive piece of work looking at current allergy capacity in relation to the local population. The Postcode lottery – is an assessment of access to adult allergy service across the UK. We look forward to seeing this published in due course.
Thirimula Krishna has ably led our Ethics, Equality, Diversity and Inclusion (EEDI) Committee. A BSACI EDI policy has been developed and approved at the 2023 AGM. Now we all need to deliver it. The nurses committee were instrumental in the development of an adult allergy action plan which will be available on the BSACI website shortly. Again, another gap that is now filled.
BSACI Conference has gone from strength to strength and continues to increase and attract a wide range of healthcare professionals for the UK and globally, next year we are moving to ICC Wales which will enable us to continue growing our
Your input is invaluable to us during this critical phase, and you can support us by sharing your thoughts and expertise with the appraisal committee by providing feedback directly into the appraisal consultation document here. Your firsthand experience and knowledge are instrumental in advocating for the importance of ACARIZAX® (please click here for prescribing information).
On behalf of everyone at ALK, thank you for being an integral part of our journey.
Professor Graham Roberts
Looking forward
conference. Our Global Symposium, in partnership with AAAAI, EAACI, and WAO, is in its third year.
BSACI Registry for Immunotherapy has over 3055 patients registered across 70 sites. Its user dashboard was launched in early 2023. Peanut Immunotherapy was initiated in the second phase of the registry. The first peer-reviewed published study is underway.
Dietetics Strategic Group have played a huge role in helping shape the conference programme and working with the society to increase the overall dietetic input.
We have also had a good look at the BSACI organisational structure. It had not changed for many years and was creaking with the huge growth in the society and all the ongoing activities. We have strengthened the leadership structure by appointing four vice presidents and formalising senior leadership meetings. It has been great this year seeing Lucy Common, Louise Michaelis, Jürgen Schwarze and Gillian Vance developing great ideas around Workforce, Services, Research and Science and Education. I look forward to seeing lots of initiatives in the coming years. These changes have also partly delivered my ambition to diversify the leadership team - only one of the senior leadership
We have strengthened the leadership structure by appointing four vice presidents and formalising senior leadership meetings.
BSACI Conference has gone from strength to strength and continues to increase and attract a wide range of healthcare professionals for the UK and globally.
team is now London based! Three are from the North of England, one from Scotland and two are allied health professionals.
Nationally we have been busy on the policy front. We have launched a joint committee between the National Allergy Strategy Group and the Department of Health and Social Care. This will seek to develop a better approach to allergy services in the UK. This will be assisted by the General Practitioner with an Extended Role that Liz Angier has negotiated with the Royal College of General Practice. We now need to shine the spotlight on allergy services in Northern Ireland, Scotland and Wales.
I would like to thank Lucy Common, Adam Fox, Robin Gore, Runa Ali, Sue Leech, Deb Marriage, Louise Michaelis, Jurgen Schwarze and Gillian Vance, Matt Doyle who for many years has been rotated on and off as Chair of the Primary Care Committee has now stepped down from this role and Fiona Rayner and all the BSACI office staff for all their support over the last three years. Also, I would like to mention our allergy charities for their support and key role in championing our patients and providing resources and support to them.
GP with extended role (GPwER) application process open
General Practitioners from across the UK are invited to submit applications for the BSACI GPwER in allergy framework for accreditation for the GPwER in Allergy, which is endorsed by the Royal College of General Practitioners (RCGP). The application process opened on 1st July for one month.
All those involved in the delivery of care for patients with allergies recognise the need to ensure that General Practitioners with an Extended Role (GPwER) are suitably qualified, with demonstrable competences, training and experience. These factors underpin the delivery of safe, high-quality care.
The aim of the accreditation is to provide high quality allergy care in primary care across the NHS.
A GPwER in allergy management of the patient extends beyond the medical model, bringing additional skills in practising holistically and dealing with complexity and uncertainty to these roles.
To find out more about GPwER accreditation in allergy visit www.bsaci.org/professional-resources/primarycare-resources/gp-with-extended-role-gpwer-framework/
You can watch the BSACI open access webinar at https://www.bsaci.org/education-and-events/ webinars/2023-webinars/from-primary-to-tertiary-care-webinar/
Conferences and events
Networking with allergy experts
BSACI had a stand at AAAAI in Washington DC in February and at EAACI Congress in Valencia in May. These were fantastic opportunities to network with allergy experts from across the globe. We were delighted to see many BSACI members at both these events. Thank you for stopping by the BSACI stand.
Right top: Nicola Brathwaite, Fiona Rayner, Rebecca Batt and Matt Doyle at EAACI. Right below Usmaan Ahmed (BSACI incoming Trainee Lead) and Lisa Shen; Nasreen Khan and Leyla Pur. Below: BSACI members Dr Kok Loong and Dr Alla Nakonechna with BSACI CEO Fiona Rayner (middle) at the AAAAI in Washington in February
Primary Care Show 2024
We were proud to be an event partner of The Primary Care Show on 15th and 16th May by developing allergy sessions on the programme. Thank you to all BSACI speakers and chairs for their contribution to the event Liz Angier, Paul Turner, Nasreen Khan, Karen Wright, James Gardner and in particular Dr Matt Doyle for facilitating this on behalf of BSACI.
Left: BSACI speakers Liz Angier, Paul Turner, Nasreen Khan and Matt Doyle
Below: BSACI team members Melanie Parrianen and Tamara Reid at the exhibition stand
BSACI Strategy Day
BSACI has reformed its senior leadership team structure. Recent appointees to the new vice-president (VP) positions are: Prof Gillian Vance (Education and Training); Mrs Lucy Common (Workforce); Dr Louise Michaelis (Services), and Prof Jürgen Schwarze (Science and Research). Each VP led discussions on their respective portfolios.
Medical specialty training and UK demography
Mr Tom Claydon (NHSE Workforce) outlined demographic trends within the United Kingdom and how these are already affecting workforce planning. As an example, a 63% increase in over-65s in London is predicted by 2041. The current number of UK doctors in training (7,900) will double to 15,000 by 2031. Modelling of the number and distribution of trainees for allergy and clinical immunology has not yet been completed, although it is clear there will be a large impact on our specialty.
Education
BSACI hosts a wide range of educational activities including primary care training days, allergy trainees’ days, nursing competencies development and our Annual Conference.)
Professor Vance and Dr Jenny Gane (chair, BSACI Allergy Education Network (BAEN) facilitated discussions on the new BSACI Allergy Education Strategy https://www.bsaci.org/wpcontent/uploads/2021/10/National-EducationStrategy-2021.pdf. The vision is to make allergy education available to all HCPs in a manner appropriate to their professional role. However, to have the greatest impact, priorities need to be set. Delegates voted to prioritise delivery of the strategy to HCPs with more limited experience of allergy education but who, collectively, are responsible for delivering care to a large number of patients. BAEN will continue to promote allergy education across the HCP community but the delegates’ views on prioritisation will help shape the next steps.
Workforce
Robin Gore President -Elect
Above: Robin Gore and Graham Roberts
BSACI strategy
Mrs Lucy Common led discussions on nursing / AHP career progression and competency roll-out. Problems identified included a dearth of higher-grade posts, a lack of access to training, and limited awareness of opportunities for participating in research.
The need to attract overseas medical trainees into clinical fellow posts was highlighted: numbers have fallen over recent years. Increasing numbers of pharmacists are now prescribers, presenting an opportunity to improve allergy care at the pharmacy level.
Years of hard work by BSACI, NASG, and the All Party Parliamentary Group on Allergy have led to a sustained increase in allergy trainee and consultant numbers. However, a recent national survey presented by Dr Steve Jenkins (chair, adult allergy group) highlighted significant gaps: in some parts of the country there is no specialist allergy provision at all.
The SPIN (Special Interest) training programme in allergy for paediatricians has been successful in reducing gaps in paediatric allergy provision. The question posed was whether a similar approach for adult allergy could help increase access to high-quality care. There was much interest in this idea, discussed in both the Services and Workforce sections, which will be further explored by the senior leadership team.
Services
Dr Louise Michaelis presented work packages on paediatric transition, models of seamless allergy care, and paediatric accreditation. Work on an optimum transition pathway through the transition working group is ongoing. An accreditation scheme for paediatric allergy services is already being developed. National service standards are being updated in collaboration with RCPCH.
Science and Research
The Society‘s commitment to research excellence is evidenced by the successful BSACI Annual Conference and by its journal, Clinical and Experimental Allergy
Professor Schwarze asked delegates to consider how to build on this. Ideas included the promotion of an allergy research network, support for early researchers in obtaining funding applications and collaboration with other societies through co-badged sessions at the Annual Conference.
The energy and commitment of delegates made for a very successful day. The current BSACI president, Prof. Graham Roberts and I would like to thank all delegates on behalf of the leadership team for their work in helping to shape BSACI strategy, which will be presented in more detail as the workstreams evolve.
Below left: Delegates working together to shape the BSACI strategy
Below right: Runa Ali, Louise Michaelis, Natasha Gunawardana
Online learning and development
Building Global Collaborations for the future
Dr George Gkimpas
This year, BSACI once again worked with the World Allergy Organisation (WAO), the European Academy of Allergy and Clinical Immunology (EAACI), and the American Academy of Allergy, Asthma and Immunology (AAAAI) to deliver the BSACI Global Online Allergy Symposium held on Friday 26th January 2024. The symposium was a great success and attracted over 400 attendees from around the world, who very much enjoyed the overall collegiate approach. Exceptional
talks were delivered by high calibre, world-class speakers. An overwhelming number of delegates felt that the quality of the content was very high, and the feedback indicated that they very much welcomed this initiative, and they were keen to see it continue.
On this basis and following on from this year’s successful collaboration, BSACI are embarking in January 2025 on the 3rd ‘BSACI Global Allergy Online Symposium in partnership with AAAAI, EAACI and WAO’, to again reach out to an international audience. The over-arching vision is that this will become a recurrent annual event which will bring together four global societies as permanent partners, and one regional Allergy society to be selected each year as a supporting partner. The program will once again have a strong clinical focus with the partner sessions full of interesting updates on the Societies’ clinical guidelines, and with the BSACI speakers delivering highly inter-
Image taken from Presidents Session. Chair - Glenis Scadding; AAAAI President (at the time) Jonathan Bernstein; BSACI President Grahm Roberts; WAO President Bryan Martin; EAACI President (at the time) Stefano Del Giacco
active presentations of challenging cases, a session that received excellent feedback in this year’s event. The highlight of the day will once again be ‘The Presidents Forum’ where the presidents of the partner societies will meet and discuss on global issues that affect our speciality.
We hope that everyone will join us again for the 2025 Symposium on 17th January, making it possible to build even closer links for the benefit of the global allergy community.
BSACI guidance for prescribing Palforzia®
Peanut Oral Immunotherapy published
We were delighted to announce the publication of this BSACI guidance in CEA. The guidance will support healthcare professionals undertaking a peanut immunotherapy service using Palforzia®
Guidance includes how to consent, prepare and monitor children and young people taking peanut immunotherapy, as well as recommendations to ensure it is safely practiced in clinics.
The demand for peanut immunotherapy outstrips current National Health Service (NHS) capacity and requires services to develop a national consensus on how best to offer Palforzia® in a safe and equitable manner. There is urgent need to increase the clinical capacity for allergy services to undertake diagnostic food challenges in the NHS as well as developing Palforzia® immunotherapy pathways.
The guidance is now published online for clinical practice in the UK in Clinical & Experimental Allergy, the official journal of BSACI. Access the guidance at www.bsaci.org/bsaci-guidance-for-prescribing-palforziapeanut-oral-immunotherapy-published/
Global Online Symposium Chair
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
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
1. Chu EK and Drazen JM. Am J Respir Crit Care Med. 2005; 171:1202–1208; 2. History of asthma (part 1). 2017. https://asthma.net/living/history-of-asthma-part-one-in-the-beginning [Accessed June 2024]; 3. Holgate ST. Allergy Asthma Immunol Res. 2010;2(3):165–171; 4. Rackemann 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(3-4):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 2024]; 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 2024. All rights reserved. GB-56189 | Date of preparation: June 2024.
Prof Ian Pavord & Dr Simon Couillard for the original work of which this was adapted from.
Rise above the complexity1-4 Treat across phenotypes and irrespective of key clinical biomarker levels1-4
No restrictions across eosinophilic and non-eosinophilic, allergic and non-allergic phenotypes, irrespective of key clinical biomarker levels (bEOS, IgE and FeNO). The most commonly reported adverse reactions during treatment (n=665) are arthralgia (3.8%) and pharyngitis (4.1%). 1,2 The mechanism of action of tezepelumab in severe uncontrolled asthma has not been de fi ni tely established.
Indicated as an add-on maintenance treatment in adults and adolescents 12 years and older with severe asthma who are inadequately controlled with high dose inhaled corticosteroids plus another medicinal product for maintenance treatment1,2
Adverse events should be repor ted. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be repor ted to AstraZeneca by visiting https://contactazmedical astrazeneca com or by calling 0800 783 0033
bEOS=blood eosinophils; FeNO=fractional exhaled nitric oxide; GB=Great Britain; HCP=healthcare professional; IgE=immunoglobulin E; NI=Northern Ireland; NICE=National Institute for Health and Care Excellence
GB Prescribing Information available here. For HCPs in GB and NI with a respiratory interest.
NI Prescribing Information available here.
1. Tezspire (tezepelumab). Summary of Product Characteristics. 2022. https://www.medicines.org.uk/emc/product/14064/smpc. [Accessed June 2024]; 2. Tezspire (tezepulmab). Summary of Product Characteristics (Northern Ireland). 2022. https://www.emcmedicines.com/en-gb/northernireland/medicine?id=3fdefedf-5567-430a-9305-51de764defd2&type=smpc [Accessed June 2024]; 3. Menzies-Gow A, Wechsler ME, Brightling CE. Respir Res. 2020;21(1):268; 4. Menzies-Gow A, et al. N Engl J Med. 2021;384(19):1800–1809.
Annual Conference 2024
Harrogate 2024
Dr Nandinee Patel
BSACI Scientific
Joint Programme
Lead
Dr Natasha Gunawardana
BSACI Scientific
Joint Programme
Lead
The Annual Conference is coming up fast! This is our last year holding the conference in beautiful Harrogate. Next year we are moving to ICC Wales. The early bird deadline is 29th July so register soon to take advantage of the lower registration fees.
Programme highlights
Our theme this year is ‘The Power of Data, the Power of People’ with an exciting plenary envisioning the future of integrating big data and artificial intelligence into our future practice. Definitely not to be missed!
In the era of multiple biologics how do you decide which one will suit your patient? How do we manage the use of biologics in multisystem allergic disease? We’ll have a special expert panel discussing these pertinent issues and future directions.
Extra sessions with an extra half-day
This year we are delighted to add an additional half day to discuss practical allergy management. Our ‘Allergy mythbusters’ session is specifically aimed to discuss the evidence behind aspects of our clinical practice. We have added dedicated sessions on education and EDI in allergy– two areas BSACI is dedicated to championing. Make sure you also check out the workshops for hands-on practical advice on EoE management, hereditary angioedema, SCARs, and skin testing for excipients to name a few!
Collaboration through Joint sessions
We have a host of national and international experts sharing their cutting-edge research and are hosting joint sessions with the British Thoracic Society (BTS), CIPN, the British Gastroenterology Society, the British Association of Dermatology, and a special session with the World Allergy Organisation. In addition, do not miss the sessions covering the latest BSACI guidelines, surgical crossover specialties, drug allergy, immunotherapy and food allergy. We will be rounding up our programme with the ever popular CEA year in review and ‘Tricky Cases’ rapid review. The full conference programme can be viewed at https://bsaciconference.org/programme/
Abstracts
We are delighted so many people submited abstracts this year to discuss their research - our highest number ever! This year we will have topic-based poster walks facilitated by key experts in each field – a really great opportunity to engage with researchers and share ideas and experience.
Social programme
This year, we’ve worked hard to re-design the Welcome Reception. We have organised special surprise entertainment and a more generous package of drinks and food for attendees.
The 5k fun run returns this year! Come and chat with friends while you run, race your colleagues or simply start the day energised before joining the day’s lectures - and, as a BSACI first, receive a BSACI race t-shirt for participating! We expect they’ll be popular so don’t miss your chance to pick one up!
Finally, make sure you book your tickets for the Gala dinner. This year there will an improved menu and even more dancing and music late into the night!
We do hope you join us for what is sure to be a memorable BSACI 2024 and we look forward to welcoming you in person soon.
Follow us on Twitter @BSACI_Allergy #BSACI2024 www.bsaciconference.org
Early Bird registration closes Monday 29th July – register now!
www.bsaciconference.org/registration
Book your tickets for the Welcome Reception and Gala Dinner and 5K fun run at the same time www.bsaciconference.org/meetinginformation/
BSACI Allergy and Clinical Immunology
Conference 2024, Harrogate
Date: Thursday 3rd October
Time: 17:15 – 18:15
Location: Auditorium
A symposium from
†The first dose should be taken under medical supervision, and the patient should be monitored for at least 30 minutes. Please refer to the ACARIZAX® D. Pteronyssinus & D. farinae Summary of Product Characteristics for more detailed information.3
HDM, house dust mite; SLIT, sublingual immunotherapy.
*Trials: MT-01: 2005-002151-41; MT-02: 2006-001795-20 / NCT00389363; MT-03: 2007-000402-67; MT-04: 2010-01862119 / NCT01433523; MT-06: 2011-002277-38 / NCT01454544; TO203-1: JapicCTI-111624(en); TO-203-3-1: JapicCTI-121847(en); TO203-3-2: JapicCTI-121848(en); TO-203-3-3: JapicCTI-152953(en); MK-8237-001: NCT01700192; MK-8237-003: 2012-001855-38 / NCT01644617; MK-8237-009: 2012-005621-70 / NCT01852825; MITI3001: ID:1000603874; MT-09: regID 2006L10180.
PRESCRIBING INFORMATION Refer to the Summary of Product Characteristics (SmPC) before prescribing
ACARIZAX® 12 SQ-HDM sublingual lyophilisate (tablet) for allergy immunotherapy contains standardised allergen extract from the house dust mites Dermatophagoidespteronyssinus and Dermatophagoides farinae Indications: 1) Indicated in adult patients (18-65 years) diagnosed by clinical history and a positive test of house dust mite (HDM) sensitization (skin prick test and/or specific lgE) with at least one of these conditions; persistent moderate to severe HDM allergic rhinitis despite use of symptom-relieving medication, or HDM allergic asthma not well controlled by inhaled corticosteroids and associated with mild to severe HDM allergic rhinitis. Patients’ asthma status should be carefully evaluated before the initiation of treatment. 2) Indicated in adolescents (12-17 years) diagnosed by clinical history and a positive test of HDM sensitisation (skin prick test and/or specific lgE) with persistent moderate to severe HDM allergic rhinitis despite use of symptom-relieving medication. Posology and administration: The recommended dose for adults (18-65) and adolescents (12-17 years) is one sublingual lyophilisate (12 SQ-HDM) daily. The first tablet should be taken under medical supervision for at least half an hour. The daily dose is one tablet to be placed under
Licensed and proven treatment for house dust mite respiratory allergy1,2
Evidence based:
• Building on a legacy of both evidence and experience*1-4
Proven efficacy:
• ACARIZAX® is the only SLIT-tablet indicated for:
• Treating both HDM allergic rhinitis and allergic asthma in adults (18+ years)3
• Treating HDM allergic rhinitis in adolescents (12+ years)3
At home treatment†
• A licensed, proven and patientcentric approach to HDM respiratory allergy3,5,6
Discover how ACARIZAX® can help your eligible patients
This information is intended for healthcare professionals only.
the tongue. Avoid swallowing for about 1 minute. Food and beverage should not be taken for the following 5 minutes. Treatment should be initiated by physicians with experience in treatment of allergic diseases. (Allergic rhinitis: Use in children <12 years of age have not been established. Allergic asthma: Use in children <18 years of age has not been established.) Contraindications: Hypersensitivity to excipients. Predicted FEV1<70% (after adequate pharmacological treatment) at initiation of treatment. Severe asthma exacerbation within the last 3 months. Patients with asthma and experiencing an acute respiratory tract infection, initiation of treatment should be postponed. Active or poorly controlled autoimmune diseases, immune defects, immunodeficiencies, immunosuppression or malignant neoplastic diseases with current disease relevance. Acute severe oral inflammation or oral wounds. Special warnings and precautions: Asthma is a risk factor for severe systemic allergic reactions. ACARIZAX is not intended to treat acute asthma exacerbation and should initially be used as add on therapy. Abrupt discontinuation of asthma controller medication is not recommended. Treatment should be discontinued, and a physician should be contacted immediately in case of severe systemic allergic reactions, severe asthma exacerbation, angioedema, difficulty in swallowing, difficulty in breathing, changes in voice, hypotension or feeling of fullness in the throat. One option for treating severe systemic allergic reactions is adrenaline. The effects of adrenaline may be potentiated in patients treated with tricyclic antidepressants, MAOls and/or COMT inhibitors with possible fatal consequences. The effects of adrenaline may be reduced in patients treated with beta-blockers. Initiation in patients who have previously had a systemic allergic reaction to subcutaneous HDM immunotherapy should be carefully considered. Cases of eosinophilic oesophagitis have been reported in association with treatment. In patients with severe or persisting gastro-oesophageal symptoms such as dysphagia or dyspepsia, treatment should be interrupted, and medical evaluation must be sought. There are additional precautions listed including regarding use in patients with oral inflammation or oral wounds, local allergic reaction, autoimmune diseases in remission. ACARIZAX may contain trace amounts of fish protein. Interactions: Concomitant therapy with symptomatic antiallergic medications may increase the tolerance level of the patient to immunotherapy. Pregnancy and lactation: Treatment should not be initiated during pregnancy. No clinical data are available for use during lactation. Undesirable effects: Expect mild to moderate local allergic reactions to occur within the first few days and subsiding with
continued treatment (1-3 months). For most events, the reaction should be expected to start within 5 minutes after intake and abate after minutes to hours. More severe oropharyngeal allergic reactions may occur. Severe acute worsening of asthma symptoms and serious systemic allergic reactions, including anaphylaxis, have been reported. Hypertensive crisis has been reported following respiratory distress shortly after intake. Very common adverse reactions (≥1/10): nasopharyngitis, ear pruritus, throat irritation, lip oedema, mouth oedema, oral pruritus. Common (≥1/100 to <1/10): bronchitis, pharyngitis, rhinitis, sinusitis, dysgeusia, eye pruritus, asthma, cough, dysphonia, dyspnoea, oropharyngeal pain, pharyngeal oedema, abdominal pain, diarrhoea, dysphagia, dyspepsia, gastroesophageal reflux disease, glossodynia, glossitis, lip pruritus, mouth ulceration, oral pain, tongue pruritus, nausea, oral discomfort, oral mucosal erythema, oral paraesthesia, stomatitis, tongue oedema, vomiting, pruritus, urticaria, chest discomfort, fatigue. Consult the SmPC for details of adverse reactions. Overdose: If doses higher than the recommended daily dose are taken, the risk of side effects may increase, including the risk of systemic allergic reactions or severe local allergic reactions. ATC Code: V01AA03 Legal Category: PrescriptionOnly Medicine (POM). Marketing Authorisation Holder: ALK-Abelló A/S, Bøge Alle 6–8, DK-2970 Hørsholm, Denmark. Marketing Authorisation Number: PL10085/0058. NHS List Price: £80.12 per 30 tablets. Updated: March 2024. GB-AZX-2300002
Adverse events should be reported. Reporting forms and information can be found at UK: https:// yellowcard.mhra.gov.uk/or search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to ALK-Abelló Ltd at drugsafetyuk@alk.net
References: 1. Data on File. ALK 2019 annual report. 2019. REF-00424. ALK.
2 Demoly P et al. J Allergy Clin Immunol 2016;137:444–51.
3 ACARIZAX® Summary of Product Characteristics.
4 Virchow JC et al. JAMA 2016;315:1715–25.
5 Damm K et al. Health Econ Rev 2016;6:32.
6 Ohashi Doi K et al. Int Arch Allergy Immunol 2017;174:26–34.
GB-AZX-2400007 June 2024
12-SQ HDM SLIT
National Allergy Strategy Group
Development of a National Allergy Strategy
Professor Adam Fox Chair – National Allergy Strategy Group (NASG)
In the last issue of Allergy Update, I mentioned that we had obtained ministerial approval to establish the Expert Advisory Group on Allergy (EAGA), co-chaired by NASG and the Department of Health and Social Care. One of our primary strategic objectives has been representation and the ability for key stakeholders to raise issues with the appropriate government departments where policy change could have a positive impact for those suffering with allergy.
I am delighted that EAGA has now met on two occasions. In December, we had an introductory meeting, to review Terms of Reference and membership and highlight the current state of NHS allergy provision. I would like to thank Steve Jenkins for illustrating the current inequity in adult allergy provision through his work, which was presented to the group. At our next meeting in April, we focussed on issues relating to Allergy management in schools and had a compelling presentation by Helen Blyth of the Benedict Blyth Foundation, presenting the findings from the REACT report, based on a freedom of information request sent to thousands of UK schools. This highlighted worrying evidence of a lack of training and inconsistency in allergy policies. As a senior policy advisor was present from the Department for
Education, this allows us to progress this conversation with the intention to influence future policy.
Our next meeting will hopefully be the first to focus on what will be the key body of work for the group going forward – the development of a National Allergy Strategy. The cost of developing a strategy is significant and the NASG is committed to avoid potential conflicts by not receiving funding directly from industry so raising funds can be challenging. Funding therefore needs to come from our core members and I have therefore been working with Fiona Rayner, BSACI CEO to explore funding opportunities. Thankfully, this has been met with some success through different avenues, putting BSACI in a position to support NASG and the BSACI has also generously agreed to underwrite any potential shortfall. This has enabled us to advertise for a project manager. Carla Jones has been appointed as the National Allergy Strategy Project Manager. Carla has a decade of experience leading Allergy UK, making her the ideal candidate to support the National Allergy Strategy Group (NASG) to deliver the UK’s first National Allergy Strategy.
In the interim, we have already successfully recruited a number of key organisations to be stakeholders in the NASG and these will support the strategy development work. I look forward to letting you know how we get on!
NASG campaign to make children with allergies safer in school
In April, the Benedict Blythe Foundation wrote an open letter to the secretary of state for Education which was supported by over 40 organisations including all the NASG members. I had the opportunity to travel to Downing Street with Helen Blythe and her family to deliver the letter. This is part of an ongoing campaign to push for a series of legislative and other chances by the Department for Education to make children with allergies safer in school. This has been one of the key focusses of the work of the NASG.
Rebecca Batt
Paediatric Allergy Nurse Consultant
Ibegan my nursing career in allergy in 2007 when I became a CNS at King’s College Hospital. Soon after I started the MSc at Imperial and was suddenly launched into a whole new world of multi system allergy and immunological processes I had never even heard of. The course was a game changer though, and it gave me the knowledge and confidence to start running independent nurse led clinics. I attended as many training days and conferences as possible and had the opportunity to be one of the lead nurses for the Barrier Enhancement for Eczema Prevention (BEEP) study. I became involved in the organisation of study days and courses as well as speaking at events.
I spent a few years working in the private sector while gaining the Non-Medical Prescribing Course then in 2018, I became the Advanced Nurse Practitioner at the Evelina, London. I am a Course Director for the Allergy Academy and more recently, I was promoted to be the new Nurse Consultant, which has always been a personal and professional goal. .
The four pillars of the Nurse Consultant role are advanced clinical practice, leadership, training and education and research. Meeting these expectations is challenging but I work with a fantastic, motivated team which helps to keep me both passionate about allergy, as well as leading the nursing team with integrity and pride. There are many challenges ahead, all of which we are aware of, but I am determined to keep the service developing and make sure we are
ready to deliver the expert, latest evidenced based care our patients deserve. Of course, along the way, I have met some of the nicest people on the planet and have made life long friends. Allergy is a fascinating speciality and I feel honoured to be a part of it.
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
https://www.bsaci.org/about-bsaci/ways-to-support-bsaci/
Rebecca Batt
Distinguished contributions of Professor Rajakulasingam to Allergy Research and Clinical Excellence
Professor Rajakulasingam, a distinguished graduate of the University of Colombo, Sri Lanka, began his UK medical career as a trainee doctor (pre-registration house officer) in Stoke-on-Trent. He held various positions in Birmingham, Nottingham, and Wigan as a Junior and Senior House Officer. He then worked as a registrar in respiratory medicine at Hope Hospital, Manchester, followed by a role as Senior Registrar in Allergy and Respiratory
Medicine at the Royal Brompton Hospital, London.
He had an illustrious career in allergy and respiratory medicine. Graduating with outstanding results in 1982, he moved to the UK in 1984 to further his training. He completed his MRCP diploma in 1986 and his DM thesis in rhinitis and asthma, along with Allergy training at Southampton General Hospital (University medicine department) under the mentorship of Professor Peter Howarth and Professor Sir Stephen Holgate. He then moved to the Royal Brompton Hospital, London, and completed his higher training as a senior registrar in allergy and respiratory medicine under Professor Stephen Durham, the late Professor Barry Kay, and many other eminent and distinguished physicians and scientists.
In October 1996, Professor Rajakulasingam joined Homerton Healthcare NHS Trust as a Consultant in respiratory medicine. Driven by his passion for allergy, he took the bold step of introducing skin prick tests as a standard investigation for all patients with respiratory allergy-related problems. He initiated clinical research in allergy with industry funding and a research nurse, escalating the allergy service provision to the local population and eventually making allergy a recognized and viable service in the Trust. While continuing his role as a general and respiratory physician, he managed to develop the allergy service to its current level, which includes three consultants in allergy, five nurse specialists, a pharmacist, a dietician, and dedicated administrative support. Under his leadership, the Homerton Allergy Unit achieved IQAS accreditation in 2021, becoming only the ninth service to do so (second in London) in the UK, reflecting his dedication to quality and excellence in patient care. This service has become a benchmark for excellence in allergy
care, significantly enhancing patient outcomes.
Despite his significant contributions to allergy, he continued to develop the respiratory service in parallel. This service now includes five consultants and has established NIV, CPAP, lung cancer, and ILD services. He also served as the clinical lead for allergy and respiratory medicine for several years, bringing in innovations and implementing changes while keeping patient care at the forefront.
His contributions extend beyond clinical practice. His involvement in medical education and training has shaped the careers of numerous medical students, junior doctors, nurses, and allied healthcare professionals. He was voted and received the prestigious Best Teacher Award from QMUL in 2011. He worked as the principal and senior internal examiner for the Year 3 undergraduate medicine course and was the lead for the cardio-respiratory/haematology module. His tireless contribution earned him an honorary title of Clinical Professor in the Institute of Health Sciences, a rare achievement among full-time NHS consultants.
With over 100 publications, his research has made substantial contributions to the fields of allergy and respiratory medicine. His work has advanced the understanding of allergic diseases and informed clinical practice, benefiting countless patients.
Professor Rajakulasingam retired from his role as Consultant and Lead for Respiratory and Allergy in April 2024. His legacy of excellence in patient care, education, and research will continue to inspire and guide the medical community. We extend our deepest gratitude for his years of dedicated service and outstanding contributions, which will undoubtedly endure as an inspiration to all.
Thippeswamy
Billahalli
Homerton Healthcare NHS Foundation Trust
From left to right: Senty Loganathan, Rahul Rajakulasingam, Ramyah Rajakulasingam, Aneeta Rajakulasingam, Professor Rajakulasingam, Professor Shanthini Rajakulasingam and Ramanan Rajakulasingam
BRIT registry
Maria Smith BRIT Co-ordinator
2024 is proving to be an exciting year for the BSACI Registry for Immunotherapy (BRIT). The BRIT team has been working closely with statisticians to analyse the data collected in the last 5 years. The result will be the registry’s first peer-reviewed published paper discussing inequalities in access to specialist allergy immunotherapy. In addition, specific analysis of 4 different types of immunotherapy are being undertaken and will be
shared in letters to the editor in the coming months, beginning with peanut immunotherapy.
As the registry moves into its next phase, the committee is looking to appoint new members to help expand the registry. At the end of 2023, a statistician was elected to the committee, alongside representatives from Allergy UK and Anaphylaxis UK. In 2024 the committee is hoping to elect a primary care physician, dietician, dermatologist and pharmacist.
On 23 April, the Daily Mail published an extensive article about aeroallergen immunotherapy, featuring interviews with BRIT committee members Tom Dawson and Amena Warner. The article also included numbers from the registry.
Earlier this year, the BRIT committee met in London for their annual face-to-face meeting to discuss plans for the registry and the BSACI AGM in October. At this year’s AGM, BRIT will be featured in a talk by committee members Mich Erlewyn-Lajeunesse and Deb Marriage, as well as an open workshop and a special meeting for BRIT stakeholders and users.
If you are interested in learning more about the registry, visit the BSACI website (https://www. bsaci.org/professional-resources/bsaci-registries/ immunotherapy-registry/) or email brit@bsaci.org To sign up, visit the registry.: http://brit.e-dendrite. com/
Primary Care Training days
To raise allergy awareness among those working in primary care, BSACI conducts primary care training days across the UK. These training days are held in person and encourage dialogue between primary care workers and local allergy specialists.
Sessions include presentations, case studies, and workshops. Topics you can expect are, allergic disorders in children and young people, existing guidelines, and management of common allergies in primary care, updates in the management of asthma, hay fever, anaphylaxis, food allergies, eczema, and more. Further, meetings cover issues such as what can be managed within primary care, referral pathways, and how local allergy clinics work.
In 2024, primary care training days have been held in Worcester, Plymouth, and Exeter, with two more events planned for July 2024 in Nottinghamshire and later in the year, in Greater London.
To date, 77 days have been funded, and over 3296 practitioners trained. The primary care training days are kindly sponsored by Thermo Fisher, Viatris, and ALK, and the BSACI appreciates the commitment of the facilitators and speakers without whom these events would not be possible. To find out more visit: https://www.bsaci.org/education-and-events/primary-care-education/primary-care-allergy-trainingdays/
Registry Steering Committee meeting, 19 April at the BSACI office in London. Standing: Tom Dawson; Leya Pur; Sarah baker; Louise Michaelis; Mary Kelly; Sophie Vallis; Anna Thursby-Pelham. Sitting: Shifa Shaikh; Maria Smith; Mich Erlewyn-Lajeunesse
The Frankland-Kay Centre for Allergy
Paul Turner Reader in Paediatric Allergy and Immunology, Imperial College London
The Frankland-Kay Centre for Allergy by the National Heart and Lung Institute at Imperial College London launch event took place on 20th May.
The aim of the new Centre is to bring together the strong adult and paediatric allergy clinical research teams based at St Mary’s and Royal Brompton hospitals, state-of-the-art experimental research laboratory and data science teams, together with the bioengineering and engineering teams at Imperial, to solve some
of the key questions in reducing the impact of allergy on affected individuals and their families, with a particular
I wish we were opening our new Centre with Bill Frankland and Barry Kay present. That said, they are with us in the hearts and minds of those they have touched throughout their careers.
Adnan Custovic
focus on asthma and food allergy. Our emphasis is on collaborative working, both internally and with external partners including policymakers and patient bodies.
Professor Sir Stephen Holgate launched the Centre, with talks from allergy experts, followed by drinks and networking.
Pictured below: Adnan Custovic; Stephen Holgate and Barry Kay; William Frankland
Supporting the society
Why BSACI is important to me
First and foremost, the BSACI exists to promote and maintain state of the art patient care. This is accomplished through its integrated network of Allergy experts including the National Allergy Strategy group (NASG), the Allergy Expert Advisory group, which embraces the NASG, the Head of Strategy and Policy at the Department of Health and Social Care and the Standards of Care Committee. Naturally there is liaison with national bodies which set similar standards such
as the National Institute for Clinical Excellence (NICE). Input from all of these organisations contributes to the definition and real time updating of excellence in Allergy care, embracing advances made worldwide but with an emphasis on management of patients through our own National Health Service.
Secondly, the BSACI is the ultimate port of call when it comes to dealing with crises and controversies in Allergy management. Recent examples include Position Statements on issues such as the use of unlicensed medicines to treat Allergic diseases, the recall of potentially faulty devices and approaches to healthcare inequalities arising from poverty or distancing of patients from centres of Allergy care.
Thirdly, the BSACI is responsible for Allergy management input into the entire range of doctors, nurses, dietitians, parents and others who manage children and adults with Allergic diseases. This is accomplished though the BSACI’s national adult and paediatric networks, primary and allied care groups, adult monthly education sessions and Primary Care Shows. This input facilitates clinical governance and alignment of patient management with the latest guidelines. In this the BSACI works alongside patientcentered help organisations such as Allergy UK and Anaphalaxis UK.
Fourthly, the BSACI is deeply involved in, and committed to the training and Continuing Professional Development of those managing children and adults with Allergic diseases. This is accomplished through national adult and paediatric training days held at Allergy training centres and available remotely online. These activities are overseen by the adult and paediatric Allergy committees. In addition, the Annual Conference of the Society is replete with advice on practical, clinical Allergy management and educational projects embracing primary, secondary and community care.
Fifthly, the BSACI is a strong supporter of new research, both through the amalgamation of nationwide
BSACI is responsible for allergy management input into the entire range of doctors, nurses, dietitians, parents and others who manage children and adults with allergic diseases.
outcome data for example through BRIT, the British Registry for Immunotherapy, and by the promotion of careers in Allergy and Allergy research for example by subsidising the attendance of prospective Allergy trainees at the Annual Meeting, and by rewarding outstanding research with a number of prizes, honoraria and scholarships. The BSACI is also a funnel of new, peer-reviewed research communicated through its official academic outlet, Clinical and Experimental Allergy, one of the leading international repositories of ground breaking, basic and clinical Allergy research, comment and opinion.
And finally, mention must be made of the BSACI Executive Team in Battersea, those largely unsung heroes and heroines who bind all of these strands together and who deserve our admiration and support.
In summary, then, the BSACI is a huge garden. Long may it blossom and flourish...
Professor Chris Corrigan Inaugural BSACI Fellow
Chris Corrigan - BSACI Fellow
Committee and SIG news
BSACI Allergy Education Network
Dr Jennie Gane
Respiratory Specialst, Royal Derby Hospital
In the last edition of Allergy Update we talked about BAEN’s future direction of work. I’m pleased to report that work is now well underway to develop the concept of a National Allergy Capability Framework.
The framework is modelled on the published National Capability Framework for Children and Young People with Asthma. It is composed of five “tiers of practice”, with ten key “allergy
capabilities” and outlines the educational learning outcomes required for professionals involved in the care of children and adults with allergy.
We hope the framework will provide one unifying document to guide individuals in meeting their
allergy learning needs, including non-healthcare staff such as sport coaches at tier one, to primary care healthcare professionals at tier 3, through to staff working regularly in Allergy services at tiers four and five. Our vision is that the framework will link to a platform of educational resources, tier specific and in some cases profession specific.
There remains lots to do! This includes wider consultation within the BSACI on content and feasibility, engagement with national stakeholder organisations, development of resources and ensuring alignment with established training pathways.
Finally, we plan soon to share the results of the Shaping Allergy Training in the UK Foundation Programme project; a national survey examining the views of newly qualified doctors on their training in Allergy and confidence to manage patients with allergic disease. Watch this space!
Nursing and allied health care professionals in Allergy
Sarah Baker, Mary Feeney, Karen Wright and Justine Dempsey
The British Dietetic Association (BDA) Food Allergy Specialist-Group (FASG) are working with the British Allergy Education Network (BAEN), to identify and develop support for the professional development of healthcare professionals (HCP) working within allergy. As part of this work, the BDA FASG conducted a survey to understand the scope of practice of dietitians within allergy across the UK. The survey aimed to capture all levels of practice, from graduate to advanced practitioners. and was shared across various clinical practice groups of the BDA including food allergy, paediatrics and freelance. Dietitians answered questions about their care settings, activities carried out within their role, current levels of allergy education and engagement in post registration training, current proficiencies in allergy recognition and management and current proficiency in allergy knowledge and care. 83 responses were received, of which the majority were members of the FASG (89.3%), 87% had worked in allergy for > 10 years, 4.8% >5-<10 years, 6% 2-5 years, 2.4% < 2 years. The BDA FASG aim to use the results to inform allergy specific competencies for dietitians aligned to roles, identify education gaps and plan how dietitians can be supported to advance their allergy expertise, practice, and improve allergy services. This work will align the BAEN’s development of allergy competencies that aim to cover all HCPs working within allergy.
Bethen Almeida sits on the BSACI Allergy Education Network under the competencies team. She has worked at Imperial College NHS Trust as a Paediatric Asthma and Allergy Clinical Nurse Specialist for 9 years and has recently moved to CLCH as a Senior Nurse within the Children and Young People’s Team.
Beth’s final year research project addressed a notable gap in the literature concerning the representation and roles of nurses working in allergy in the UK. There is an increasing demand for allergy care services, and Allied Nurse Specialists play crucial roles in meeting these demands. Despite the significant presence of ANS in allergy care, there is a lack of formal job definitions, standardised education, and clear career pathways for these professionals. In order to gather both qualitative and quantitative data to detail and document the current landscape of ANS training and competencies, a comprehensive national survey involving nurses working in secondary, tertiary, research, and private allergy care settings was conducted. The
survey recorded various aspects of their roles, including job titles, banding, levels of responsibility, training undertaken, perceived competence, opinions on their jobs and training needs, and the strengths and weaknesses of ANS in the UK.
The findings highlight significant presence of ANS in advanced roles throughout the UK. However, they also expose the absence of formal job definitions, education, and ANS career pathways. This project is the first to map out ANS roles and responsibilities in the UK and to highlight their training and career needs. Beth has won awards for her work, presented these research findings nationally, is undergoing publication, and collaborates with key stakeholders such as the BSACI and Higher Education Institutes with the aim of informing healthcare organisations, professional bodies, and educational institutions, with the hope of improved professional development and better patient outcomes in allergy care across the UK. The project advocates for recognising nurses in the allergy workforce and standardising allergy care in the UK.
Ethics, Equality, Diversity and Inclusivity Committee (EEDI)
The Ethics, Equality, Diversity and Inclusivity (EEDI) committee was formed in 2020, the aim of which is to coordinate and advance EEDI across the entire organisation. We believe there can be no equality of opportunity if difference is not valued, harnessed and considered.
Foremost, the committee drafted the first ever BSACI Ethics, Equality, Diversity and Inclusivity Policy. Thi spolicy is based on teh following three defining principles.
1. Equality
Regardless of any difference in race, physical ability, sexual orientation, gender, age, ethnic or religious
background, fair treatment and impartiality must be considered and employed.
2. Diversity
Diversity of thought and the inclusion of new ideas and perspectives help to increase creativity, generate new ideas, enhance problem solving and increase flexibility, productivity, and effectiveness. With variety comes the responsibility to respect differences,
recognise and value individuals.
3. Inclusion
Deploying systems, policies, and practices that support, engage, and demonstrate value for all individuals.
We want to ensure that active engagement extends across our membership, in all aspects of its diversity, including, for example, profession, roles, functions, ethnic origin, sex and age. In seeking to be a membership body that reflects the allergy community we aim to have our active members proportionately reflect the diversity of the communities served by our members. Through its work and as a member of the Royal College of Physicians’ Inequality in Health Alliance, the BSACI is committed to supporting initiatives aimed at reducing health disparities for patients. No matter the differences in access, treatment or outcomes for certain populations, all patients should be granted the right to reach their full health potential. The committee further aims to create awareness around EDI, increasing visibility at the annual conference, and ensuring speakers at our events follow the BSACI’s guidance in relation to EEDI.
Psychology Special Interest Group
Professor Rebecca Knibb
Associate Professor in Health Psychology, Ashton University; Chair of the BSACI Psychology Special Interest Group
The Psychology Special Interest Group is chaired by Dr Rebecca Knibb, an Associate Professor in Health Psychology, and aims to promote the psychological care and wellbeing of patients with allergies and their families. The group has members from research and clinical practice, spanning paediatric and adult allergy. We now have our own space on the BSACI website and will be uploading lots of information and resources over the next few months. Please look there for information on the group members, resources you can use with your patients, such as patient reported outcome measures, and how to manage allergy-related anxiety. We are also busy drafting an example business case you could use as a template for applying for money to support a psychologist in your area.
Our group members are involved in a range of research projects looking at psychological support needs for patients and families. Findings from the
global survey on adult and caregiver reporting food allergy-related distress have now been accepted for publication in Allergy. The paper will be out soon. We have also published a systematic review on psychological interventions for parents and children with food allergy which contains recommendations for practice. You can find this in the recent special online issue of Pediatric Allergy and Immunology.
We have given talks at a number of conferences, and to industry and patient organisations to promote awareness of the psychological impact of allergy. Anne Macdonald recently gave a talk at the BSACI nurses training day and Rebecca Knibb is giving a talk at the BSACI primary care training day in July.
We are busy organising a training event for later this year for health care professionals wanting to know more about how they can support their patients in managing food allergy-related distress. Based on feedback from other similar events, we plan to hold this as a half-day online workshop to begin with. Look out for adverts for this as soon as we have decided on the date.
If you are interested in being involved with our group or becoming a member please do get in touch. We would love to hear from you.
Paediatric Special Interest Group
Nick Makwana Consultant Paediatrician, Sandwell and West Birmingham NHS Trust
Time has flown and this will be my final report on behalf of the paediatric allergy committee as I have completed my tenure and will be handing over the reins to Tom Marrs from October 2024 – congratulations to Tom!.
I am excited that we have finally completed the Palforzia® practice statements and they will be released in June 2024, offering some practical guidance on implementation in practice. This has been a big piece of work, and we hope will be a useful tool for discussions with service development managers and commissioners.
We have updated the BSACI allergy action plans and have incorporated a dropdown box so that the action plan can be tailored to a child or young person,
and in addition a FPIES action plan has also been approved by the committee and will be accessible on the BSACI website in the next few weeks.
The committee have been working with the transition group and IQAS accreditation and are pleased that transition is now one of the key standards that services will be measured against when being assessed.
One of the projects we will be working on over the next few years is an audit of paediatric perioperative allergy services across UK, with the aim of developing a toolkit to support practice. If you do run a perioperative allergy clinic and would like to be involved, please do get in touch, if you have not already done so.
To finish, I’d like to once again thank the committee members for their ongoing support and input as without them none of the work we do would be possible. Have a great summer and I look forward to seeing many of you at the BSACI meeting in October.
Adult Allergy Commitee
Consultant, Broomfield Hospital; and Co-Chair of Adult Allergy Committee
One of the priorities of the group in recent times has been to widen representation with input from trainees, allied health professionals, and from a wider geographic area. There has also been close alignment with the work of IQAS, with a shared goal of improving and documenting high quality allergy care for adults..
There is increasing evidence of paucity of provision, and wide geographic variation in provision for adult allergy. Two separate
draft reports, from Steve Jenkins and Lavanya Divankar have been shared with members. These will be
published shortly, and will hopefully encourage debate about possible solutions, working with the BSACI Senior Leadership Team. One area being explored is to look at an adult equivalent of the SPIN training programme which has been so successful in paediatric allergy.
The Allergy in the Military working group, led by Andrew Whyte, have agreed draft guidelines which have been submitted to SOCC for review prior to wider dissemination.
The recent retirement of Prof Rajakulasingham, from Homerton hospital (see page 16) is reminder of what can be achieved in allergy when dedicated, inspirational individuals work hard to increase the profile of allergy. The Allergy service at Homerton is now thriving and a tribute to Raj. If we could all emulate his work across the country then adult allergy would be in a better place!
Dietetic Strategic Group
In 2023 we set up the Dietitians strategic group and we continue to meet regularly with BSACI to further our mutual objectives. Our aim is to ensure dietetics is represented across all relevant areas of BSACI activities, share expertise and collaborate to advance our profession in Allergy, through workforce planning and promoting opportunities for education and research. .
The BDA Food Allergy Specialist Group (FASG) will be supporting 5 dietitians to attend the BSACI Annual Meeting this year. We have also launched new research and education awards to support members.
In May FASG and BSACI jointly hosted a webinar on “Sustainable diets alongside food allergy” by paediatric dietitian Paula Hallam. This was well attended and well-received. The recording is available on the BSACI website for those who missed it.
Junior members
We have an upcoming trainee day on food allergy, conducted by Southampton hospital. Please register for it.
My tenure as BSACI junior members representative is coming to an end in October 2024 and I am pleased to announce that Usman Ahmed, ACI trainee based at Cambridge University hospital would be taking over from me. We aim to provide highest level of education in our training days and are in the process
• Integration and collaboration with BSACI
• Supporting conference attendance for dietitians
• Sustainable diets webinar (May 2024)
• Improving accessibility of diet sheets
One of the major outputs of FASG is our patient information sheets, of which we now have 36. These cover all different aspects of adverse reactions to foods for both adults and children and are under regular review by our members. We are undertaking a project to digitise our information and ensure they all meet accessibility requirements.
Justine Dempsey, Karen Wright, Hannah Hunter, Isabel Skypala
of developing our training programme in a way that it does not overlap with ACP training days and helps you to develop competencies and acquire knowledge needed for both allergy and Immunology. I am excited to see you all at upcoming BSACI Conference at Harrogate. Please don’t forget to take advantage of early bird registration, available until 29th July.
For any queries/communication, please contact us at juniormembers@bsaci.org.
Dr Neha Christian, Adult Allergy Registrar, Guy’s and St Thomas’ NHS Foundation Trust
Dr Steve Jenkins
Committee and SIG news
Primary Care Group
The Primary Care Group continues to work and engage with GP and Allied Health education platforms. We were pleased to have BSACI involved with this year’s Primary Care Conference at the NEC in Birmingham and were given the opening conference spot. With thanks to James Gardner, Nasreen Khan, Karen Wright and Paul Turner for offering their time and being speakers at the event.
Nurses in Allergy
Our second annual nurses event took place this year on the 26th of April with a great turnout. Including the team and speakers, a total of 128 wonderful people were online on the day.
This year the event was open to members and non-members, and we received a diversity in medical speciality and almost a 50:50 ratio members vs nonmembers. We believe this day was not only successful in imparting highly relevant information but in sharing the work and the aims of the Society. In the post-event survey, 23 said they would be interested in becoming a member, and 16 answered possibly. 17 wished to remain non-members but be notified of training and educational events. That amounts to a great number of non-members from the day having a positive impression.
The training was a half day event was chaired by James Gardner and Co-chaired by Phoebe Moulsdale and Rebecca Batt. Sessions were 20 min in length and allowed for a few minutes of Q&A. Sessions were a resounding success and left some wanting more! A variety of subjects were covered including anaphylaxis, developments in food allergy treatments, management of penicillin allergy and urticaria. A popular session was that of psychology in allergy and the role of the nurse. The comment section was alive with questions, compliments, and thanks, and was well fielded by the co-chairs. The slides were
Allergy (GPwER) scheme has now more than ten GPs interested in starting the process of accreditation, overseen by the BSACI and the RCGP. As before, Liz Angier is to be congratulated on her tireless work in making this accreditation a reality and the UK becoming the first nation to formally accredit GPs working in Allergic Medicine.
I will be stepping down as the current Chair this summer and joining the Standards of Care Committee. We would encourage our Primary Care colleaguesto consider being involved in the strategic direction of allergy in primary care with BSACI. If you are interested please email fiona@bsaci.org .
highly regarded, and speakers have kindly offered these as a resource post-event and are available on the members portal. Melanie Parrianen kindly edited the recording of the day which is available on our YouTube channel.
As a committee we are passionate about continuing these days and making it a BSACI mainstay for the calendar.
We are pleased to be launching a mentorship programme for nurses in allergy and we will be calling for members to act as mentors. Please watch your emails over the next few weeks. This will be followed by a call for mentees which will be open to non-members as well as members to not only offer the support needed for many nurses working independently in allergy but also the benefits of being a member of the society in order to grow our membership.
The aim of the Mentorship programme is to provide Nurses with the opportunity to obtain guidance from a more senior BSACI Nurse member on a one-to-one basis.
While many institutes have their own Mentoring Programs, the BSACI Nurses Group have expanded this idea for the BSACI community, which is ideal to complement a Mentee´s local training. This programme is merely a relationship between two parties; it is not a funded partnership with structured learning. The BSACI MP will not replace any existing mentoring currently taking place or the important role of the supervisor.
We look forward to updating you more on the project as the year progresses.
James Gardner Consultant Nurse in Children’s Allergy in London; Chair of the Nurses in Allergy Committee
The General Practitioner with Extended Role in Dr Matt Doyle GP, Jersey
Standards of Care Committee
Dr
Isabel
Skypala Consultant Allergy Dietician, Royal Brompton Hospital; Co-Chair of Standards of Care Committee
Dr Sue Leech
Co-Chair of Standards of Care Committee
TThe Standards of Care Committee continues to evolve. A Core Committee with specific roles will provide breadth of experience. After a 3 year term of office, members still involved with guideline production will join an advisory group to retain knowledge and experience. Andy Clark continues to lead on SOCC audits, assisted by trainee representatives.
We have published several patient information leaflets on the BSACI website https:// www.bsaci.org/professionalresources/patient-informationleaflets-2/. We hope you find these useful. Further PILS will be produced by the patient support charities, who have robust mechanisms for monitoring their impact and keeping them up to date.
The BSACI NSAID guideline, led by Rita Mirakian, is in the
final throes of production. An audit on NSAID allergy management will be run prior to its publication.
In January we reviewed the survey on Emerging Foods, and agreed a scope and PICO questions for the guideline led by Isabel Skypala. Isabel is leading
a Clinical Practice statement on LTP allergy for publication later in the year, and a Clinical Practice statement on oral food challenges.
Steve Till has written an editorial on the adult anaphylaxis action plans for Clinical and Experimental Allergy, which is in press.
The BSACI urticaria guideline was due to be updated around the time that EAACI/GALEN proposed a revision of the previous EAACI guideline. The BSACI trustees agreed we would contribute to the European guideline and adopt it following production. Six BSACI members are on the EAACI/ GALEN urticaria taskforce.
We continue to be indebted to Dr Shifa Shaikh, Chief Scientific officer of the BSACI for supporting the Standards of Care Committee
Online learning and development
Webinars and Grand Rounds
Our annual programme of webinars offers 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.
To see the schedule of Webinars and Grand Rounds visit www.bsaci.org/education-andevents/