Issue 39

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e a w a r e n e s s a n d p r o v i d e i n f o r m a t i o n o n u r t i c a r i a a n d C S U

X o l a i r i s l i c e n s e d f o r t h e t r e a t m e n t o f C h r o n i c S p o n t a n e o u s U r t i c a r i a ( C S U ) i n a d u l t a n d a d o l e s c e n t ( 1 2 y e a r s a n d a b o v e ) p a t i e n t s w i t h i n a d e q u a t e r e s p o n s e t o H 1a n t i h i s t a m i n e t r e a t m e n t a s a n a d d - o n t h e r a p y P r e s c r i b i n g I n f o r m a t i o n a n d A d v e r s e E v e n t R e p o r t i n g I n f o r m a t i o n c a n b e f o u n d h e r e U K | 2 4 5 0 9 0 | O c t o b e r 2 0 2 2

H e l p f o r H i v e s i s a n o n - p r o m o t i o n a l u r t i c a r i a a w a r e n e s s p r o g r a m m e c r e a t e d a n d f u n d e d b y N o v a r t i s T h e p r o g r a m m e h a s b e e n d e s i g n e d t o r a i s e a w a r e n e s s a n d p r o v i d e i n f o r m a t i o n o n u r t i c a r i a a n d C S U X o l a i r i s l i c e n s e d f o r t h e t r e a t m e n t o f C h r o n i c S p o n t a n e o u s U r t i c a r i a ( C S U ) i n a d u l t a n d a d o l e s c e n t ( 1 2 y e a r s a n d a b o v e ) p a t i e n t s w i t h i n a d e q u a t e r e s p o n s e t o H 1a n t i h i s t a m i n e t r e a t m e n t a s a n a d d - o n t h e r a p y P r e s c r i b i n g I n f o r m a t i o n a n d A d v e r s e E t R t i I f t i b f d h U K | 2 4 5 0 9 0 | O c t o b e r 2 0 2 2

Dr Shauna McKibben

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

Welcome to the Winter 2022 issue of Allergy Update, my first as editor. Many thanks to my predecessor Dr Erika Harnik for her contribution to the role. I am delighted to have been given the opportunity to be the first nurse to hold this position. I hope this increases the visibility of nurses and allied health care professionals in allergy and encourages others to become actively involved in BSACI.

It’s been a fantastic six months in allergy. Highlights include the landmark Natasha Allergy Research Foundation global symposium at Dumfries House in Scotland, hosted by the now King Charles III and BSACI being shortlisted as a finalist in three categories at The Association Excellence Awards 2022.

This edition includes updates on two key national allergy strategies: the BSACI Allergy Education Network, who aim to improve standards of and access to allergy education, and the National Allergy Strategy Group

who continue to keep allergy on the government’s agenda. With a special thanks to all contributors, we have new BSACI guidelines on penicillin allergy de-labelling and pollen food syndrome, Committee updates from those working to improve allergy care within subspecialities at a local and national level, and the latest news from the three BSACI Registries working to improve outcomes for people with allergies.

Moving forward, 2023 looks set to be an exciting year celebrating BSACI’s 75th Anniversary with the Global Collaborative Online Symposium ‘Clinical Allergy: State Of The Art 2023’ on 10th February. This is not to be missed.

If you have any comments or suggestions regarding content, please feel free to email me on s.mckibben@nhs.net. I’d particularly like to hear from nursing and AHP members. I hope you all have a happy and peaceful Christmas and New Year. I look forward to working together in 2023.

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

Editor of Allergy Update

Dr Shauna McKibben Co-ordinator Louise Colonnese

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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 – Co-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 David Luyt – Co-Chair of BSACI Standards of Care Committee

Dr Tomaz Garcez – Chair of the Clinical Immunology Committee

Dr Matt Doyle – Chair of Primary Care Committee

Co-opted Members

Dr 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

Contents

President’s message 4

Association of Excellence Awards 5

Online learning and development 5 BSACI registries 6 BSACI Global Allergy Online Symposium 2023 9

NARF Allergy Symposium report 10

BSACI guidelines 12

NASG report 14 BSACI Allergy Education Network 16

Primary Care Training days 17 Remembering Professor Tak Lee 19

Committee and Group news 20

BSACI team

Chief Executive: Fiona Rayner fiona@bsaci.org

Clinical Guidelines and Registry Manager: Dr Shifa Shaikh shifa@bsaci.org Finance & Administration Officer: Sandie Campbell sandie@bsaci.org

Membership Officer: Melanie Parrianen melanie@bsaci.org

Marketing & Communications Manager: Louise Colonnese louise@bsaci.org

Training & Education Coordinator: To be appointed Managing Editor, Clinical & Experimental Allergy: Catherine Hyland catherine@bsaci.org

BRIT Coordinator: Maria Smith maria.smith@bsaci.org

BSACI Studio 16, Cloisters House 8 Battersea Park Road London SW8 4BG info@bsaci.org 0207 501 3910 0207 627 2599 www.bsaci.org

Registered charity no: 1069199

My first year as President

Professor Graham Roberts President

My first year as president of the BSACI has flown by. Our society has emerged well from the pandemic and has been very active in all areas of allergy. I’m particularly pleased that we’ve managed to progress my priorities in particular broadening participation in BSACI activities and started a constructive dialogue with government along with the other key stakeholders.

The achievements of our society are too numerous to list in full. I would though like to highlight a few. The

joint Edinburgh conference with the World Allergy Organisation was a particular highlight of the year, it nicely served to emphasise the pre-eminence of the UK in leading allergy practice across the globe. The standards of the care committee have been particularly active with new guidelines focused on pollen foods syndrome and penicillin allergy relabelling published. The BSACI and Royal College of Physicians held a joint training webinar in May, this reflects the new joint allergy immunology training curriculum which we need to support going forward. Lastly, I must mention all the BSACI webinars that have been delivered over the year. They’ve proved extremely popular with lots of attendance and interaction – perhaps some good has come out of the pandemic.

At the start of my presidency, I challenged all our committees and working groups to come up

In the next year, we plan to appoint a few vice presidents to strengthen the senior leadership in the society. I would encourage you to consider applying for one of these positions.

with aims that could be incorporated into a threeyear BSACI strategy. I know all the groups have been working hard to deliver their objectives and I look forward to seeing the results.

In the next year, we plan to appoint a few vice presidents to strengthen the senior leadership in the society. I would encourage you to consider applying for one of these positions. They will each cover three of the areas of education and knowledge, science, workforce and services. The appointment of these vice presidents starts a process of rethinking the structure of the BSACI. As the society has grown, our council has become so large that meetings are dominated by reporting with little time for discussion. We are

We are therefore going to start a conversation about how to update the structure of the BSACI to allow it to more effectively support the activities of its membership.

therefore going to start a conversation about how to update the structure of the BSACI to allow it to more effectively support the activities of its membership.

Looking forward to next year, we have a number of major events in planning. The first is our global symposium on Friday 10th February. We have arranged joint sessions with the American, European and world allergy societies. Plus Professor Sir Stephen Holgate will be delivering the keynote lecture. Then in October will have our annual face-to-face meeting which next year will be held again in Harrogate. I hope to see you at both these meetings. At each, we will be celebrating the 75th anniversary of the BSACI in 2023.

Thank you to all our partners

We are proud of our work with our partners. Their support helps us to improve the management of allergies through education, training and research. You can find out more about how organisations have funded projects, events and activities to improve allergy care at www.bsaci.org/about-bsaci/partnership-working/

Association of Excellence Awards

Afew months ago, we were delighted to announce that BSACI was shortlisted as a finalist in three categories at The Association Excellence Awards 2022.

Fiona Rayner Chief Executive

The awards salute, celebrate and encourage the vital work that associations, trade bodies, professional organisations, and chartered institutes do for and on behalf of their members to ensure their voices are heard and their

causes are championed.

BSACI was shortlisted as a finalist in The Association Excellence Awards in the following categories:

• Association Leadership Award

• Best Association Partnership or Collaboration

• Best Membership Support Since Covid-19 (up to 4,000 members)

The awards presentation took place on 14th October at The Kia Oval, London. While BSACI did not win an award it was a fantastic opportunity to recognise the dedication and commitment of BSACI to our members and the impact of our work. As a judge for the awards and on behalf of BSACI I would like to congratulate the winners. For a full list of winners visit www.associationexcellenceawards.co.uk

Online learning and development

Webinars

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. BSACI would like to thank Dr Dinusha Chandratilleke for coordinating the webinar and Melanie Parrianen for providing administrative as well as technical support.

Grand Rounds

Organised by the BSACI Paediatric Allergy Committee (PAC), Grand Rounds 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.

BRIT Registry - making it simpler and improving feedback

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

Registry for Immunotherapy (BRIT) is well into its second phase and we continue to welcome new users to the registry. We currently have 288 users registered and over 1700 consented participants being treated with aero-allergen, venom, and peanut immunotherapy, and omalizumab for chronic spontaneous urticarial (CSU). BSACI recently welcomed Dr Shifa Shaikh as Clinical Guidelines and Registry Manager. Together with BRIT Administrator Maria Smith, Shifa is working toward building more cohesion between the organisation’s three registries. Here are some of the new advances in our work:.

As part of our effort to ease the administrative burden for BRIT users, we have changed the process

of reconsenting patients when they turn 16 and move from child to adult consent. Going forward, on a patient’s 16th birthday, an email will be automatically triggered to the BRIT administrator who will request updated consent from the patient without added work for the consultant.

BRIT uses patient reported outcome measures

(PROMs) to get direct feedback on how your treatments are working. As part of our remodelling of this system, we have begun the process of acquiring text message consent from BRIT participants in order to boost our returns. This is built into the consent package for new patients. To download the SMS consent form for existing patients, visit the BRIT Registry documents page or email maria.smith@bsaci.org

BRIT has a lot to look forward to in the coming year. In addition to our new PROM reporting, we hope to get our user dashboard up and running to improve the user experience. We have begun to closely analyse the data we have collected since 2018 and will be releasing our next 3-year report by the end of 2023. We are also working hard to reach out to and register new services across the UK.

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

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

BSACI Registry for Immunotherapy (BRIT)

BSACI

BSACI Registry for Immunotherapy (BRIT)

BSACI Registry for Immunotherapy (BRIT)

Does your centre use aero-allergen, venom or peanut immunotherapy or treat chronic urticaria?

Why BRIT?

Why BRIT?

Does your centre use aero-allergen, venom or peanut immunotherapy or treat chronic urticaria?

•

• Designed by consultants for consultants to help busy allergy services across the UK

• Designed by consultants for consultants to help busy allergy services across the UK

Why BRIT?

• Allows patients and their clinicians to see if their treatment is working

•

• Allows patients and their clinicians to see if their treatment is working

• Centres can access their data at the touch of a button

• Designed by consultants for consultants to help busy allergy services across the UK

• Centres can access their data at the touch of a button

•

• IQAS accreditation recommend the use of BRIT for allergy centres

• Allows patients and their clinicians to see if their treatment is working

• IQAS accreditation recommend the use of BRIT for allergy centres

• IQAS accreditation recommend the use of BRIT for allergy centres

• Improving access to allergy services across the UK and quality of care

• Centres can access their data at the touch of a button

• Improving access to allergy services across the UK and quality of care

• Improving access to allergy services across the UK and quality of care

• Although BRIT registered consultants must be BSACI members, their delegate users don’t have to be

• IQAS accreditation recommend the use of BRIT for allergy centres

• Although BRIT registered consultants must be BSACI members, their delegate users don’t have to be

• Improving access to allergy services across the UK and quality of care

Have you registered yet? Already registered but not utilising BRIT? brit.e-dendrite.com In

• Although BRIT registered consultants must be BSACI members, their delegate users don’t have to be

Have you registered yet? Already registered but not utilising BRIT? brit.e-dendrite.com In

• Although BRIT registered consultants must be BSACI members, their delegate users don’t have to be Have you registered yet? Already registered but not utilising BRIT? brit.e-dendrite.com

Have you registered yet? Already registered but not utilising BRIT? brit.e-dendrite.com In

Maria Smith

UK Fatal Anaphylaxis Registry

In 2020, BSACI in collaboration with Manchester Foundation Trust (MFT) received a one-off grant of £100,000 from the Foods Standards Agency (FSA) towards UK Fatal Anaphylaxis Registry (UKFAR).

The aim of the registry is to include all cases of fatal anaphylaxis irrespective of age and cause. Studying these events closely will help us understand more about what causes people to die from anaphylaxis and improve survival rates.

Lead Investigator on the UK Fatal Anaphylaxis Registry Dr Vibha Sharma explains:

“The UKFAR is unique in the kind of information it can collect and retain. This registry has been informative for allergic individuals and for those involved in their management. There is still a lot that remains ill understood. We are aware that anaphylaxis is common, but deaths from anaphylaxis are rare. Why some die and many recover is ill understood. Continued detailed review of each case of fatal anaphylaxis is

likely to enhance our understanding and help avoid future deaths. Attempts must be made to learn from each of these cases. When a death from anaphylaxis is suspected, early involvement of UKFAR is useful. UKFAR can provide advice on relevant investigation.

The grant from the FSA has enabled time investment towards collection of information on cases, but more importantly the liaising with allied specialities when cases of fatal anaphylaxis occur.

BSACI are looking at how the registry can be supported going forward.

To make a referral for UKFAR involvement visit www.bsaci.org/professional-resources/bsaciregistries/ukfar/ Or email Mft.fatal.anaphylaxis@nhs.net

Dr Vibha Sharma Lead Inverstigator, UKFAR

UK Anaphylaxis Registry

National reporting platform for allergic reactions and anaphylaxis in the community

Dr Paul Turner Reader in Paediatric Allergy and Immunology, Imperial College London

Through the UK Anaphylaxis Registry, launched in October 2021, we hope to collect data relating to unintended allergy reactions and anaphylaxis, to help guide public policy and better protect those with food allergies. The Registry serves as a platform for clinicians to record episodes of significant allergic reactions in the community following unintended allergen exposure to both food and non-food triggers, in people of all ages (children, young people and adults).

We are delighted to announce that from September 2022 we have partnered with the Paediatric Emergency Research in the United

Kingdom & Ireland (PERUKI) network. This involves the collecting of real-time information from individuals presenting to Accident & Emergency departments and other acute care environments (Acute Assessment Units, GP surgeries), using an abbreviated record form to reduce the time needed to report cases.

While over 50 BSACI members have signed

Data collection process: overview

Once a registered HCP has identified a potential case, they obtain verbal consent from the patient and their parent/guardian

up to the Registry, only a minority are reporting cases. We need many more contributors to help us understand more about accidental allergic reactions. To make this as easy as possible, we have developed paper versions of the case report forms, which can then be entered into the Registry platform at a later time. We also offer centre-based accounts, so contributors can share account details with their colleagues to record all cases of anaphylaxis presenting to their unit. This can help with internal audits.

Since the end of 2021, the Registry has been included on the NIHR-CRN portfolio, which means that for each case reported, your NHS organisation will receive an accrual via the CRN, which increases local NIHR funding to your organisation.

• To register as a contributor, visit bit.ly/ukanaphylaxis

• If you are already registered and want to report a case, visit www.anaphylaxie.net/ survey/admin/authentication/sa/login

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

Healthcare professionals (HCP) must register to report cases bit.ly/uk-anaphylaxis

They must ask for the patient/parent’s email address. This is entered into the Registry and used to email the patient/ parent’s information sheet and an electronic consent form

The HCP then completes an electronic case report form (CRF), which collect anonymous data relating to the allergic reaction

The patient is sent a separate online s urvey by email, which asks for additional information relating to symptoms and possible risk factors

Join us for BSACI Global Allergy Online Symposium 2023

We are delighted to be hosting a Global Collaborative Online Symposium on Friday 10th February 2023 at 08:00 – 18:30 GMT to celebrate our 75th Anniversary. This unique symposium ‘CLINICAL ALLERGY: STATE OF THE ART 2023’ is supported by our international partner organisations The World Allergy Organization (WAO), The European Academy of Allergy & Clinical Immunology (EAACI) and The American Academy of Allergy, Asthma & Immunology (AAAAI).

will be the penultimate session from the BSACI on the Challenges in Allergy. Dr Isabel Skypala will be discussing food protein-induced enterocolitis syndrome (FPIES) and eosinophilic esophagitis (EOE) in adults, followed by a talk from Dr Claudia Gore on approaching difficult conversations with adolescents and young adults. Finally, Professor Alexandra Santos will be discussing the future of allergy diagnostics, a session not to be missed!

There will be one final industry symposium before the final session of the day on Immunotherapy from the AAAAI.

Scientific Joint Programme Lead

The event will kick off with a WAO session on drug allergy. This will be followed by an Industry Symposium. Then our friends and colleagues at EAACI will be discussing the Environmental Impact on Allergy – a hugely topical discussion. After a short break, Professor Sir Stephen Holgate will deliver a Key Note Lecture on the key outcomes from The Natasha Allergy Research Foundation Global Symposium at Dumfries House hosted in September 2022 by the

now King Charles III..The world’s leading allergy & environmental experts came together in Scotland for the two-day meeting. They took part in a round table discussion with His Majesty focusing on the environmental causes of allergic diseases and effective interventions. Professor Sir Stephen Holgate will be addressing the vital role that we, the global allergy community, have in delivering and sustaining change.

Following the Key Note Lecture will be an industry symposium. After a short break, there

Each of the sessions will be followed by a Q&A session for 25 minutes where delegates will be given the opportunity to send in questions to our panel of expert speakers.

This is an exciting opportunity for the BSACI to work together with our global partners, developing closer collaborative working relationships and sharing world class knowledge to benefit the global allergy community.

Speakers & Chairs include: Riichiro Abe (Japan), Andrew Bird (USA), Ricardo Madrigal Burgualeta (UK), Sharon Chinthrajah (USA), Claudia Gore (UK), Alexandra Santos (UK), Wayne Schreffler (USA), Jurgen Schwarze (SCOTLAND), Isabel Skypala (UK), Stephen Durham (UK), Pascal Demoly (France) Brian Vickery (USA), Glenis Scadding (UK), to name a few. To read Speakers and Chairs biographies visit bsaciconference.org/speakers

BSACI is delighted to be working together with our global partners to develop this exciting programme. If you haven’t done so already, please visit the website bsaciconference.org to view the programme and register for the early bird discount.

Early bird registration closes: Thursday 26th January

Late registration opens: Friday 27th January

On demand content available: Monday 13th February Access to on demand content closes: Friday 10th March

Dr Nandinee Patel

BSACI Scientific Joint Programme Lead

Dr Natasha Gunawardana BSACI

NARF Allergy Symposium

Understanding the environmental causes of allergic disease to identify effective interventions

The last three decades have witnessed an unprecedented increase in the incidence of all types of allergic disease which is not simply restricted to the more widely distributed allergies such as hay fever, but to serious life endangering disorder such as anaphylaxis, food allergy and asthma. For example, one in 13 children, or two in every classroom now have food allergy. Natasha Laperouse is one young person who died of anaphylaxis in 2016 after eating a Pret a Manger sandwich containing sesame, which she was highly allergic to. For over 100 years, the UK has an impressive record of accomplishment

of pioneering research into allergy and yet still has among the highest incidence of these disorders worldwide. It has become clear that a focus on prevention is needed. It was for this reason that the Natasha Allergy Research Foundation (NARF) –created by Nadim and Tanya Laperouse to tackle allergy with ambitious new research – partnered with the King’s (formerly Prince’s) Foundation, the BSACI and the University of Southampton to hold a unique Allergy Symposium at Dumfries House in Scotland the conclusions of which were presented to the King. The event took place over 2 days during which we heard from 15 leading scientists from across the world whose research has drawn on the environmental drivers of allergy. After hearing the tragic story of Natasha poignantly delivered by

her parents Nadim and Tanya, we were introduced to the Biodiversity Hypothesis, which states that contact with natural environments enriches the human microbiome, promotes immune balance, and protects from allergy and inflammatory disorders. In contrast, urbanisation with global warming and nature loss operate in reverse.

Of the multiple genes now causaly linked to the origins and progression of allergic disease, many are involved in epitheial barrier functions. As a key part of the innate immune system, these barriers communicate with and trigger the adaptive immune system when their integrity is compromised. Through 16S rRNA gene amplicon studies, healthy lungs have a characteristic microbiome which undergoes loss of diversity in asthma. Changes also occur in the susceptibility to virus infection such as ORMDL3 and gasdermin-B (encoded together on Chr 17q), increasing interaction between rhinoviruses and the induction of childhood wheezing and asthma. However, it was noted that greater inclusivity of ethnic and other diverse groups needs attention when studying genetic influences in allergy.

There is now overwhelming evidence that exposure to livestock (especially cows) on farms strongly protect children from hay fever, allergic sensitisation, and asthma with the beneficial being driven by early life exposure to animal sheds and consumption of unprocessed raw cow’s milk. Studies on the Amish and Hutterite communities in the USA that have almost identical genetic origins but widely differing environmental

Professor Sir Stephen Holgate NARF Allergy Symposium lead

The Global Allergy Symposium was held at Dumfies House on 6th & 7th September 2022

NARF Allergy Symposium

exposures, confirm that intense and sustained exposure to microbes activates innate pathways to calibrate downstream immune responses. Children from Hong Kong also have three times the amount of asthma compared to mainland rural China but in this case the link was domestic poultry exposure. Of importance, the protective effects of rural and farm exposures on allergic disease are reproduced in animal models. Such protection is attributable to a certain ‘cocktail’ of relevant microbial exposures rather than ‘the more the better’ with accelerated maturation of the infant gut and lung microbiomes to increase epithelial barrier function and innate immunity. ‘Trained immunity’ in pregnancy and early childhood provides a new framework for intervening in the maladaptation of immunity associated with allergic diseases. Harnessing such knowledge with a focus on prevention, mucosal administration of several bacterial lysates e.g., MV130, Broncovaxon to non-atopic children are beginning to yield promising results. These bacterial products strongly suppress lung inflammation in allergen-treated mice by acting on multiple innate immune targets to induce tolerance as also occurs to peanut, egg, and dust mite allergens with high dose mucosal allergen exposure early in life.

Another key factor shaping mucosal immune training across the life course is exposure to environmental chemicals, outdoor and indoor air pollutants. Over 75% of the global population reside in urban environments where exposure to pollutants (especially air pollutants) is most severe. By 2050

this proportion is expected to increase to 95%. Understanding how body burdens of chemical residues influence allergy is an urgent research priority. Loss of biodiversity and its association with allergy converges with human degradation of the environment.

To conclude, and in the presence of King Charles, Nadim Laperouse expressed the mood of the meeting well: “There is no time to lose in confronting the allergy and environment crisis alongside the climate action agenda. The learnings from this inspiring and informative symposium provide us with a blueprint for eradicating allergies and that new landmark studies in this field are urgently needed.

Congratulations

Congratulations to NARF on achieving the Charity Breakthrough of the Year at Third Sector Awards

The event heard from 15 leading scientists from across the world

New BSACI guidelines

We have recently launched two new BSACI Guidelines. In August we announced the publication of the BSACI Guideline for the diagnosis and management of Pollen Food Syndrome/Oral Allergy Syndrome.

The guideline is a valuable resource for healthcare professionals and will benefit patients affected by Pollen Food Syndrome. To access the full guideline, visit www.bsaci.org/guidelines/bsaci-guidelines/ Medscape Guidelines has produced a summary of the guideline. The summary provides key points for each sub-section of the full guideline. To access the summary visit www.medscape.co.uk/s/viewarticle/ guideline-diagnosis-and-management-pollen-food-syndrome-uk-2022a100226f

In September we announced the publication of the BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting. To access the full guideline, visit www.bsaci.org/guidelines/bsaci-guidelines/ Medscape Guidelines has produced a summary of the guideline which provides key points for each sub-section of the full guideline. To access the summary visit www.medscape.co.uk/viewarticle/bsaci-guideline-set-penicillin-allergy-de-labelling-services2022a100258d

BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting

This new guideline provides a framework for the set-up and delivery of penicillin allergy delabelling services by non-allergists with an interest in clarifying the penicillin allergy status in adults and children with an untested label of penicillin allergy.

Consultant, Leeds Teaching Hospitals NHS Trust and Doctoral Fellow with the NIHR

BSACI, allergy experts and a range of key stakeholders, have collaborated on the development of the latest BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting. The recommendations identify patients at low risk of allergy and a framework for the conduct of drug provocation testing by non-allergists.

There are separate recommendations for adults and children within the guideline, in recognition of the common differences in reported allergy history and likelihood of true allergy.

Greater accessibility to testing is vital and non-allergists will play a key role in this. Defining which patients are suitable for a direct penicillin provocation test, as well as the minimum safety standards required to conduct this test, are critical steps to facilitating

non-allergist delivered de-labelling.

The impact on patients of penicillin allergy labelling, as well as de-labelling, is described by patient and co-author Rochelle Gold, who told us:

‘I had a label for penicillin allergy in my medical notes since childhood. I’d had many bouts of tonsillitis that was treated with penicillin I was always physically sick, so my family wrongly assumed that this was because I was allergic to penicillin, and this became part of my medical history. Being part of a de-labelling programme not only enabled me to test this assumption – I also learnt the importance and value of being able to take penicillin.’

The recommendations summarised in this guideline are endorsed by The Royal College of Pathologists, Association of Anaesthetists, Royal College of Anaesthetists, Royal College of Physicians, Royal College of Physicians (Edinburgh), British Infection Association, Society for Acute Medicine, British Association of Dermatologists, Royal Pharmaceutical Society, British Society of Antimicrobial Chemotherapy and Allergy UK.

Access the BSACI guideline for de-labelling of penicillin allergy in a hospital setting by nonallergists at www.bsaci.org/guidelines/bsaciguidelines/

The BSACI guideline on Pollen Food Syndrome

Dr Isabel Skypala Consultant

Allergy Dietician, Royal Brompton Hospital, London

This guideline covers one of the most prevalent types of food allergy in the UK, affecting children and adults alike. Pollen Food Syndrome (PFS), is known by several names, including Oral Allergy Syndrome and Pollen Food Allergy Syndrome. It has very recognisable symptoms and trigger foods, and so can be diagnosed from the clinical history alone, without the need for confirmatory tests. Unfortunately, tree nuts are a common trigger and so there is often confusion regarding whether the symptoms are caused by an allergy to tree nuts or to PFS.

Specific IgE tests to whole individual nuts or to mixed nuts may be positive due to crossreactivity but could be interpreted as indicative of a tree nut allergy rather than PFS which requires very different management advice.

So, one of the reasons for writing the guideline was to support the diagnosis of PFS in primary care, but also to recognise when individuals may need more specialist advice and tests. Since

• Up to 40% of children and 70% of adults sensitised or symptomatic to birch pollen are likely to have PFS

• In the case of individuals presenting with immediate mild oro-pharyngeal symptoms to typical raw plant foods (apples, stone fruits, kiwi, carrots, celery, almonds, hazelnuts, peanuts or peeling potatoes), a diagnosis can be made from the clinical history alone,

• Concentrated forms of fruits/vegetables, or rapid consumption of a large amount of the food, e.g., fresh fruit/vegetable juices or smoothies, soya milk, raw nuts, large quantities of roasted nuts or nut bars, can cause more severe reactions

• For those reporting more severe symptoms to plant foods, or if reactions are to cooked or roasted fruits, vegetables, or nuts, or to nonPFS nuts such as cashew/pistachio nut, then a specialist allergy review is warranted.

• For all those referred to a specialist clinic, sensitisation to grass and birch pollen should be ascertained, even if they do not report any seasonal allergic rhinitis, especially if reactions to nuts are reported.

PFS affects children and adults, and the major management is through dietary exclusion, the writing group for the guideline needed to include a wide range of professionals working in allergy. Thus, the group included paediatric and adult allergists, an immunologist, nurse and two dietitians, and importantly a patient representative.

The guideline focussed on diagnosis and management, using PICO questions to inform a literature search. Unfortunately, there is a sparsity of literature on PFS, especially on diagnosis and management, so although 527 references were generated, only 156 were relevant, and further references were generated using additional searches. Even then, there was insufficient evidence for some of the PICO questions. The main findings of the guideline are given below, but the most crucial take-home messages are that diagnosis can be made through clinical history alone and skin prick or specific IgE tests to hazelnuts and peanuts are very often positive in pollen sensitised patients, so if PFS is suspected, then undertaking tests to the component allergens in these foods is essential.

• Standard skin prick and blood allergy tests for peanuts, almond and hazelnut are usually positive in those allergic to tree pollen, but component allergy tests can distinguish PFS from a tree nut or peanut allergy.

• Rather than testing for sensitisation to birch cross-reacting PR10 allergens in peanut, hazelnut and walnut, evidence suggests a more useful test is to ascertain sensitisation to the allergens involved in a primary peanut allergy (Ara h 2 and Ara h 6), hazelnut allergy (Cor a 9 and Cor a 14), and walnut allergy (Jug r 1).

• People with PFS only need to avoid their specific food triggers; reactions are usually mild and symptoms generally disappear after a short time, often without the need for antihistamines, and self-injectable adrenaline devices are rarely required

• Current evidence suggests that pollen immunotherapy is not an effective treatment for PFS, and there is currently insufficient evidence for immunotherapy or desensitisation with fresh foods to make a recommendation

National Allergy Strategy Group

Professor

Adam Fox Chair – National Allergy Strategy Group (NASG)

In July of this year, having been a founding member of National Allergy Strategy Group (NASG) 20 years ago, Dr Pamela Ewan stepped down as our Chair. I would like to thank Dr Ewan for her many years of dedicated service, advocating for improvements in NHS service provision, and the many concrete gains she has achieved. Thankfully, Pam will remain involved in the NASG as its President, joining Prof Sir Stephen Holgate who is now NASG Patron. These are non-voting, advisory roles. I would also like to thank Mandy East, who provided the secretariat for the All Party Parliamentary Group (APPG) in allergy as Parliamentary Officer since 2007, for her enormous

contributions, following her step down in June this year.

My first role as incoming chair has been to revisit the Terms of Reference of the collaboration between BSACI and the two national allergy charities that form the NASG - Allergy UK and Anaphylaxis UK (formerly Anaphylaxis Campaign). These had not been changed since the NASG was first established and were focused exclusively around lobbying for NHS services. As times have changed, there is wider recognition that improving the life of people who suffer from allergies means there is lobbying to be done across a much broader range of areas of government policy such as education, food safety and transport. Both professional societies and charities all have a role to play here. There is also a role for more stakeholders to be part of this conversation and the new terms of reference will make provision for this.

We have continued to have meetings with policy

makers at the DHSC, but due to the many changes in leadership, concrete progress has been frustratingly limited. However, this is a long game and quick wins will be infrequent. We continue to lobby health ministers including Dr Caroline Johnson MP, recently appointed as a junior health minister and a consultant pediatrician herself. Our key aims remain to build on the recommendations laid out in our 2021 report – ‘Meeting the Challenges of the National Allergy Crisis’, with the focus of representation for Allergy at a high level of the DHSC and the development of a National Allergy Strategy.

World Allergy Organization Special Achievement Award

BSACI is delighted to announce that Professor Graham Roberts and Dr George Gkimpas have been chosen by WAO to receive a ‘Special Achievement Award’ in recognition of the 2022 Edinburgh conference partnership between BSACI and WAO. The award will be presented during the WAO 2023 Pan-Arab Allergy Meeting in Dubai, which will take place on 27th29th January 2023. The award presentation will take place on the 27th January 2023. To register for the WAO Meeting visit sciencepro.me/wao-pasaai.html. BSACI would like to congratulate both on being selected for this award.

Mandy East and Dr Pam Ewan at lunch hosted by BSACI in June 2022

Professor Graham Roberts Dr George Gkimpas

New content on bsaci.org

New BSACI guidelines

BSACI recently published the guideline for the diagnosis and management of Pollen Food Syndrome/Oral Allergy Syndrome. To access the full guideline, visit www.bsaci.org/guidelines/bsaciguidelines/ Medscape Guidelines has produced a summary of the guideline. The summary provides key points for each sub-section of the full guideline.

To access the summary visit www.medscape. co.uk/s/viewarticle/guideline-diagnosis-andmanagement-pollen-food-syndrome-uk2022a100226f

BSACI guideline for the set-up of penicillin allergy de-labelling services by non-allergists working in a hospital setting. To access the full guideline, visit www.bsaci.org/guidelines/bsaci-guidelines/ Medscape Guidelines has produced a summary of the guideline. The summary provides key points for each sub-section of the full guideline.

To access the summary visit www.medscape. co.uk/viewarticle/bsaci-guideline-set-penicillinallergy-de-labelling-services-2022a100258d

Support BSACI while you shop

BSACI has joined AmazonSmile. This is a really quick and easy way to donate to BSACI, a registered charity, every time you shop, at no cost to you. Support BSACI through AmazonSmile using this link https://smile.amazon.co.uk/ch/1069199-0

Omalizumab Standard Operating Procedures

The BSACI Nurses in Allergy Committee have updated the Omalizumab Standard Operating Procedures for use in allergy clinics. To view visit www.bsaci.org/guidelines/bsaci-standardoperating-procedures/?mc_cid=e8d4ef392a&mc_ eid=7dfe1243f2

Changes to the membership application process

The requirement for new applicants to have two current BSACI Members propose and second applications might be a barrier to joining, particularly for those who do not know any BSACI members. Therefore, the new application process removes the need for referees, although applicants should demonstrate allergy experience. Applications for new members will be approved by Council. If you know of someone who is interested in BSACI membership please share this link www.bsaci.org/about-bsaci/ membership/

Find a Clinic list updates now live

The latest round of routine updates to the Find a Clinic list on the BSACI website is complete. Patients can search the list for their nearest allergy clinic and request a referral from their GP. To view the Find a Clinic list visit www.bsaci.org/ workforce/find-a-clinic/

Thank you to everyone who responded to our clinic update request.

Membership videos

If you know someone who is interested in becoming a member,please share this link where they can hear from BSACI members about their experiences www.bsaci.org/about-bsaci/ membership/

BSACI Allergy Education Network

– Join our strategy!

Consultant in Paediatric Allergy, Imperial College Healthcare NHS Trust

BSACI Allergy Education Network (BAEN) was established in 2020 to shine a light on the needs, and opportunities for allergy education and training across the UK. With an ambitious, and transformative strategy, we aim to ensure that all healthcare professionals who look after patients with allergy have an awareness of, and can access education appropriate to their role. It is only with high quality education and training that we can ensure all patients have high quality clinical care.

The strategy’s implementation plan is based on 3 main areas. We set

these out below and invite you to contribute to the programme of work, and success of this important network.

Curriculum Group

The “curriculum” group is focusing on the education of various healthcare professional groups who are involved in caring for patients with Allergy, in particular thinking about newly qualified practitioners such as foundation level doctors, recently qualified nurses, pharmacists, dieticians, health visitors, physician assistants, advanced clinical practitioners, and paramedics. Raising the level of basic Allergy knowledge across large groups of HCPs is likely to have benefits for patient care.

Specifically, we are looking at how Allergy is included in existing curricula that these groups access and where the gaps might be. We are creating draft curricula for these groups, thinking about what a newly qualified HCP in this profession might need to know with respect to Allergy knowledge and skills. Alongside this we are developing survey tools to establish an evidence

As a group, we aim to ensure workforce planning recommendations recognise ALL specialist healthcare professional roles, their contributions and workforce needs to deliver excellent allergy care within the UK.

base for where the gaps in training are. We are working with the Resources group to identify existing learning resources which could address training and knowledge gaps.

If you are interested in helping, please do get in contact. We are particularly looking for physician assistants, advanced clinical practitioners, and paramedics with an interest in this work.

Competencies Groups

Comprehensive educational training in allergy is required of all healthcare professionals working within the speciality. However, educational standards for allergy management and training remains inconsistent. As a group, we aim to ensure workforce planning recommendations recognise ALL specialist healthcare professional roles, their contributions and workforce needs to deliver excellent allergy care within the UK

Our objectives are

1. To develop competencies for healthcare professionals at three knowledge levels: basic, intermediate, advanced and specialist/expert levels.

2. Map roles and skills of individual professions to the 4 levels of practice: basic, intermediate, advanced specialist/expert

We are developing a questionnaire exploring current roles, the level of service provision and training of all healthcare professionals in allergy. It will also be designed to measure self-perceived competency of healthcare professionals, compared to their actual competency, through assessment of answers to set case study scenarios. The questionnaire will be benchmarked against known national outcomes (where these exist) to determine if current practice meets, exceeds, or falls below current standards.

This will provide information to develop competencies and to map roles to skills. BAEN also intends to utilise the questionnaire results to develop a united strategy to meet the educational needs of all healthcare professionals working within the UK allergy. It will allow education gaps to be identified, and accredited courses to be developed to better meet HCP training needs to standardise allergy practice across the country.

We need help to achieve the objectives outlined above. We need to recruit a diverse group of healthcare professionals to develop the

Dr Erika Harnik

competencies and role mapping exercise alongside public and patient involvement. This includes senior specialist role representatives to lead on individual professional groups. If you are interested to improve allergy care in the UK and ensure all healthcare professionals have the knowledge and skills to practice and can work with us online for 1 hour per week, we would love to hear from you.

Resources Group

In this group we are aiming to identify both existing opportunities and gaps in the educational offer in the UK. We then want to consider what, and how we might produce innovative resources to meet student and practitioner needs. If you have an interest in design and evaluation of educational materials, please do contact us. We are keen to hear from you. No experience necessary!

Right now we want to hear about ‘really good stuff’ going on in allergy education and training - whatever this may be - an event, course, or self-directed materials. This information can help us plan how we might share opportunities more widely and develop resources to fill any gaps.

Please click this link http://tiny.cc/BSACIeducation to tell us what you recommend, and where this is. Your input will be invaluable to the BSACI education strategy.

Thanks go to all the members of the BSACI Allergy Education Network for all their support and hard work. Our thanks must also go to Professor Judith Holloway for her enthusiasm, encouragement, and tireless leadership of the strategy. As you can see, we have several projects ongoing, so if you would be interested in joining one of the groups, please contact erika.harnik@nhs.net

Primary Care Training days

BSACI’s aim is to improve allergy knowledge and competency in primary care, and part of this initiative involves delivering Allergy Training Days for Primary Care Health Professionals.

The events are proposed and organised by BSACI local allergy services (allergy clinics) and funded by BSACI. This funding is made possible by an education grant from ALK-Abelló and Thermo Fisher. Successful applications will receive an exclusive support grant of up to £3000.

BSACI has so far funded 80 training days, training around 3300 primary care practitioners. Trainings have taken place all over the UK, including virtual events during the pandemic. More recently we have returned to faceto-face Primary Care Training Days. BSACI has received lots of positive feedback from Primary care practitioners who have attended an allergy training day:

Primary Care Training Days are proven to be extremely beneficial in supporting health professionals with the day-to-day management of people with allergy in their practices.

How to apply for funding

Applications are considered by a BSACI selected panel

comprised of GPs and allergy specialists in both primary and secondary care. The decision will be based on the following criteria:

• Producing a Primary care focused programme with both adult and paediatric components

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

• Priority will be given to centres with limited funding opportunities to hold a similar event

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

To find out about upcoming Primary Care Training Days visit www.bsaci.org/educationand-events/primary-care-education/primarycare-allergy-training-days/

Professor Tak Lee

Working with Tak

I first met Dr. Tak Lee, Specialist Medical Registrar, in January 1988. An ambitious young doctor of 37 years, he wanted to find a cure for asthma. He was awarded the National Asthma Campaign Chair in Asthma and Allergy in July that year and I became his research secretary for the next 15 years.

Tak was a taskmaster with a very strict work ethic and worked tirelessly to produce research papers. He demanded high standards from all his PhD students whose research earned each their Doctorate. Eight o’clock each morning saw us dealing with the day’s post. Upon arrival Tak donned a faded blue knitted zip-up and on my retirement, I presented him with a replacement. He did wear it!

A social animal, Tak loved his ‘Golf days’ when he’d close the Department for the day for all to play golf. He loved Christmas and I organised a large party at a different venue each year. At one venue, reminiscent of the Singapore Raffles Hotel, he asked the pianist to play “Misty” by Johnny Mathis. He also enjoyed karaoke.

In January 1998 Tak first consulted his ENT colleague for a lump in his neck. It was first thought to be benign but in April he underwent a 9-hour radical surgery. A few days post-op, young Adrian told his father, “Dad, you look like the Incredible Hulk!” Tak had turned green with bruising. He laughed delightedly as he told me, sick as he was.

To aid Tak’s recovery and to prove the department ran like clockwork whilst he was recovering, I organised a ‘photo shoot’ with everyone in the Department which I took to his home. Our captioned album had to be removed as he laughed so much, he hurt his throat. He returned to work, a shadow of his former self but undaunted and the Department went from strength to strength. He became Professor of Medicine over Guy’s and St. Thomas’s hospitals.

Tak taught me to edit the written word. We wrote, rewrote and then re-wrote the re-write until he was satisfied. He was a tireless perfectionist. I learned a great deal from this man and greatly mourn his passing. He is a loss to patients and to research.

Sheila Luster Research Secretary to Professor Tak Lee

Junior members

Iam pleased to inform you all that September’s training day focused on basic immunology was virtually conducted by the Immunology department at Manchester University NHS Foundation Trust and was well attended. This is really important as we start integrating into the new curriculum of adult allergy and clinical immunology for my adult allergy colleagues.

Our most recent training day in November focused on immunotherapy for inhalant allergens. Conducted by Royal Brompton Hospital in London, this was our first face-to-face return

since the COVID-19 pandemic. We aim to adopt a hybrid model of virtual and in-person training with initial focus on the return to more face-toface training days. Our next training day on drug and vaccine allergy will be conducted in person by the allergy service at Addenbrooke’s Hospital, Cambridge. Virtual sessions are recorded and are available to view again for BSACI members. Please do take advantage, as there are some excellent talks available. We said goodbye to Cherry as she decided to step down from junior members rep position due to her other work commitments.

I would like to ask services with new adult Allergy and Clinical Immunology (ACI) and Allergy, Clinical and Laboratory Immunology (ACLI) trainees to please contact info@bsaci.org. This is to ensure trainees are added to the ‘junior members’ list to be kept up-to-date with the latest news and opportunities. The Global Allergy Symposium on 10th February 2023, as hosted by BSACI in collaboration with WAO, EAACI and AAAAI is a virtual event with excellent talks from world experts. I would strongly encourage all trainees to register and take advantage of the early bird discount.

This year we offered free, one-year BSACI junior membership to our medical scholars. I am pleased to update that 17 out of 21 students took the offer. Furthermore, 3 of our previous medical scholars have joined training pathways: ACLI (2) and ACI (1). A few were awaiting results at the time of survey. It’s great to see such a positive interest in allergy and clinical immunology. Finally, I understand that the transition to new curriculum of allergy and clinical immunology has been quite challenging. I hope things have slowly started settling for trainees, but if anyone has any queries or requires any support, please kindly get in touch with us on juniormembers@bsaci.org.

Nurses in Allergy Commitee

It is all change as we near the end of 2022. We bid farewell to Tiffany North and Kelly Parker, thanking them for their contributions to the group over the years. We offer a hearty welcome to Daisy Stevens (Royal Cornwall Hospital) who will be our new Twitter representative, to Phoebe Moulsdale (Worcestershire Acute Hospitals NHS Trust) as our paediatric representative, and to Joanne Miles (Luton and Dunstable NHS Trust) as our membership secretary.

We are very pleased to announce that our newly established annual nurses study day will be held on Thursday 20th April 2023, 1.30pm to 5.30pm. This will be a free, virtual

event for BSACI members. The event programme and details of how to register will be sent to nurse members in the coming weeks.

We have recently published the standard operating procedure ‘Omalizumab for Urticaria’. This is available via the BSACI website - www.bsaci. org/guidelines/bsaci-standard-operatingprocedures/?mc_cid=e8d4ef392a&mc_ eid=7dfe1243f2. Thank you to those of you who responded to the questionnaire regarding the allergy nurse competency document. The feedback was very helpful and will guide our ongoing work in updating the document.

As always, we welcome any communication via our email address: nurses@bsaci.org. Please do get in touch if there is anything we can support you with, or why not follow us on Twitter @BSACInurses

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

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

Standards of Care Committee

Dr David Luyt

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

Since our last update in the summer where we reported a number of changes to the membership of SOCC, there have been even more changes, not only in the members but also the committee structure. We were delighted to appoint Dr Shifa Shaikh into the role of Clinical Guideline and Registry Manager. Many colleagues will already have met and worked with Shifa as she supports progressing guidelines towards publication and the review of other documents by SOCC. We welcome Shifa and congratulate her on her appointment, and also further congratulate her on recently passing her driving test – at the first time of asking!!.

As the role of SOCC has expanded in the society, the trustees

felt that the role was perhaps too busy for a single chair and decided that a leadership with two co-chairs would be more effective and robust, and also provide smoother transition and effective succession planning. We welcome Isabel Skypala, already an experienced

member of the committee, who has agreed to take on this role. Lastly, farewell and thank you to Liz Powell who was the trainee representative, leaving as she has now completed her training, and welcome in her place to Amruta Fulmali.

Aside from the committee membership, other developments were the publication of two new guidelines; on pollen food syndrome led by Isabel, and Penicillin de-labelling with Louise Savic as lead author. We are currently working on guidance for primary care on auto-injector prescriptions with Liz Angier as lead author, and two much newer projects on NSAID hypersensitivity and urticaria with their respective writing group leads Rita Mirakian and Chris Rutkowski. We look forward to seeing these progress towards publication. Further in to the not too distant future, the committee has, after canvassing the society for suggestions on future guidelines, plans to develop guidelines (or shorter guidance) on food challenges and spontaneous anaphylaxis. We also plan to collaborate with other organisations (where appropriate) on guidelines of mutual interest and expertise. Members are therefore encouraged to look out when we call for members of these, and other, working groups.

Primary Care Committee

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

Liz Angier, a GP in Southampton, and other colleagues within the primary care group have been working on a framework for General Practitioners with Extended Roles (GPwERs) in allergy. This is based on the Royal College of General Practitioner’s (RCGP) accreditation framework for GPwERs in Dermatology, which is now working successfully with good results. This is currently under review with the RCGP with encouraging initial feedback.

The benefits of accreditation include proof of training and competencies that could support GPs

in their roles in hospitals, the community, and primary care networks. It is envisaged the BSACI would support with connecting with specialists for this process. This would also help establish better relationships and connections with both the paediatric and specialist networks local to those GPs.

The BSACI will be surveying its primary care

membership and GPs that have attended its conferences for further insight. Many GPwERs in Dermatology have had expenses covered by their employers for this, although some were selfpaying. We would hope that employers would be supportive if GPs are part of the team reviewing patients and supporting the service. Furthermore, many primary care staff have expressed an interest in on-going education, with increasing numbers on the MSc and diploma courses at Imperial College London, University of Southampton, and Newcastle University.

The BSACI currently has about 60 GPs as members and the primary care group has a diverse membership. A framework for GPwERs in allergy would help with workforce planning and delivery of quality care within the community. Not all GPs would want or need this, but those with portfolio interests in delivering their own clinics in allergy may find this a good framework and a welcome support. We will update accordingly with feedback received.

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:

• Programme of webinars

• Online learning module under development

Hannah Hunter Specialist

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

In July we co-hosted a webinar with BSACI on Food protein-induced enterocolitis syndrome (FPIES) in both children and adults. This was very well received and many thanks to Dr Marta Vazquez-Ortiz, Anna Conrad and Dr Isabel Skypala for their excellent presentations. The recording can be viewed in the members’ section of the BSACI website.

We will continue our programme of webinars throughout 2023.

Dietitian Sarah Baker is working on our online learning module “taking an allergy focussed diet history”. This supports our aim to improve allergy education for allied health professionals. We are also working on developing competencies along with the BSACI Allergy Education Network.

• Supporting workforce planning

An important objective for the coming year is to support NHS services with business planning and service development for allergy dietetics. We will be collaborating with BSACI colleagues to develop resources in this area.

Twitter: @BDA_FASG

Clinical Immunology Committee

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

The focus of the BSACI Clinical Immunology Committee (CIC) remains firmly set in training and education. We have broadened our membership with the inclusion of two health care scientists since our last update. 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 aim to work with partner organisations to minimise duplication and enhance service development where possible.

We welcome two healthcare scientists to the group to ensure we are fully representative of the immunology community. Our healthcare scientist members will strengthen the education focus of the committee by contributing to

discussions on the changing landscape of training and examinations. Healthcare scientists work closely with clinical immunologists and their input

is vital at this stage when the medical specialty is undergoing structural changes.

The trainee group continues to grow in strength and has representatives from all the major ACI organisations. We intend for the healthcare scientist members of the CIC to contribute to the trainee group.

We are also due to engage in 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). UKPIN, in collaboration with the BSI, have formed the CIPN, which will focus on all the work of clinical immunologists. 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.

Dr Tomaz

Paediatric Allergy Committee

Dr Niten Makwana Consultant Paediatrician, Sandwell and West Birmingham NHS Trust; Chair of the Paediatric Allergy Committee

As we move into the winter months, the nights draw in and the weather gets colder, it already seems a long way off from my first report in Spring 2022. The committee continues to meet on a regular basis virtually, with members signing in from all over the UK and Ireland to discuss issues relevant to children and young people with allergic disease. It has been a pleasure to be able to meet and connect face-toface in other meetings, and we felt that this would be an important part of ongoing networking across the services in the UK and are planning a face-to-face meeting next year.

We continue to work on several

projects, including a multi-disciplinary approach to standardisation of food challenge protocols based on PRACTALL, a co-produced document with BSACI/RCPCH on National Paediatric Allergy Service Standards and our virtual grand rounds continue to move from strength to strength.

Best practice guidance for delivery of Palforzia® is

in progress, and to ensure that we reflected what our children and young people wanted, we started the process by holding a series of workshops with those who had experience of peanut immunotherapy and could discuss the benefits and challenges of the treatment. This input was vital to allow development of statements that are currently undergoing a Delphi consensus process. We have been working closely with SOCC to ensure that the guidance is available as soon as possible.

We remain focused on recognising the impact of inequalities and, noting the current cost of living crisis, we are putting together some guidance for paediatric allergy services to help patients who may need additional support. Working with Allergy UK we are developing video resources in different languages, to help those patients whom we look after, where English is not their first language.

As the year ends, I would like to take this opportunity to thank the members of the committee who continue to work together to provide a cohesive approach to tackling the challenges our colleagues and patients face, whilst maintaining high quality care to ensure positive outcomes.

Adult Allergy Commitee

The Adult Allergy committee is aiming to build on the excellent work of Andrew Whyte and make progress on some key issues, under new Co-chairs and new committee members, with the first meeting held in September 2022.

One of the key objectives is for an updated guidance for clinicians dealing with patients with allergy aiming to join the armed forces. Andrew Whyte continues to lead this work with support from a number of colleagues, and after extensive discussion with military medics, a draft guidance is expected shortly.

The committee has aimed to broaden its membership to include trainees, and to have representation from Clinical Immunology, Paediatrics and Allied Health professionals, to give a broader perspective on the challenges

involved in delivering allergy services for adults, and to reflect the fact that across the country this is done by a diverse group of clinicians. Alongside this the committee is aiming to take broader look at access to services across the UK and consider strategies to improve this. Alongside this, work is being done to re-establish the regional allergy networks and to look at how they may contribute.

Key to this of course will be training, and the committee continues to review the impact of the new revised curriculum. In addition the committee aims to link closely with the work of IQAS to ensure that there is a coordinated approach to improving standards across the whole UK.

Adult allergy services face some major challenges in the years ahead. Unlike paediatrics, where there a significant number of trainees with experience and training in allergy, there are simply not enough trained clinicians to provide service across the nation, at a time of increasing demand, so we hope to contribute to addressing these issues for the future.

Dr Steve Jenkins Consultant, Broomfield Hospital; and

Dr Paul Ciclitira Consultant, Guy’s and St Thomas’ NHS Foundation Trust; Joint Chairs of Adult Allergy Committee