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Winter 2024 Issue 41

Celebrating 75 years of BSACI 6

New Senior Leadership Team

Annual Conference 2023 report

Global Allergy Online Symposium – 26th January 2024

The official newsletter of the

British Society for Allergy and Clinical Immunology

Azelastine hydrochloride 0.15% nasal spray

Another Azelair moment

™

NEW Azelair

A steroid-free option to effectively treat allergic rhinitis1

mins

Triple mode of action2,3

INAH* are recommended in national guideline5

Symptom relief within 30 minutes4

6+ For use from 6 years of age1

*INAH – Intranasal antihistamines

Indication: Azelair™ is indicated for the symptomatic treatment of allergic rhinitis in adults, adolescents and children 6 years and older. 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

References: 1. Azelair™ Summary of Product Characteristics 2023. 2. Lee C, Corren J. Review of azelastine nasal spray in the treatment of allergic and non-allergic rhinitis. Expert Opin Pharmacother 2007;8(5):701-709. 3. Horak F. Effectiveness of twice daily azelastine nasal spray in patients with seasonal allergic rhinitis. Ther Clin Risk Manag 2008;4(5):1009-1022. 4. Shah et al. Allergy Asthma Proc 2009;30:628-33. 5. Scadding GK, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2017;47(7):856 889.

AZR-2023-0008 Date of preparation: August 2023

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

Editorial

elcome to the latest update of all things BSACI. A special thanks to all who contributed to the newsletter in the middle of a very busy winter period. I would also like to extend a warm hello to any new members who have recently joined the Society.

Contents

President’s message

Celebrating 75 years of BSACI

Senior Leadership Team

GPwER update

Annual Conference report

Jack Pepys Lecture

William Frankland Award

Barry Kay Awards

Global Allergy Symposium

12th Hong Kong Allergy Convention report

Registries

BSACI EDI policy

China Allergy Event report

If you have any suggestions regarding content for the next edition, whether there is something you would like to see or to share, please get in touch. I would also like to hear from any nurses currently working in primary care. Please drop me an email at s.mckibben@nhs.net.

BSACI Allergy Education Network

Committee and SIG news

Wishing you all the best for the year ahead. I hope you all enjoy this edition.

BSACI team

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

Chief Operating Officer: Vivine Smith vivine@bsaci.org

Dr Shauna McKibben

This edition is an opportunity to reflect on the Society’s achievements in 2023, notably the milestone 75th Anniversary and another successful Conference. 2024 is set to be an exciting year with a number of new leadership appointments to help shape the direction and delivery of allergy care nationally.

There are a number of excellent learning and Allergy & Asthma development opportunities already planned for the Clinical Nurse year ahead, a highlight being the imminent Global Specialist, St Mary’s Hospital, London Allergy Symposium 2024 in collaboration with global partners WAO, AAAAI and EAACI. One not to be missed! Other events to look forward to include the Nurses study day and webinars from primary care, BRIT registry, Dietetics, and the Perioperative network. Keep your eye on the website for the latest information.

Editor of Allergy Update Dr Shauna McKibben Managing Editor Louise Colonnese Layout INQ Design Ltd (020 7737 5775) BSACI Trustees 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 – TBA Elected Members Dr Steve Jenkins Dr George Gkimpas Dr Dinusha Chandratilleke Standing Committees Chairs 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 – Professor M Thirumala Krishna 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 Committee – Lead rotated Ms Hannah Hunter/Mrs Karen Wright/ Mrs Justine Dempsey Chair of Primary Care Group – Dr Matt Doyle Psychology Lead – Dr Rebecca Knibb 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

His nerves are about his date Not what’s on his plate

Together we know more. Together we do more.

Eosinophilic oesophagitis (EoE) can turn any meal into an emergency, with chronic inflammation and progressive fibrosis obstructing the passage of food.1 Jorveza was specifically designed to treat EoE.2 Not only did 85% of patients achieve clinical and histological remission within 12 weeks of 1 mg bd induction therapy, similar levels of efficacy were reported with the 0.5 mg bd maintenance dose at 3-year follow-up.3,4 The BSG recommend Jorveza - the only oral medicine with European regulatory approval for EoE - over other steroid formulations for both the induction and maintenance of remission in adults.5

0.5 mg & 1 mg now available

RECOMMENDED IN

SMC ADVICE6 NICE GUIDANCE7 BSG GUIDELINES5

PRESCRIBE FRE EDOM For more information about EoE, please email your interest to: eoe@drfalkpharma.co.uk Prescribing Information (refer to full SmPC before prescribing). Presentations: Jorveza 1mg and 0.5mg orodispersible tablets containing 1mg or 0.5mg of budesonide. Indications: treatment of eosinophilic esophagitis (EoE) in adults (older than 18 years of age). Dosage: Induction of remission: one 1mg tablet taken twice daily (morning and evening) after a meal and immediately after removal of the tablet from the blister pack. Usual duration of induction treatment is 6 weeks. Extend up to 12 weeks for non-responding patients. Maintenance of remission: 0.5mg twice daily or 1mg twice daily depending on clinical need. A maintenance dose of 1mg twice daily is recommended for patients with long-standing disease history and/or high extent of esophageal inflammation in the acute disease state. Duration of maintenance treatment - to be determined by the treating physician. Administration: tablet is placed on tip of tongue and pressed to top of mouth then swallowed slowly without liquid or food and without chewing or swallowing undisintegrated. May take 2 to 20 minutes to disintegrate and swallow completely. Wait at least 30 minutes before eating, drinking or performing oral hygiene. Contraindications: hypersensitivity to budesonide or any ingredient of the tablets. Warnings/precautions: infections - Suppression of inflammatory response and immune function increases susceptibility to infections and their severity which can be atypical or masked. Oral, oropharyngeal and esophageal candida infections occur at high frequency. Treat symptoms with topical or systemic anti-fungals. Jorveza treatment can continue. Chickenpox, herpes zoster and measles - can be more serious in patients treated with glucorticosteroids. Check vaccination status. Avoid exposure. Vaccines - avoid co-administration of live vaccines and glucocorticosteroids. The antibody response to other vaccines may be diminished. Special populations - monitor patients with tuberculosis, hypertension, diabetes mellitus, osteoporosis, peptic ulcer, glaucoma, cataract, family history of diabetes, family history of glaucoma. Systemic effects of glucocorticosteroids may occur, depending on duration of treatment, concomitant and previous glucocorticosteroid treatment and individual sensitivity. Patients with reduced liver function - an increased systemic availability of budesonide may be expected, with increased risk of adverse reactions. Patients with hepatic impairment should not be treated. Not recommended for use in patients with severe renal impairment. Angioedema - treatment should be stopped if signs of angioedema are observed. Visual disturbance - patients with blurred vision or other visual disturbances should be considered for referral to an ophthalmologist. Causes may include cataract, glaucoma or central serous chorioretinopathy resulting from corticosteroid use. Others - glucocorticosteroids may cause suppression of the hypothalamic–pituitary–adrenal (HPA) axis and reduce the stress response.

When patients are subject to surgery or other stresses, supplementary systemic glucocorticosteroid treatment is therefore recommended. Concomitant treatment with ketoconazole or other CYP3A4 inhibitors should be avoided. Serological testing - adrenal function may be suppressed by budesonide so an ACTH stimulation test for diagnosing pituitary insufficiency might show false (low) results. Sodium - contains 52 mg of sodium per daily dose. Interactions: CYP3A4 inhibitors - concomitant treatment with ketoconazole or other potent CYP3A inhibitors including grapefruit juice should be avoided to reduce the risk of systemic side effects unless the benefit outweighs the risk. Such treatment should be monitored. Oestrogens, oral contraceptives - may elevate plasma concentrations and enhance effects of glucocorticosteroids. Concomitant intake of low dose combination oral contraceptives has not shown this effect. Cardiac glycosides - action of glycoside can be potentiated by potassium deficiency - a potential and known adverse reaction of glucocorticoids. Saluretics potassium excretion can be enhanced and hypolalaemia aggravated. Use in pregnancy should be avoided unless there are compelling reasons for therapy. Breast-feeding - budesonide is excreted in human milk. The benefit of breast feeding for the child and the benefit of therapy for the woman should be assessed. Fertility - there are no data on the effect of budesonide on human fertility. Undesirable effects: fungal infections in the mouth, pharynx and the oesophagus were the most frequently observed adverse reactions in clinical studies. Long term treatment did not increase the rate. Adverse reactions and frequencies: Very common: esophageal candidiasis, oral and/or oropharyngeal candidiasis, Common: sleep disorder, headache, dysgeusia, dry eyes, gastroesophageal reflux disease, nausea, oral paraesthesia, dyspepsia, upper abdominal pain, dry mouth, glossodynia, tongue disorder, oral herpes, fatigue, blood cortisol decreased. Uncommon: nasopharyngitis, pharyngitis, angioedema, , anxiety, agitation, dizziness, , hypertension, cough, dry throat, oropharyngeal pain, abdominal pain, abdominal distension, , dysphagia, erosive gastritis, gastric ulcer, lip edema, gingival pain, rash, urticaria, sensation of foreign body, osteocalcin decreased, weight increased. Other (class) effects with unknown frequency that may occur: increased risk of infection, Cushing’s syndrome, adrenal suppression, growth retardation in children, hypokalaemia, hyperglycaemia, depression, irritability, euphoria, psychomotor hyperactivity, aggression, pseudotumor cerebri including papilloedema in adolescents, glaucoma, cataract (including subcapsular cataract), blurred vision, central serous chorioretinopathy (CSCR), increased risk of thrombosis, vasculitis (withdrawal syndrome after long-term therapy), duodenal ulcers, pancreatitis, constipation, allergic exanthema, petechiae, delayed wound healing, contact dermatitis, ecchymosis, muscle and joint pain, muscle weakness and twitching,

osteoporosis, osteonecrosis, malaise. Legal category: POM. Cost: 1mg - pack of 90 - £323; 0.5mg - pack of 60 - £214.80. Not currently available in Ireland. Product licence holder: Dr. Falk Pharma GmbH. Product licence number: IE/NI: 1mg: EU/1/17/1254/004, 0.5mg: EU/1/17/1254/008. GB: 1mg: PLGB08637/0030; 0.5mg: PLGB08637/0032. Date of preparation: February 2023.

Further information is available on request. Adverse events should be reported. In the UK visit www.mhra. gov.uk/yellowcard. In Ireland: https://www.hpra.ie/homepage/ about-us/report-an-issue/human-adverse-reaction-form. Adverse events should also be reported to Dr Falk Pharma UK Ltd on pv@ drfalkpharma.co.uk or 0044 (0)1628 536600.

References: 1. Attwood S, Epstein J. Frontline Gastroenterol 2020; 12(7): 644-9. 2. Miehlke S et al. Therap Adv Gastroenterol 2020; 13: 1756284820927282. 3. Lucendo AJ et al. Gastroenterology 2019; 157: 74-86. 4. Schlag C et al. Gastroenterology 2022; 162(7): S-213. 5. Dhar A et al. Gut 2022; 71(8): 1459-87. 6. SMC2158, October 2020. Available at: scottishmedicines.org.uk/ medicines-advice/ budesonidejorveza-full-smc2158/ Accessed on: 07.10.22. 7. NICE TA708, June 2021. Available at: nice.org.uk/guidance/TA708 Accessed on: 07.10.22. BSG: British Society of Gastroenterology EoE: eosinophilic oesophagitis NICE: National Institute for Health and Care Excellence SMC: Scottish Medicines Consortium UK--2300036 Date of preparation: March 2023 Dr Falk Pharma UK Ltd, Unit K, Bourne End Business Park, Cores End Rd, Bourne End, SL8 5AS. Registered in England No: 2307698

President’s message

A milestone year H

appy New Year. 2023 was busy with our BSACI 75th anniversary. I hope you enjoyed the celebrations, especially around our 2023 annual meeting in Harrogate.

2023 was also a year of renewal for the BSACI. We have put into effect a major overhaul of the society’s structure which will Professor see it better able to deal with the Graham Roberts challenges of the here and now, President and in the future! Plus we have a new President Elect, Robin Gore. Robin will become President in October 2024. He will be starting a conversation about the future strategic priorities of the society and will be happy to hear your thoughts. The BSACI has made substantial progress on the

2023 was also a year of renewal for the BSACI. We have put into effect a major overhaul of the society’s structure which will see it better able to deal with the challenges of the here and now. policy front in the last year. The first joint National Allergy Strategy Group - Department of Health and Social Care meeting happened in December. This joint working will hopefully help us to move forward with our aim of better provision of allergy services across the UK. Lastly, I hope you will be joining the BSACI Global Allergy Online Symposium on Friday 26th January. The World, European, American and British allergy societies will entertain you to an update on allergy in 2024.

Eosinophilic oesophagitis leaflet for patients

BSACI has recently published a new patient information leaflet Eosinophilic oesophagitis (EoE). We hope this helps patients understand more about the symptoms, diagnosis and treatment of EOE. The leaflet can be found on the BSACI website www.bsaci.org/ professional-resources/ patient-informationleaflets-2/ 5

o celebrate our milestone anniversary we held our first Global Allergy Online Symposium, supported by our international partner organisations WAO, EAACI and AAAAI in February last year. ‘Clinical Allergy: State of the Art 2023’ programme included a WAO session on Drug Allergy, EAACI session on Environmental Impact on Allergy, BSACI session on Challenges in Allergy and AAAAI session on Immunotherapy. In the Keynote lecture, Professor Sir Stephen Holgate discussed effective interventions on the environmental causes of allergy and what we can do as an allergy community, based on the landmark global workshop hosted by King Charles III in Scotland

RATIN

the previous year. Attracting delegates from all over the world, our first Global Allergy Online Symposium was a huge success. Find out about this year’s Global Allergy Online Symposium focusing on “In the Clinic” including the State-of-The-Art in allergy and clinical immunology which will be delivered by the most influential international experts in allergy on pages 17-18. In the summer we published a special edition of Allergy Update featuring retired and long-standing members personal memories of BSACI and how it has changed over the years. You can read the special edition on the BSACI website w w w. b s a c i . o r g / p r o f e s s i o n a l - r e s o u r c e s / publications/allergy-update/

75 Y E A

Throughout 2023 we celebrated 75 years of BSACI. Since its inception in 1948, many changes have occurred in the field of allergy.

Celebrating 75 years of BSACI

CEL

Celebrating 75 years of BSACI

Celebrating 75 years of BSACI To mark the special occasion of 75 years of BSACI, we celebrated our significant milestones and achievements over the years with special sessions throughout the 2023 BSACI Annual Conference Programme including the most influential figures in UK Allergy taking us through the breakthroughs that have been made in allergy over the past 75 years, and a special session with past BSACI Presidents Dr Pamela Ewan, Dr Glenis Scadding, Professor Stephen Durham and Professor Sir Stephen Holgate. The conference was attended by 770 delegates, speakers, industry partners and exhibitors. Over 200 people attended the special Gala Dinner, including those retired members who were invited on behalf of the President. Photos from over the years were displayed on screens during the drink’s reception, taking us back in time! You can read more about the conference including the 2023 awardees on pages 12-17. Dr Pamela Ewan wrote an article for Clinical & Experimental Allergy on ‘Celebrating 75 Years of BSACI’ coauthored by Professor Stephen Durham with contributions from Dr Glenis Scadding and Professor Sir Stephen Holgate which can be read at https://onlinelibrary.wiley. com/doi/epdf/10.1111/cea.14428 BSACI would like to thank all our members for supporting the work of the society to improve allergy care now and for the future and of course for sending us your wonderful photos. Here’s to the next 75 years of the BSACI.

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

Senior Leadership Team

The BSACI restructuring project The BSACI re-structuring project will strengthen the leadership of the Society, streamline our processes and align them with the legal framework governing the Society. Dr Robin Gore President-Elect

hen I joined the BSACI nearly twenty-five years ago, I never thought I’d now have the honour of serving as the next BSACI president. In the time since then, the tireless work of those in the Society has resulted in a significant expansion in trainee and consultant number, a large portfolio of influential clinical guidelines, a national and international educational agenda, and of course a steady and significant growth in membership number and inclusivity. My own interest in allergy started in 1998 when Professors Ashley Woodcock and Adnan Custovic mentored me through a three-year research degree in Manchester. I was transported from general respiratory medical training to a stimulating environment where the fundamentals of aeroallergen exposure, atopy, and their relationships with disease expression were being studied. My interest in respiratory allergy was piqued, and has led subsequently to a career in severe asthma and respiratory medicine in Cambridge. It also led to service for BSACI as trainee representative, scientific meetings committee lead and then treasurer. The Society has always felt like a ‘broad church,’ welcoming allergists and immunologists alongside allied health professionals, paediatricians and organbased specialists. Trainees have always been strongly encouraged, particularly at our flagship annual scientific meeting, where they can enjoy scrutiny of their submitted work and the chance of winning the prestigious Barry Kay award. The Society is tasked with helping its members meet the current challenges: To increase the number of professionals delivering allergy care, and in particular

This new structure puts the Society in an even stronger position to meet these challenges and to draw on the breadth of expertise within the Society’s membership.

to address the large geographical inequalities in service provision; to ensure patients receive prompt access to the best care close to home; to help disseminate the fascinating research taking place within allergy and thereby encourage bright young people to choose allergy as a career; to improve care for our young adults with allergic disease, ensuring that healthcare processes work seamlessly at this vulnerable stage of life. These are complex problems, not necessarily unique to the specialty and its Society. The recent restructuring of the BSACI leadership by Professor Graham Roberts and the executive team means that the Society now has vice-presidents in place for education, science, services and workforce. This new structure puts the Society in an even stronger position to meet these challenges and to draw on the breadth of expertise within the Society’s membership. Furthermore, working more closely with colleagues in other societies can bring fresh perspectives to our work, and we have already started to do this. I am very much looking forward to serving as BSACI president when Professor Roberts hands over the baton later this year. I hope to meet as many of you as possible over the next few months, whether at BSACI Global, our various webinars, or in person at the next Scientific Meeting.

Dr Runa Ali Treasurer

’m delighted to return to the BSACI council, having been on the BSACI Executive Board between 2006-2009, as Communications Secretary & Editor of Allergy Update. I was also our coding lead (with Dr Pam Ewan) in discussions with the Dept of Health and sat on the Joint Committee for Immunology & Allergy at the Royal College of Physicians. As the new BSACI Treasurer, I’ll now be responsible for the financial affairs of the Society. As a Director/Trustee, I’ll also be involved in contributing to strategic direction and policy setting.

Senior Leadership Team I, myself, am an Adult Allergist and Clinical Lead for Adult Allergy at Barts Health. I’m also a Respiratory Consultant working in the field of Severe Asthma and I have found that having a dual role has always given me a different perspective. So, I’m very much looking forward to working with the new VP’s and a much bigger council than the one I was in before. As the society grows, it’s important that we have wide representation and access to all kinds of experience and voices.

Professor Gillian Vance

Vice President for Education

’m delighted to have been appointed Vice President for Education. My ambition is that BSACI becomes a world leader in education and training, given the importance of effective education and training for high quality allergy care, and a ‘levelling up’ of patients’ experience. Over the next 3 years, I will be working closely with all those leading educational streams for BSACI, and especially, the BSACI Allergy Education Network (BAEN). BAEN, uniquely, aims to drive the changes in education and training needed to address gaps in practice. I have been a keen member of BAEN from its inception, where I helped form the strategy and implementation plan. Beyond allergy, I hold national strategic leadership roles in clinical education, which I hope to use to leverage influence on stakeholders and bring academic insights to our planning and outputs. My main objectives are to:

• Agree collaboratively an overarching strategy for all educational activity.

• Support delivery of the BAEN implementation plan, gathering evidence to inform future directions.

• Establish processes to maximise awareness

and reach of education and training needs and initiatives, both nationally and internationally.

BSACI Allergy Education Network (BAEN), uniquely, aims to drive the changes in education and training needed to address gaps in practice.

As Vice President, I look forward to working with society members to achieve this ambition.

Lucy Common Vice President for Workforce

he Vice President (VP) role for workforce is a new leadership position. I am pleased and honoured with the appointment and opportunity to gain experience in this role. I bring a wealth of experience to the BSACI, with a strong background in clinical Immunology and allergy clinical experience and management. My current post is a Consultant Nurse in Immunology and Allergy at the Northern Care Alliance in Salford.. Firstly, I aim to understand BSACI member’s needs, challenges, and ideas, ensuring that the society’s strategies are aligned with members’ expectations. I attended the Clinical Immunology Professional Network (CIPN) and British Society for Immunology (BSI) meeting in Belfast this month. My goal is to help strengthen the relationship between BSACI and this organisation, fostering collaborative efforts and shared learning and initiatives. My vision includes a focus on non-medical roles such as advanced nursing and Allied Health Professional (AHP) roles. I understand the crucial part these roles play in the field of allergy and clinical immunology in helping with workforce demands. I will also be comparing medical training between Adult and Paediatric Clinicians to understand the differences and workforce challenges and look at possible ways forward working collaboratively with other colleagues within the society. Part of this collaboration will involve working strategically with the VP for Services and Education and Training. Our work will be informed by recent research conducted by other society members including a UK nationwide survey of access to Adult Allergy services and Workforce numbers in each region. Working together with the BSACI Adult Allergy group we hope to present this data and make recommendations and drive change and improvements where needed. We particularly want to connect more with the devolved nations to provide support. I recently attended the RCP Outpatient Summit series and gained valuable experience of being part of the consultation listening to what service users’ needs are and blue sky thinking on how we deliver our Outpatient care. This includes considering practical

Senior Leadership Team ways of delivering services outside the hospital environment. My vision encompasses a strong focus on listening to society members, fostering collaborations, understanding, and aligning training programmes, and exploring the potential of non-medical roles, all while closely collaborating with other key positions within the BSACI. Please contact me via the BSACI if you would like to discuss any workforce related topics and developments.

Dr Louise Michaelis

Vice President for Services

am a Consultant Paediatrician and Senior Lecturer in immunology and allergy at the Great North Childrens’ Hospital, Newcastle-upon-Tyne. Over the last 10 years, I have developed and successfully implemented a model of seamless allergy care in the North-East. I will use my expertise and innovative models of care from our BSACI (the Society) members, to explore and address areas of unmet need, inequality and diversity in this field.

The Society members support children, young people and our adult population who face unprecedented challenges suffering from allergic disease with more than 5 million patients requiring specialist care.

The Society members support Children, Young People (CYP) and our adult population who face unprecedented challenges suffering from allergic disease with more than 5 million patients requiring specialist care. My vision is to overcome national barriers and identify health policy solutions for fragmented allergy services between our communities and health professionals. Currently, national policies and services display a blatant disregard for the prevention and recognition of allergic disease, treatment of disorders and optimisation of allergy services. I will support, collaborate and work closely with fellow trustees to oversee, develop and improve our national allergy services. My focus as Vice President for Services will be to support and underpin the Society’s policy work to align with the National Allergy Strategy Group (NASG) mission to ‘meet the Challenges of the National Allergy Crisis’. As a Trustee, I will present and deliver key discussions and lead high level national policy decision-making to support the growth, delivery and geographical dispersion of allergy services. This includes the development of a National Allergy Representation Plan for regional Intercalated Care Boards. I shall work to develop, implement and expand services and platforms to share resources, exchange ideas, improve standards, and engage with stakeholders for

• Adult Transition and Paediatric Allergy Committees,

• Improving Quality In Allergy Services (IQAS), in particular for CYP,

• Clinical Immunology Professional Network (CIPN), and

• Allergy-focused primary care networks.

Summary of Adrenaline Auto-Injector Prescription for Patients at Risk of Anaphylaxis: BSACI Guidance for Primary Care In June this year we announced the publication of the Adrenaline auto-injector prescription for patients at risk of anaphylaxis: BSACI guidance for primary care. It is for primary care healthcare professionals managing patients who have either experienced anaphylaxis or may be at risk of anaphylaxis. This is important guidance as primary care is often the first place where advice and guidance is sought from patients. WebMD has produced a summary of the guideline. To access the summary visit www.medscape.co.uk/viewarticle/adrenaline-auto-injector-prescription-patients-risk-2023a1000egf To view all BSACI Guidelines visit www.bsaci.org/guidelines/primary-care-guidelines/

Primary care

GP with Extended Role (GPwER) update W

e are pleased to announce that the Royal College of General Practitioners (RCGP) has now endorsed the general practitioner with extended role (GPwER) in allergy framework. The BSACI are currently in the process of piloting two GPs. If you are interested in the accreditation process, please contact the Dr Liz Angier BSACI on GPwER@BSACI.org. Portfolio GP, A BSACI webinar about GPwER NHS Hampshire, accreditation in allergy was held Southampton and Isle of Wight in November 2023. The recording CCG is open access and available at www.bsaci.org/education-andevents/webinars/2023-webinars/. The framework is also on the BSACI website under resources and can be accessed via the link www.bsaci.org/professionalresources/primary-care-resources/gp-withextended-role-gpwer-framework/ or via the RCGP website. We are already receiving enquiries from GPs interested in this which is encouraging. The BSACI are collating a list of those expressing an interest so that after the learning from the pilot is established, we can start to enter more through the programme. We plan to

hold another webinar to show the learning of the pilot. We are currently collating a frequently asked questions information sheet about the process. We plan to reach out to our GP colleagues in other primary care organisations such as dermatology, gastroenterology and respiratory to share learning opportunities. The plan is to map out where the GPwERs are in both the allergy

We are hoping that this initiative will support better communication and closer working together across the system and help to improve the provision of care in the community. units and in the community to understand how many there are and to improve networking and integrated care working. Some GPs after completing postgraduate courses have reported difficulties in trying to link or set up services with their local units. We are hoping that this initiative will support better communication and closer working together across the system and help to improve the provision of care in the community. This will form an important strand of the workforce strategy for allergy care. We think this is the first framework for GPs with extended roles in allergy and look forward to seeing how it develops.

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 our industry partners. Successful applications will receive an exclusive support grant of up to £3000. BSACI has so far funded 77 training days training around 3296 primary care practitioners. Training has taken place all over the UK. BSACI has received lots of positive feedback from Primary Care Practitioners who have attended an allergy training day. Applications are considered by a panel selected by BSACI and comprise of GPs and allergy specialists in both primary and secondary care. The decision will be based on the following criteria: • Producing a Primary care focused programme with both adult and paediatric components • Priority will be given to centres with limited exposure to allergy training • Priority will be given to centres with limited funding opportunities to hold a similar event. To apply for funding for an allergy training day for primary care practitioners, please send an email to tamara@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: https://www.bsaci.org/education-and-events/ primary-care-education/primary-care-allergy-training-days/

Annual Conference 2023

Annual Conference 2023 report I t was tremendous to see over 770 delegates attend the BSACI Annual Conference in Harrogate this year, the largest gathering for our society so far.

Dr Nandinee Patel BSACI Scientific Joint Programme Lead

Dr Natasha Gunawardana

BSACI Scientific Joint Programme Lead

We were delighted to introduce some new session formats to the conference including rapid review sessions which were very wellreceived. The ‘Tricky Cases’ rapid review session was a particular highlight! We delivered more practical hands-on workshops than ever before and we had a return of the paediatric and adult case rounds - brought back this year by popular demand! We had over 160 abstracts presented so judging posters was harder than ever - congratulations to all the Barry Kay Abstract Award winners! A very special congratulations also to Dr Carina

Venter, the first dietitian to deliver the Jack Pepys lectureship for her outstanding contribution to international allergy and clinical immunology. Thank you also to those of you who joined us for the fun run on a cold, wet and dark morning! It was great that so many continued to exercise late into the

Natasha and Nandinee at the conference with Fiona Rayner

evening on the dance floor at the Gala dinner, assisted by the fabulous Singing Waiters. We hope the conference was one of your scientific highlights of the year. We are delighted with the very positive feedback. We also hope you managed to enjoy the best that Harrogate has to offer during your time there. We’ve also heard all your feedback on catering, reception drinks and workshop locations – and are already underway with making improvements for October 2024. We hope you’ll find these experiences greatly more satisfying next year. We would like to extend a huge thanks to all our amazing faculty, our sponsors, our Charity partner presenters, our joint session collaborators (British Society of Gastroenterology, British Association of Dermatology and the Clinical Immunology Professional Network group) and Medivents who once again

Left: Bianca Olivieri receiving the Barry Kay Adult Clinical Award Right: Carina Venter receiving Jack Pepys Lecture Award.

Delegates taking part in the first BSACI 5K fun run

Networking, workshops and poster walk through

Annual Conference 2023

BSACI Fellows Award

Congratulations to Professor Chris Corrigan who has been awarded the BSACI Fellows Award, this award recognises BSACI members who have made significant contributions to the society in providing a continuously active role for 20 years or more, helping to shape the society and UK allergy & clinical immunology as a specialty within the UK. It’s is a great honour and a great privilege but above all it’s a delight to receive this first BSACI Fellows Award…it’s a chance to celebrate the way the society and grown and developed in the past 20 years. Chris wasn’t able to collect his award in person as he was at the Hong Kong Allergy Convention (see pages 20-21), he recorded a video message for the Annual Conference which you can view at https://youtu.be/pzDpe9VP4D0

Professor Chris Corrigan (centre), at the BSACI office with BSACI team collecting his award and certificate.

delivered on all organisational aspects of running such a large event. A huge thanks to our Programme Planning Committee, the BSACI team, the BSACI council and most of all to the delegates who attended to make this year’s conference a success. Next year will be our final in Harrogate! We’re excited to announce the theme for next year’s conference “The Power of Data, the Power of People”. To match our

theme, we’ll be launching a new category of abstracts: ‘Equality, Diversity and Inclusivity’ with a special award for the best poster presentation. We will also be continuing our education abstracts category – so do start planning projects. We’d love to share your work on these areas. We cannot wait to see you at BSACI Annual Conference 2024! Celebrating 75 years of BSACI at the Gala Dinner

Annual Conference 2023

Jack Pepys Lecture

The Jack Pepys Lecture recognizes those who have made outstanding contributions to the science of allergy and clinical immunology internationally.

rofessor Jack Pepys was Professor of Clinical Immunology. He was an outstanding clinical researcher who made substantial contributions to the understanding of allergic diseases. This year Professor Carina Venter was chosen by BSACI council to deliver this year’s prestigious Jack Pepys Lecture. Dr Venter is a Professor of the Paediatrics Section of Allergy/Immunology at the Hospital Colorado and University of Colorado Denver School of Medicine, where she is conducting research in allergy prevention and working with children with food allergies. She has focused her research and clinical practice over the past 20 years on the prevention, diagnosis and management of food allergies and other allergic diseases. Her research examines how nutrition and other modifiable factors contribute to the development of allergic diseases. She uses observational studies to identify risk facts, focusing on epigenetical changes and the role of the microbiome in the development of allergic diseases. Clinically, she supports families to induce minimal

food restrictions despite their child’s food allergies and incorporate nutritional strategies to induce tolerance. Dr Venter is the past chair of the International Network of Dietitians and Nutritionists in Allergy, and a member of the American Academy of Allergy and Clinical Immunology, American College of Allergy and Clinical Immunology, EAACI and BSACI. Carina is also a senior advisor to Food Allergy Research and Education (FARE) as well as a registered dietitian in the United Kingdom and United States. She has publications in international journals, book chapters and has edited a book on Food Hypersensitivity. She moved from the UK in 2015 where she had been performing research into allergy prevention. She contributed to the EAACI and AAAAI food allergy guidelines on Allergy Prevention and the EAACI guidelines on the Diagnosis and Management of Food Allergy guidelines, as well as the NICE food allergy guidelines and the National Institute for Allergy and Infectious Diseases Peanut Allergy Prevention Guidelines. Dr Venter is currently the chair of of the EAACI working group on Immunomodulation and nutrition.

Annual Conference 2023

William Frankland Award 2023 T he William Frankland Award recognises BSACI members who have provided outstanding services in the field of Clinical Allergy in the UK which is over and above normal everyday duties that a member has made to clinical allergy.

This years award was presented to Dr David Luyt. David who is a consultant paediatrician at University Hospitals of Leicester NHS Trust. After qualifying as a paediatrician, he undertook a research fellowship in Leicester from which he obtained a Doctor of Medicine from the University of Leicester for his thesis. He is the lead consultant in the Children’s Allergy Service in Leicester. Since his appointment in 1996, he has been instrumental in expanding and further developing the allergy service to provide food challenge and subcutaneous and sublingual immunotherapy programmes; and with dietetic colleagues in providing the first milk and egg oral tolerance induction programmes in the UK. David has transformed the allergy service from four immunology clinics a month (sixteen patients), to a service of sixteen multiprofessional clinics per month, seeing over eighty patients a week. His insistence that no allergy service should run without Dietetic and Nursing support has allowed the service to grow and develop. Many specialist allergy clinics are now being offered under his leadership including a patient centred email service. His skill in collaborative working has

contributed to significant advances in patient care, both within the trust and externally. The drive for David has always been to improve the patients’ care and enhance the lives of children with allergy. Year on year the allergy service receives exemplary feedback. As an academic researcher and author he has contributed to research in topics such as wheeze & food allergy and has an h-index of fifteen, co-authored thirty four publications, receiving almost a thousand citations. He has published articles on the Leicester experience of both milk and egg oral immunotherapy and was the lead author in the development of the BSACI milk allergy guidelines. David became a member of the BSACI Standards of Care Committee (SOCC) in 2013 and took over as Chair in 2020. Under his leadership, three major guidelines were published:

• BSACI guideline for the management of egg allergy was updated and published.

• BSACI guideline for the set-up of penicillin

allergy de-labelling services by non-allergists working in a hospital setting.

• BSACI guideline for the diagnosis and

management of pollen food syndrome in the UK

“I feel honoured and privileged to be selected by my peers to be worthy of this award. I feel that its not only a recognition of my contribution to paediatric allergy in Leicester, but should also recognise the amazing support I have received from dietetic, nursing and medical colleagues in providing allergy care.” Dr David Luyt

Annual Conference 2023

Barry Kay Awardees 2023 We would like to congratulate the following authors for winning the Barry Kay Award in the following five categories. Each Barry Kay winning abstract was presented with the Barry Kay Award, at the BSACI 2023 Conference. Adult clinical

A retrospective analysis of patients sensitised to Pru p 3 from a London allergy clinic. Dr Bianca Olivieri University Hospital of Verona, Italy

was privileged to receive the Barry Kay Award in the adult clinical category at the BSACI 2023 Conference in Harrogate, UK. The awarded study, conducted under Dr. Isabel Skypala’s guidance, titled A Retrospective Analysis of Patients Sensitised to Pru p 3 from a London Allergy Clinic’ focused on Lipid Transfer Protein (LTP) allergy diagnostic challenges. We analysed 184 patients sensitized to Pru p 3 at the Royal Brompton & Harefield NHS Foundation Trust. The study distinguished those diagnosed with LTP allergy from those without, finding that 60.3% had LTP allergy, typically younger patients with a history of A&E visits, and exhibiting allergic reactions such as urticaria, angioedema, and laryngeal symptoms. We also identified specific trigger foods, such as tomato puree, mustard and composite foods, and observed a lower prevalence of allergic rhinitis, asthma, and mouth/throat itching among these patients. In contrast to previous research, sensitisation to birch pollen did not reduce severe reactions in LTP allergic patients. The study defined the clinical profile of LTP allergy, highlighting Cor a 8 and Ara h 9 as potential additional diagnostic markers. Receiving the prestigious Barry Kay Award is a profound honor that inspires and encourages me - a young physician - to persevere in scientific research. My experience working with the team at the Allergy Unit of the Royal Brompton Hospital, led by Prof. Stephen Durham, has been invaluable. This award acknowledges not just my efforts but the collective excellence of the team in advancing food allergy research and beyond.

Primary Care Time-trends, regional variation andassociations of specialised formula prescribing in England. Karen Li Imperial College London, UK

ur investigation revolves around the concern of specialised formulas being over-prescribed to infants due to overdiagnosis of cow’s milk allergy. This issue is concerning since these formulas commonly contain free sugars which have been associated with early-childhood obesity, and is also a financial burden costing NHS around £60 million annually. Using national prescribing data in England, we explored the trend of specialised formula prescribing, observed regional variation and identified possible risk factors contributing to higher prescribing rates. From 2007-2022, we found a 3.4-fold increase in specialised formula prescribing rates. In 2022, the prescribing rate was 15-fold greater than expected, based on a 1% incidence of milk allergy. Additionally, we observed a 60-fold variation in prescribing rates across CCG regions, ranging from 0.8 to 48 litres per infant annually between 2017-2019. A key finding was the strong association between specialised formula prescribing and infant anti-reflux medication prescribing at the CCG-level, suggesting that healthcare practitioner behaviours could be significant determinants of milk allergy over-diagnosis and subsequent over-prescription of specialised formula. I would like to thank everyone who expressed interest in our project at the annual conference. It was a privilege to present our findings, which we hope may contribute to safer formula prescribing in the future. Receiving the Barry Kay award was an unexpected honour, and I thank the BSACI for the opportunity and recognition. My gratitude also goes to my supervisors and team. This award reflects our collective efforts and inspires continued research in this vital field.

Allied Health Understanding the goals and concerns of young people embarking on oral immunotherapy for food allergies – a qualitative study. Clare Jackson Imperial College Health Care Trust, UK

cross the globe, the use of oral immunotherapy (OIT) is increasing. An important role of health care professionals (HCP) is to help families make informed treatment decisions best suited to their

Annual Conference 2023 needs. However, there is limited data reporting the motivations of families considering OIT. Understanding the goals and concerns of families considering OIT will help HCPs facilitate a more constructive shared decision-making process. We surveyed 264 families who were invited to participate in 1 of 3 OIT clinical research studies, to either peanut or cow’s milk. We asked the families two questions:

• What do you think will be the main benefits of immunotherapy for you?

• What do you think will be the main problems of immunotherapy for you?

A qualitative analysis of the responses was undertaken using a thematic content-analysis approach. The results showed that within families differing goals and barriers were present when considering undertaking OIT. It is essential to explore these concerns with families, particularly those that do not align with the realities of OIT. The young person should be central to any discussion before commencing OIT. I am very proud to receive the Barry Kay Award for Allied Health in recognition of the exciting research being undertaken at St Mary’s. I would like to thank our participants and their families for contributing to our research to increase understanding of the goals and barriers to treatment when undertaking OIT. Through this we hope to improve the shared decision making process and provide patient-centred OIT.

Paediatric clinical Patient-responsive paediatric allergy care pathways: creating safe and efficient acceptance, discharge and rejection criteria for referrals. Dr Serena Braccio University College London Hospital, UK

he recent pandemic negatively impacted already long paediatric allergy referral waiting lists. For our centre this meant being unable to respond appropriately and promptly to those patients who are at risk of severe allergic reactions or those with multi-allergic disease. With this project, we addressed this problem by creating one-page rejection letters for those referrals not meeting the acceptance criteria to our paediatric allergy service. We did this in discussion with the multi-disciplinary paediatric allergy team in our Trust and local GPs, including in each letter simple advice for GPs on the management of allergic conditions and on referral threshold. The rejection criteria aligned with established guidelines from BSACI, NICE, Allergy UK and Anaphylaxis UK. . Using these criteria, we rejected nearly a third of

referrals received during a 2-month period. With the use of the rejection letter, we saw a 20% reduction in patients requiring secondary care appointments, a 6% reduction in NHS duplications, and nearly 5% patients were redirected to their local allergy services. We are currently working alongside local GPs, organising weekly meetings with them to discuss referrals, educate and work collaboratively to improve allergy management in primary care. I was honoured to receive this award and would like to thank the members of the multidisciplinary team who, with daily hard-working and dedication, have made this improvement possible. I hope that this work will open further discussion within the paediatric allergy community on how to best manage long waiting lists, keeping patient safety and GP support in mind.

Undergraduate Implementation of the REMA score into routine NHS practice to identify clonal mast cell disorders in a cohort of Hymenoptera venom anaphylaxis patients. Kieran Murdoch University of Plymouth, UK

am delighted to have received the BSACI undergraduate Barry Kay award for my first oral presentation at a conference! I had a nerve-racking, but overall, very enjoyable day. I am grateful for the opportunity to present, as well as learn from the vast number of fascinating abstracts. This process has inspired me to get more involved in both research and presentation. Clonal mast cell disorders (cMCD) are characterised by clonal mast cell proliferation. The prevalence of Hymenoptera venom anaphylaxis (HVA) in adults with cMCD is up to 30%. Venom immunotherapy (VIT) is effective in HVA patients but those with cMCD are at continued risk despite a 3-year course, so may benefit from lifelong VIT. Serum baseline mast cell tryptase (bMCT) is often used to screen for cMCD in HVA, but the REMA score may perform better as it incorporates the characteristic clinical features of prominent cardiovascular symptoms with an absence of urticaria and angioedema. We applied the REMA score to the 83 patients on VIT on our unit between 01/01/2021 and 31/05/2023 and offered bone marrow biopsy (BMB) to all with a score of >2. Eight patients (9.6%) had a cMCD (2 BMM; 5 mMCAS; 1 mastocytosis in the skin who declined BMB). Use of bMCT alone would fail to identify the majority of these patients. Only one VIT patient had MCT >20ng/mL: they had TPSAB1 duplication but no cMCD on BMB. We recommend the implementation of the REMA score to facilitate the diagnosis of cMCD among HVA patients.

British Society for Allergy & Clinical Immunology IN PARTNERSHIP WITH

26 January 2024 bsaciconference.org

Global Allergy Online Symposium

Global Allergy Online Symposium 2024 B •

Dr George Gkimpas

SACI is delighted to be hosting the Global Collaborative Online Allergy Symposium on Friday 26th January 2024 at 08:00 – 18:20 GMT in partnership with World Allergy Organization (WAO), American Academy of Allergy Asthma and Immunology (AAAAI) and the European Academy of Allergy and Clinical Immunology (EAACI).

Consultant Allergist, Royal Preston Hospital; Global Symposium Chair

This is an exciting opportunity for us to share world class knowledge by working together for the benefit of the global allergy community. The talks will also be available on demand for

a month after the event. This one-day online event will deliver a cuttingedge programme, focusing on “In the Clinic” including the State-of-The-Art in allergy and clinical immunology which will be delivered by the most influential international experts in allergy. The exciting programme will kick off with a WAO session on Immunotherapy and a Q&A. Our colleagues at EAACI will give an update on guidelines and answer questions. There will be a unique Presidents’ Forum session, where delegates will hear from the Presidents from each society. Following the Presidents’ Forum, BSACI will present the next session consisting of challenging interactive cases. There will be a DBV symposium on Epicutaneous immunotherapy: from science to clinic practice before our colleagues at AAAAI give us their latest guideline updates. Following a Q&A session, the Global Allergy Online Symposium will conclude with Presidents’ closing remarks.

Speakers include:

Giorgio Walter Canonica (Italy)

• Ignacio J. Ansotegui (Spain) • Dana Wallace (USA) • John Oppenheimer (USA) • Mário Morais-Almeida (Portugal) • Marek Jutel (Poland) • Alexandra F. Santos (UK) • Gunter Sturm (Austria) • Isabel Skypala (UK) • Louise Savic (UK) • Edward Gaynor (UK) • Leanne Goh (UK) • Ariharan Anantharachagan (UK) • Lynda Schneider (USA) • Jonathan Bernstein (USA) • Leonard Bacharier (USA) and others.

We look forward to BSACI members joining us for this global allergy event.

LATE REGISTRATION OPEN: Tuesday 2nd January SAVE THE DATE BSACI Annual conference 2024 3rd–5th October AAAAI 2024, Washington DC February 23rd–26th EAACI Hybrid 2024, Valencia, Spain May 31st – 3rd June

To view the full programme visit bsaciconference.org/programme/ To view the speaker biographies visit bsaciconference.org/speakers/ Register at bsaciconference.org/registration/ British Society for Allergy & Clinical Immunology IN PARTNERSHIP WITH

Convention report

12th Annual Hong Kong Allergy Convention 7-8th October 2023, Hong Kong Convention and Exhibition Centre, Hong Kong

t was both a pleasure and a great honour to be asked by Graham, Fiona and the BSACI team to represent BSACI at this collaborative meeting with our colleague Allergists in Hong Kong, not least because an important part of my mission was to say a final farewell to my dear friend and colleague Tak Lee, who Professor departed this life last year and had Chris Corrigan been working with the Hong Kong Inaugural Allergists for 10 years since he BSACI Fellow returned home there, particularly in the development of a curriculum for Allergy trainees much along the lines of the one I developed for our own trainees. Quite apart from the intrigues of the Conference (and the Conference Centre: I have never seen a larger one anywhere!) it was a personal privilege for me to be able to visit St. John’s Cathedral In Hong Kong, the site of Tak’s funeral service, and chat with his son Adrian who lives there now with his family and who jointly chaired, along with Prof. Gary Wong, the opening Plenary Lecture

which I presented and which will be retained in the future as the Prof. Tak-Hong Lee Memorial Lecture, not only a tribute to Tak but also a tangible reminder of ongoing and expanding collaboration of the BSACI with the Hong Kong Institute of Allergy in terms of clinical training, disease management and research. It was also a pleasure to meet Dr. Marco (Hok Kung) Ho, recently inaugurated as the new Director of the Lee Tak Hong Allergy Centre, founded at the behest of his son Adrian, within the Hong Kong Sanatorium and Hospital in Happy Valley, Hong Kong. The only downside was the fact that the meeting had been scheduled at exactly the same time at this year’s BSACI Annual Conference, so I was unable to join you all there. The two day Hong Kong meeting was overseen by Prof. Gary Wong, current president of the Hong Kong Institute of Allergy, Dr. Helen Chan and Dr. Roland Leung. The content of the programme was designed with the additional help of Dr. Fanny Ko, Dr. Chris Lai, Dr. Agnes Leung, Prof. Ting-Fan Leung and Dr. Phil Li, who spent some time with us in London recently. Following my tribute to Tak, which left several delegates who knew him well with tears in their eyes, I went on to talk about calcilytics: “Blocking the calcium-sensing receptor: the

Convention report Demise of Asthma and COPD?” The second plenary lecture was delivered by Dr. Kathleen May (USA) who gave an excellent update on the 2023 modifications to the current asthma guidelines. The third plenary lecture was delivered by Prof. Claudia Loureiro from Portugal and was titled “Targeting eosinophils in asthma – real world data and clinical remission”. The Plenary symposia included “Immunotherapy for food allergy” presented by Prof. Motohiro Ebisawa from Japan, “Adjuvant therapies in food immunotherapy” by Prof. Mimi Tang from Australia and “Current state on primary prevention of food allergy” by Prof. Ting-Fan Leung from Hong Kong. The Faculty Dinner on Saturday evening was a wonderful occasion blessed with beautiful Chinese food and drink, delightful company and animated discussion. I was enveloped in nostalgia when invited to deliver an after-dinner speech and even managed some of my famous Allergy jokes, but luckily I have been assured that this will not prevent my being invited again… The beginning of the second day of the Convention was aimed more closely at the trainees, with parallel symposia on practical diagnosis and management of food allergy, led by Dr. Christine Wai, Ms. Ann Au, Ms. Chloris Leung and Dr. Agnes Leung and drug allergy, led by Dr. Jane Wong, Mr. Vincent Wong and Ms. Elsie Chan. There then followed plenary symposia on dermatological conditions (“Type 2 inflammation drives skin barrier dysfunction and influences changes in the skin microbiome” presented by Prof. Henry Chan and “Targeted therapies for paediatric dermatoses” presented by Prof. Mark Koh from Singapore), food allergy (“Endpoints and outcomes after immunotherapy for food allergy” (the Sir QW Lee lecture presented by Prof. Mimi Tang), urticaria, angioedema and anaphylaxis (“Optimising the patient journey in chronic spontaneous urticaria” presented by Dr. Phil Li, “Hereditary angioedema – updated for the Asia Pacific region” presented by Dr. Jason Fok from Australia and “Anaphylaxis in focus: current understanding and future directions” presented by Dr. Agnes Leung). The final plenary symposium was a fascinating treatise on the investigation of suspected perioperative drug reactions the and elimination of factitious drug allergy, a problem in Hong Kong as in everywhere else in the world (“Preventing perioperative anaphylaxis: the anaesthetist and immunologist perspective” presented by Dr. Elaine Au and Dr. Lydia Lau, “Delabelling penicillin allergy with the direct drug challenge – a pros and cons debate” presented by Dr. Jason Fok from Australia and Dr. Phil Li and “Identifying longitudinal and region-specific patterns in drug allergy labels by analysis of 7.3 million individuals in Hong Kong” presented by Dr. Valerie Chiang). The meeting ended with a best poster award presentation very much like the corresponding BSACI ceremony, where the authors of the best posters of

Chris Corrigan accepting certificate of thanks, on behalf of BSACI

Chris Corrigan accepting certificate of appreciation

original research were chosen by judges and presented with special awards. All in all, a state of the art meeting with many similarities to our own, reflecting the current challenges and dilemmas in the diagnosis, misdiagnosis and management of allergic disease across the world. It seems that we have a lot to learn from each other, another very strong reason for continued collaboration, exchange of ideas and resources and the mutual participation of our trainees. Visit the website of the Hong Kong Institute of Allergy www.allergy.org.hk

Registries

BRIT Registry: Phase 2 and beyond T

Maria Smith

BRIT Co-ordinator

Dr Shifa Shaikh Chief Scientific Officer

he BSACI Registry for Immunotherapy wrapped up its second phase this year, with 2300 registered patients spread across 63 centres. A number of changes have been made to engage BRIT users more easily and directly and to improve the way they interact with their own data.

In November, we finally launched the BRIT User Dashboard, a project which has been over a year in the making. The dashboard allows all BRIT users to view and download helpful infographs illustrating how their service is doing and benchmarking it against the rest of the registry. We anticipate that this will be a useful auditing tool for immunotherapy centres across the UK.

All data entered in the registry from 2018 until September 2023 is being analysed by an expert team of statisticians from the university of Southampton. BRIT stakeholders in attendance at the BSACI Annual Conference in October were given a sneak peek into some early numbers from our statisticians, as well as a summary of the registry’s progress in the last 5 years. In addition to the stakeholders’ meeting, the BRIT team featured two posters at the annual conference, as well as a public presentation and a workshop. There was a great deal of engagement with BRIT, especially at the workshop, and the BRIT team left feeling very optimistic about the coming year. Once the statistical analysis has been completed, the BRIT Steering Committee will begin the process

The BRIT Committee at the stakeholders meeting

of writing, reviewing and publishing a peer-reviewed paper detailing the findings. All significant contributors to the registry will be named as co-authors, and the committee will be reaching out to users to review the paper when it is fully drafted. The committee is particularly interested in recognising the registry’s delegate users, who do the vast majority of the data entry. 2024 is shaping up to be a busy year for BRIT. In addition to the Phase 2 paper and reports, BRIT users will hopefully see the launch of a patient app which will allow patients to interact directly with their own data, complete questionnaires, and feel a more direct part of the registry. If you would like to learn more about everything BRIT has accomplished in the last 5 years, email brit@ bsaci.org with any questions you may have. You can also learn about the registry on the Anaphylaxis UK Podcast, where BRIT Chair Mich Lajeunesse was interviewed over the summer. If you are interested in registering for BRIT, please visit the BRIT Registry https://www.bsaci. org/professional-resources/bsaci-registries/ immunotherapy-registry/ to complete an application form.

UK Fatal Anaphylaxis Registry (UKFAR) I n 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 the aim of the registry was to include and examine all cases of fatal anaphylaxis, irrespective of age and cause, to help us understand more about what causes people to to die from anaphylaxis and improve survival rates .

The grant from the FSA 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 grateful to have received further funding from Viatris and charitable trusts whom we contacted..

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

Policy

BSACI’s Equality, Diversity and Inclusivity Policy published E quality, Diversity, and Inclusivity (EDI) are essential to the future of allergy and clinical immunology and we are one of the few national medical societies that are taking intentional steps towards creating a more equitable and inclusive environment. Chaired by Professor Thirumala Krishna, the EDI working group’s primary objective is coordinating and advancing EDI across the Society. This is done in two ways: working towards creating an inclusive and equitable culture within the field of allergy and clinical immunology that benefits everyone and promoting the highest quality allergy care for all patients. To this end, the BSACI now has an EDI policy, authored by EDI Working Group member, Dr Sophie Farooque. Equality is about fair treatment and impartiality to all regardless of the difference in race, physical ability, sexual orientation, gender, age, ethnic or religious background. The BSACI believes that, for our patients, equality means that every person has an equal opportunity to reach their full health potential, free from disparities in

School allergy code T

he Schools Allergy Code is a code of practice to help schools keep pupils with allergies safe. It has been created to give schools a set of standards and clear guidance to make their settings as safe and as inclusive as possible. The Code includes sections on risk reduction and inclusion, as well as emergency response. It provides a clear framework, which we know clinicians, schools and parents have been eager for. We hope that it will make it easier for schools to identify where they need to strengthen their procedures and policies and give families greater confidence in schools. Any school can sign up to the Code and use

access, treatment and clinical outcomes. Diversity is about valuing individuals, as well as acknowledging and appreciating differences. It encompasses the range of social and personal identities, experiences, abilities, know-how, and characteristics that mould each of us. Inclusivity means employing practices, policies, and systems that uplift, involve, support and show value for all. We aim to establish the BSACI as an organisation that is fair and open to all of its members. The Society is committed to ensuring adherence to the EDI policy, advocating for its fundamental principles as well as allocating suitable resources, offering leadership, and providing support to the newly established EEDI (Ethics, Equality, Diversity and Inclusivity) Committee in order to facilitate its effective implementation.

Read the BSACI Equality, Diversity and Inclusivity Policy at https://www.bsaci.org/wp-content/uploads/ 2023/10/Equality-Diversity-and-InclusivityPolicy.pdf Vivine Smith

the associated checklist to ensure it is following best practices. The code has been drawn up by The Allergy Team, ISBA and Benedict Blythe Foundation and has the backing of clinicians and families. Schools who adhere to the code can apply to be on the Schools Allergy Register at https://theallergyteam.com/schoolsallergyregister/

The Association Excellence Awards We were delighted that BSACI were shortlisted as a finalist in two of the category awards by The Association Excellence Awards. These 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. To see a list of the winners visit www.associationexcellenceawards.co.uk

Event report

China allergy event I

Dr Joanna Lukawska

n September 2023, I flew to Kunming, capital city of Yunnan, China to give a talk on “Drug allergy; focus on excipients” to Chinese Allergy specialists. The setting was a Saturday morning conference which Chinese Allergists attend once a month in person or online held at various Allergy Centres around China.

I was invited by Dr Yong Mei, Allergist and ENT surgeon who Clinical Research recently worked as an observer Fellow, Guy’s and St Thomas’ Hospital in our Department at UCLH, London. The conference was at First Affiliated Hospital of Kunming Medical University. The lectures were followed by a workshop where a leading Chinese Allergist Dr Juan Meng and I were asked to consult on three patients. Attending patients were interviewed, skin tested and challenged in the same conference room, part of which was designed as a clinical space. This format reminded me a little of the St John’s Hospital Dermatology meetings. It was friendly and very interactive. As soon as the conference came to an end (and following a delicious lunch) my Chinese interpreter – Dr Meng Li (Allergy/ENT), Dr Juan Meng and I were Skin testing at the conference

The event faculty

picked up by Mr Tang in his shiny Mercedes and whisked away on a road trip around Yunnan. Over the next 4 days we drove for 300 miles to the famous beauty spot Yulong Snow Mountain. On the way there we visited stunning Erhai Lake, ancient city of Dali, Chinese national treasure of Three Pagodas, Buddhist temples, beautiful JizhaoAn nunnery and finally Lijiang with its atmospheric old town and very modern city centre. On day four, we boarded a comfortable and unbelievably quiet high-speed train which took us back to Kunming city. What did I learn? I learned that Chinese people are very hospitable and China/Yunnan is simply beautiful and that there is more than one way to hold a medical conference.

Education

BSACI Allergy Education Network T he importance of education of the current and future workforce is recognised in the NHS Long Term Workforce Plan, with its emphasis on ‘Train, Retain and Reform’. Here at BSACI, education is also a strategic priority, with a number of new developments.

New leadership team The BSACI Allergy Education Network (BAEN) was established BSACI Education in 2020 by Professor Judith Fellow Holloway, Southampton, and represents a multidisciplinary team of health care professionals, patients and patient support organisations. Jude has recently stepped down as lead for BAEN, but we are delighted to welcome Dr Jennie Gane to the role. Jennie is a respiratory consultant in Derbyshire and has been a member of BAEN since its inception. She is excited to take the project into its next phase of implementation. Margaret Kelman

Jennie will be supported in this role by two new appointments: Margaret Kelman, [Edinburgh] has been appointed as Education Fellow. With a background in dermatology and allergy nursing, Margaret will be instrumental to operational delivery of the strategy. Professor Gill Vance, Newcastle, has been appointed as the Vice president for Education and will oversee the direction of the network as well as providing strategic guidance.

With Health Education England’s support, we are currently surveying the 15,000 foundation doctors in England to understand their practice and learning needs with respect to allergy. Progress so far In October 2021 we published the BSACI National Allergy Education Strategy - BSACI, in which the vision for allergy education across the UK was outlined. Since then, our achievements have included mapping competency frameworks for nurses and dieticians working in allergy, with surveys disseminated to explore access to education, training and role expectation within these professions. With Health Education England’s support, we are currently surveying the 15000 foundation doctors in England to understand their practice and learning needs with respect to allergy.

Gill Vance Vice President of Education and Training

Jennie Gane BAEN Clinical Lead

We hope that data gathered will inform dialogue with key stakeholders around opportunities for the strategy to support education and training. Please help us to cascade this survey to Foundation tutors and Foundation trainees within your organisations, using this link https://www.surveymonkey.co.uk/r/ ZRVW2HZ or the QR code at the end of the article We have also collated allergy education resources available nationally and carried out a gap analysis. We showcased our work at the recent BSACI conference.

New directions To incorporate all the foundational work that the network has achieved to date, we propose to develop an Allergy Capabilities Framework. This framework would be used to guide allergy education across all health care professions, supporting clinicians to be able to put their knowledge into clinical practice. It will signpost to learning resources and competency expectations appropriate to professional need and role. Ultimately, we need high-quality evidence-based allergy education available at point of need, so that patients with allergy are assured that they are being cared for by someone with the necessary skills and knowledge. If you would be interested in joining the network or would like to hear more about the work that we do – please contact info@bsaci.org or visit www.bsaci.org/education-andevents/bsaci-national-allergyeducation-strategy/ national allergy education strategy.

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

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

“Prescientific” era [Pre 1930]

First descriptions of asthma were recorded

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 December 2023]; 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-asthmamanagement-guidelines. [Accessed December 2023]; 23. Hunninghake GM, et al. Allergy. 2010; 65:1566–1575; 24. Moffatt MF, et al. N Engl J Med. 2010; 363:1211–1221; 25. Torgerson DG, et al. Nat Genet. 2011;43:887–892; 26. Couillard S, et al. Am J Respir Crit Care Med. 2021;204:731–4; 27. Couillard S, et al. ERJ Open Res. 2021;8(1):00570-2021; 28. Couillard S, et al. Thorax. 2022;77(2):199-202; 29. Parnes JR, et al. J Asthma Allergy. 2022;15:749–765; 30. Matera MG, et al. Drugs. 2020;80(5):449458.



THE NEXT ERA OF SEVERE ASTHMA MANAGEMENT HAS EMERGED

THE FIRST & ONLY BIOLOGIC APPROVED FOR SEVERE ASTHMA WITHOUT PHENOTYPIC OR BIOMARKER LIMITATIONS1

Rise above

RISE ABOVE THE COMPLEXITY 1-4

the complexity

Treat across phenotypes

Tezspire is indicated as an add-on maintenance treatment in adults and adolescents 12 years and older with severe asthma who are inadequately controlled despite high dose inhaled corticosteroids plus another medicinal product for maintenance treatment.

and irrespective of key clinical biomarker levels LEARN MORE TODAY

References: 1. TEZSPIRE® (tezepelumab-ekko) [package insert]. Thousand Oaks, CA: Amgen Inc.; and Wilmington, DE: AstraZeneca Pharmaceuticals LP; February 2023. PRESCRIBING INFORMATION

1-4

TEZSPIRE® (tezepelumab) 210MG SOLUTION FOR INJECTION IN PRE-FILLED SYRINGE Consult Summary of Product Characteristics (SmPC) before prescribing. Indication: Add-on maintenance treatment in adults and adolescents 12 years and older with severe asthma who are inadequately controlled despite high dose inhaled corticosteroids plus another medicinal product for maintenance treatment. Presentation: Pre-filled syringe containing 210mg tezepelumab in 1.91mL. Dosage and Administration: Treatment should be initiated by physicians experienced in the diagnosis and treatment of severe asthma. The recommended dose is 210mg of tezepelumab by subcutaneous injection every 4 weeks. If a dose is missed, the dose should be administered as soon as possible. Thereafter, the patient can resume dosing on the scheduled day of administration. If the next dose is already due, then administer as planned. A double dose must not be administered. Intended for long term treatment. A decision to continue the therapy should be made at least annually based on the patient’s level of asthma control. A patient or their caregiver may administer Tezspire after being trained in subcutaneous injection technique and the preparation and administration of Tezspire 1,2 according to the Instructions for Use. Administer as a subcutaneous injection into the thigh or abdomen, except for the 5 cm around the navel. If a healthcare professional or caregiver administers the injection, the upper arm can also be used. A patient should not self-inject in the arm. It should not be injected into areas where the skin is tender, bruised, erythematous, or hardened. It is recommended to rotate the injection site with each injection. No dosing adjustment is required for elderly patients or patients with renal or hepatic impairment. The safety and efficacy of Tezspire in children under 12 years of age have not been established. Contraindications: Hypersensitivity to the active substance or excipients. Warnings and Precautions: Clearly record the name and batch number of administered product to improve the traceability of biological medicinal products. Tezspire should not be used to treat acute asthma exacerbations. Asthma-related symptoms or exacerbations may occur during treatment. Instruct patients to seek medical advice if their asthma remains uncontrolled or worsens after initiation of treatment. Abrupt discontinuation of corticosteroids after initiation of therapy is not recommended. Reduction in corticosteroid doses, if appropriate, should be gradual and performed under the supervision of a physician. Hypersensitivity reactions such as anaphylactic reactions or rash may occur following administration of Tezspire. Such reactions may occur within hours of administration, but some may have a delayed onset (i.e. days). History of unrelated anaphylaxis may be a risk factor following administration. Monitor patients for an appropriate time after administration. In the event of a serious hypersensitivity reaction discontinue Tezspire immediately and initiate clinically indicated treatment. Patients with pre-existing serious infections should be treated before initiating therapy. If patients develop a serious infection and do not respond to treatment, discontinue therapy until the serious infection resolves. Advise patients of signs or symptoms suggestive of a cardiac event (for example, chest pain, dyspnoea, malaise, feeling lightheaded or faint) and to seek immediate medical attention if such symptoms occur. Discontinue if patient develops a serious cardiac event on therapy. Treat pre-existing helminth infections before initiating Tezspire. If patients become infected while receiving treatment and do not respond to anti-helminth treatment, Tezspire should be discontinued until infection resolves Drug Interactions: Avoid use of live attenuated vaccines in patients receiving Tezspire. No interaction studies have been performed. 1,2 Pregnancy and Lactation: Avoid during pregnancy unless the expected benefit to the patient is greater than any possible risk to the foetus. During the first few days after birth a risk to the breast-fed child cannot be excluded therefore a decision should be made based on the benefit of breast-feeding to the child and the benefit of therapy to the patient. Afterwards, tezepelumab could be used during breast-feeding if clinically needed. Ability to Drive and Use Machines: Tezspire has no or negligible influence on the ability to drive and use machines. Undesirable Events: Consult SmPC for full list of side effects. Common: Pharyngitis, rash, arthralgia and injection site reaction. Legal Category: POM.

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%). The mechanism of action of tezepelumab in severe uncontrolled asthma has not been definitely 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 treatment

GB Specific

NI Specific

HCPs in GB and NI with a respiratory interest. Adverse events should be reported. Reporting forms and information can be found Marketing Authorisation Number:For Tezspire has a NI licence. EU/1/22/1677/001 & Basic NHS Cost: 1 x single use pre-filled syringe: £1265.00 at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the GooglePresentation Marketing Authorisation Holder: AstraZeneca AB, SE 151 85, Södertälje, Sweden. GB UKPrescribing Information available here. Further Limited, 2 Pancras Square, 8th Floor, London, N1C 4AG United Kingdom. Play or Apple App Store. Adverse events should also be reported to AstraZeneca byInformation is Available From: AstraZeneca TEZSPIRE is a trade mark of the AstraZeneca group of companies. visiting https://contactazmedical.astrazeneca.com or by calling 0800 783 0033. Date of preparation 09/2022. RSP 22 0085 NI Prescribing Information available here.

Marketing Authorisation Number: Tezspire has a GB licence. PLGB 17901/0365 Presentation & Basic NHS Cost: 1 x single use pre-filled syringe: £1265.00 Marketing Authorisation Holder: AstraZeneca UK Limited, 1 Francis Crick Avenue, Cambridge Biomedical Campus, CB2 0AA, United Kingdom. Further Information is Available From: AstraZeneca UK Limited, 2 Pancras Square, 8th Floor, London, N1C 4AG United Kingdom. TEZSPIRE is a trade mark of the AstraZeneca group of companies. Date of preparation 09/2022. RSP 22 0026a

Adverse events should be reported.exhaled Reporting and information can be foundprofessional; at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. bEOS=blood eosinophils; FeNO=fractional nitricforms oxide; GB=Great Britain; HCP=healthcare Adverse events should also be reported to AstraZeneca by visiting https://contactazmedical.astrazeneca.com or by calling 0800 783 0033. IgE=immunoglobulin E; NI=Northern Ireland. 1. Tezspire (tezepelumab). Summary of Product Characteristics. https://www.medicines.org.uk/emc/product/14064/smpc. [Accessed December 2023]; 2. Tezspire (tezepulmab). Summary of Product Characteristics (Northern Ireland). https://www.emcmedicines.com/en-gb/northernireland/medicine?id=3fdefedf-5567-430a-9305-51de764defd2&type=smpc [Accessed December 2023]; 3. Menzies-Gow A, Wechsler ME, Brightling CE. Respir Res. 2020;21(1):268; 4. Menzies-Gow A, ©AstraZeneca 2023.2021;384(19):1800–1809. All rights reserved, GB-45948 Date of preparation: June 2023. et al. N Engl J Med.

Committee and SIG news

Primary Care Group D

r Matt Doyle, Chair of the Primary Care Group, and Dr Liz Angier have been instrumental for the accreditation and endorsement of the GP with Extended Role (GPwER) in Allergy Care by the Royal College of General Practitioner (RCGP). We all at the PCG thank them both for such an incredible achievement. The GPwER guidance is now Dr Amir Esteki available on the Primary Care Secretary of Primary Resources section of the BSACI Care Group website and applications will go live soon (https://www.bsaci.org/professionalresources/primary-care-resources/gp-withextended-role-gpwer-framework/). We are piloting this guidance with a number of GPwER candidates in spring next year. A webinar on the pilot results will be held soon after (further details to follow). We are also in discussion with other GPwER specialities such as gastroenterology and dermatology to understand their programmes and look at shared learning. We strive to expand and broaden our appeal to increase engagement among Advanced Nurse

Nurses in Allergy J

James Gardner

Consultant Nurse in Children’s Allergy in London; Chair of the Nurses in Allergy Committee

ames Gardner took over as Chair of the group and Rebecca Batt is now the vice-chair. We said a sad farewell to Jill Edmunds and Sarah Burrell from the committee and thank them for all their hard work over the years. We are actively recruiting for an Adult Rep, Secretary and Conferences Representative (vacant from Rebecca becoming vice chair). We hope to appoint these very soon. We said goodbye to our previous Chair, Hannah Kramer, back in October. We thank her for her hard work over her term even

during her maternity leave! We have continued to see nursing numbers grow in the society which is great to see. Our most recent meeting was a productive one, setting out our goals and objectives for the coming year. We saw the Nasal spray SOP reviewed and is now completed and has been published on the website.

Practitioners, Pharmacists, Dieticians, and other allied health care professionals who will contribute further to high-quality allergy care delivery both locally and nationally. A new guidance letter on adrenaline auto-injector (AAI) prescribing in primary care has been published in CEA1 and adapted by webMD.2,3 It is now available online and a webinar on the AAI guidance is planned for Feb 2024. The PCG is currently in discussion with GP education platforms and GP IT systems on their content. There is also a plan to have input from speakers at mainstream GP conferences. Dr Angier will represent the RCGP on the National Allergy Steering Group (NASG) and the Department of Health and Social Care expert advisory group for allergy where the first meeting took place in December 2023. The group will be looking at the broader strategy and vision in delivery and support in allergy services with particular focus on primary care workers across the system. 1. .Clinical Experimental Allergy, https://onlinelibrary.wiley.com/doi/10.1111/cea.14325) 2.https://www.medscape.co.uk/viewarticle/adrenaline-autoinjector-prescription-patients-risk-2023a1000egf 3.https://www.medscape.co.uk/viewarticle/adrenaline-autoinjector-prescription-patients-risk-

Hannah established the successful Annual Allergy Update study day for nurses. We had the first meeting in April 23 and this was extremely well attended and well received. Thank you to all who gave up their time to speak and thanks to all who provided feedback. We have taken your feedback on board and our first objective of our term is to run this meeting again. We are pleased to announce that we will be running it again next year on the 26th April 2024 – details will follow soon! Our second objective is to establish a mentorship programme for nurses in Allergy, those of us who have been around for a few years will act as mentor for those new to allergy. Watch this space- we aim to begin advertising the programme and further details in the Spring of next year. As always, we welcome any communication via our email address nurses@bsaci.org please do get in touch if there is anything we can support with. Or indeed you can follow us on X (Twitter) @BSACInurses We would also like to feature nursing research, audit or projects in the next edition of Allergy Update. Please email us if you would like to share your work.

Committee and SIG news

Clinical Immunology Committee T

Dr Tomaz Garcez

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

his will be the last update from the BSACI Clinical Immunology Committee. Following a restructure within BSACI, and discussions with the British Society for Immunology (BSI) Clinical Immunology Professional Network (CIPN), representation from the Clinical Immunology community will come directly from BSI-CIPN and BSACI will also have direct representation on BSICIPN. This model of collaborative representation between the two organisations will help to encourage joint working,

particularly within education and training. There are already well developed plans for joint sessions at future congresses and strong collaboration on mutual access to training opportunities for trainee members. There remains one active workstream of the BSACI CIC that will continue with input from the Royal College of Pathologists, BSACI and BSI-CIPN. This project looks at the use of laboratory allergy testing. We are working to provide guidance and recommendations on the use of laboratory allergy testing in primary care settings. This guidance is based on published evidence to improve testing and reduce unnecessary testing by providing clinical advice at the point of test requesting. The project is being delivered by a subgroup of the BSACI CIC who will continue to meet until a draft is ready for review by the stakeholder groups. Once approved we will seek input from the Royal College of General Practitioners also. We have supported a trainee led group looking at the potential opportunities posed by the revised GMC curricula in Allergy and Clinical Immunology (ACI). We have encouraged the trainee group to ensure their work continues and will ask them to provide regular reports to the stakeholder organisations via their representatives.

Jonathan Hourihane, Louise Savic, Tomaz Garcez and Patrick Yong

The members of the BSACI CIC would like to thank the membership for their support over the years and hope everyone agrees that the new structure will provide a more robust link between the Allergy and Clinical Immunology communities. Finally BSACI held an ‘Allergy’ session at the CIPN/ BSI Conference in Belfast on Tuesday 5th December, covering Penicillin De-labelling (Louise Savic) and Food Immunotherapy (Jonathan Hourihane), the session was chaired by Patrick Yong and Tomaz Garcez.

Committee and SIG news

Standards of Care Committee T he Standards of Care Committee is delighted to announce that Dr Sue Leech took up the role of co-chair just after the September meeting, joining the current co-chair Dr Isabel Skypala.

Dr Isabel Skypala

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

Dr Sue Leech

Recent SOCC activity includes final approval and launch of the adult allergy action plan, devised by the Nursing Committee, with input from the Adult Allergy Committee and SOCC members. A questionnaire survey of the membership provided useful information for the Oral Food Challenge Clinical Practice Statement, which will provide practical, expert and evidencebased guidance for all secondary care providers.

Another survey of the Paediatric Allergist, Kings College Hospital,; membership is currently underway Co-Chair of Standards to inform the new guideline on of Care Committee Emerging Food Allergens. The

guideline committee, which includes a number of external stakeholders, will meet in January to review the results and plan the structure of the guideline. The guideline on Non-Steroidal Anti-Inflammatory Drugs (NSAID) Allergy led by Dr Rita Mirakian is nearing completion and publication is planned for mid-2024. The guideline on Idiopathic Anaphylaxis led by Dr Andrew White now has agreed PICO questions, but due to a lack of published evidence a Delphi consensus process is planned. To support this, a small group of experts will ensure that an agreed methodology for the Delphi process will be part of the BSACI guideline production manual. The Clinical Practice Statement on Lipid Transfer Protein allergy is nearing completion, and the template of this new type of BSACI publication currently being formulated. The co-chairs of SOCC would like to thank all SOCC members and also all those contributing to BSACI guidelines and Clinical Practice Statements. Last, but definitely not least, we wish to thank Dr Shifa Shaikh, the Chief Scientific Officer of the BSACI, who provides magnificent support for SOCC. To view all BSACI Guidelines visit https://www.bsaci.org/guidelines/

Paediatric Special Interest Group I t was great to see many of you at the BSACI conference and particular thanks to those who attended the open committee meeting on the Thursday evening, which led to some lively discussions..

Dr Niten Makwana

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

The Palforzia guidance statements are complete, and we are awaiting final review by CEA prior to making them available on the BSACI website, together with a published narrative on the background to some of the guidance and how it can be implemented in practice.

We had a meeting for development of a national set of paediatric allergy service standards on the Thursday morning at BSACI and agreed some practical standards which focused on outcomes rather than inputs. These were sent out to BSACI members for voting to rank which were felt to be the most important,

and I do hope many of you completed that survey. In the next stages we will also be working with patients and families to further clarify which outcomes matter to them. Many of us use the BSACI allergy action plans and it was felt that the next stage of development of these was to find a process to digitise them, as most individuals no longer want to carry pieces of paper around. We are looking into how this may be developed, to enable future portability. We hope to commence some work on a mentorship programme for trainees in paediatric allergy and new consultants, to aid the transition, and a survey to get your thoughts around this will be available early in the new year. Please do take some time to complete this. Finally, the work of the committee is a team effort, and I would like to thank them for their hard work and dedication to the initiatives we are working on. Winter is here, and I hope you managed to spend time with your friends and families over the festive season. I hope to see many of you in the new year.

Committee and SIG news

Dietitians Strategic Group • U

ntil now there has been a single Dietetic Representative on BSACI council, also a representative of the Food Allergy Specialist Group (FASG) of the BDA. Alongside the structural changes to BSACI, the FASG committee has been re-evaluating how we can work more effectively with BSACI. Therefore we have created a new strategic Dietitians Group Hannah Hunter Guy’s and St. Thomas’ to be a channel between the BDA/ NHS Foundation FASG and the BSACI, furthering Trust;Treasurer of the objectives of both parties the FASG without creating any duplication of efforts. Our goal is to provide dietetic expertise within the society and ensuring this work is complementary to the FASG activities.

Advise the Society on a variety of dietetic matters which influence the care of patients.

• Be the main channel through which the Society receives the views of dietitians.

• Play a pivotal role in the communication and

linking together the wide range of activities within Dietetics and all BSACI Specialist Interest Groups.

Activities that will remain within FASG

• Publication of resources (e.g. diet sheets, BDA Food Fact sheets, public webpages)

• Webinars & education • Communication and discussion between members

for research by working closely with UK and International partner organisations.

The group consists of FASG key committee members: Chairs (Karen Wright and Justine Dempsey), FASG founder (Isabel Skypala) and FASG Treasurer (Hannah Hunter). Other members of FASG will be opted to join the group as and when required to assist with key activities.

key work of BSACI

The composition of the group will be reviewed in September 2024

Planned strategic work with BSACI

• Address workforce issues, support business planning as well as service development

• Identify, undertake and promote opportunities • Ensure dietetic expertise and representation in

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

To find out more visit https://www.bsaci.org/about-bsaci/ways-to-support-bsaci/ 31

Committee and SIG news

Psychology Special Interest Group T

Professor Rebecca Knibb

Associate Professor in Health Psychology, Ashton University; Psychology Special Interest Group Lead

he Psychology Special Interest Group is chaired by Dr Rebecca Knibb, an Associate Professor in Health Psychology, and aims to promote the psychological care and well-being of patients with allergies and their families. The group has eight further members from research and clinical practice, spanning paediatric and adult allergy. The group have been working hard to promote awareness of the impact of allergy and the effectiveness of psychological interventions and have been busy at a number of

conferences this year. We held a meet and greet at the BSACI stand at the conference in Harrogate, promoting the work of the group. Research by some of our members on psychological services for food allergy in the UK and patient experiences with health care professionals regarding psychological support for food allergy was also presented during the conference. Professor Chrissie Jones has had her booklets on psychological support for patients and families with food allergy printed. These were presented during a workshop at

the BSACI conference, which generated great interest, showing the need for materials such as this. We are planning to hold one-day training events next year for health care professionals wanting to know more about how they can support their patients in managing food allergy-related distress.

The results of a UK and a global survey on unmet need for psychological support and a systematic review on psychological interventions are under review with journals and should be published early next year. Findings from the global survey show that the UK has one of the highest proportions of adults and caregivers reporting food allergy-related distress and one of the lowest in being able to provide psychological support. A follow-up survey is planned next year to explore this further. Dr Knibb has been invited to join a new Expert Advisory Group for Allergy chaired by the National Allergy Strategy Group and Department of Health and Social Care (DHSC). This expert group will advise the DHSC and NHS England on priority areas for policy change to achieve best outcomes for people with allergies. Dr Knibb will be representing the psychology profession and will be advising on the psychological support needs of patients and their families. We are looking forward to a busy and productive 2024.

Online learning and development Webinars and Grand Rounds This year BSACI has delivered 8 webinars and 5 grand rounds. Webinars are organised by the BSACI Council with the aim of offering high quality, conveniently accessible education on key allergy topics for our members and stakeholders. The speakers are all experts in their respective fields. Webinars take place at least 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 us at info@bsaci.org During 2023 BSACI also hosted two special webinars in partnership with Education for Health (EfH) and Respiratory Futures on How to Successfully Manage Adults with Asthma and Allergies Webinar. Grand Rounds are organised by the BSACI Paediatric Special Interest Group 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 next year’s schedule of Webinars and Grand Rounds visit www.bsaci.org/education-and-events/ webinars/2024-webinars/

Committee and SIG news

National Allergy Strategy Group I n the last issue of Allergy Update, I mentioned the proposal we had made for an 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 Professor Adam Fox departments where policy change Chair – National could have a positive impact for Allergy Strategy those suffering with allergy. I am Group (NASG) delighted that EAGA has now received ministerial approval and had its first meeting in December. It included representation from various governmental agencies such as MHRA, UKHSA and the Food Standards Agency as well as representatives from multiple Royal Colleges, amongst others. Key aims include:

• Identifying priority areas to DHSC, NHSE and

others, relating to allergy that require policy change or development and advise on how to best achieve improved outcomes

• Actively support the growth and delivery of high

quality, comprehensive and geographically more diverse specialist allergy services and improving allergy care at all levels of an integrated care system.

• Ensuring diverse and collaborative views and voices of key stakeholders inform recommendations for policy-makers

improve the lives of people living with allergy

• Where appropriate, acting

as advocates for the allergy community at a governmental level

• Maintain broader contact with the allergy

community through patient advocacy groups/ charities.

EAGA will have a purely advisory function and will be accountable to the DHSC and NASG. I am also delighted to announce that we received an application from the Natasha Allergy Research Foundation (NARF) to join the NASG as a core member and this was unanimously approved in October. The addition of NARF to our group makes the NASG voice significantly louder and ensures that all the major Allergy UK charities are speaking in unison. We continue to explore fundraising options to support the development of a National Allergy Strategy. Please do let me know if you would like to be more involved in our work.

Junior members W

e had to reschedule the September and November training days, which are due to take place in January and March. Please kindly check the BSACI website for further details. .

• Support the development of a new National

Allergy Strategy and actively contributing to its implementation

• Providing an advisory function for a range of stakeholders who wish to develop policy to

Dr Lawrence Youlten obituary published

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

We shall continue to mix inperson and virtual training days with our inclination towards in-person training days to help trainee’s get protected time for their teaching and benefit from networking. We have the BSACI online global symposium on 26th January and I would urge you all

Clinical & Experimental Allergy has published the obituary of Lawrence Youlten.

to consider booking study leave for the same.

Lawrence Youlten was a distinguished allergist. His expertise was in clinical pharmacology and allergy with particular interest in venom allergy and desensitisation.

We aim to continue providing maximum level of educational opportunities to trainees and if anyone has queries or suggestions, please feel free to get in touch with us.

To read the full obituary visit https://onlinelibrary.wiley.com/doi/10.1111/cea.14403

For any queries/communication, please contact us at juniormembers@bsaci.org.