Improving food allergy management in general paediatric clinics - Audit and recommendations
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Ahmad A.
Alam Z.
Alam, M.
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2025
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Objectives: National guidelines from NICE and BSACI set the standards for allergy care. This audit aimed to evaluate current practice against these standards and identify areas for improvement in the management of paediatric food allergy patients seen in a general paediatric clinic. Key indicators assessed included: Documentation of allergy-focused history (AFH) Diagnostic testing (skin prick or specific IgE) Provision of adrenaline auto-injectors (AAIs) Follow-up arrangements Issuance of written allergy action plans (WAAPs) Method: A retrospective review was conducted of electronic medical records, clinic letters, and test results from 50 paediatric patients (<18 years) diagnosed with food allergies over the past 6-12 months. Result(s): Allergy-focused history (AFH) documented in 100% of cases. Diagnostic testing completed in 90% of patients. Adrenaline auto-injectors (AAIs) prescribed in 100% of patients with history of anaphylaxis. Follow-up arranged in 88% of patients. Written allergy action plan (WAAP) provided in only 10% of patients (Target: 95%). Spectrum of Allergy in the Patient Population Single food allergy: 44% Multiple food allergies: 56% Atopic comorbidities: Eczema: 50% Asthma: 18% Hay fever: 12% Common allergens: Nuts: 48% (Peanut 29%, Hazelnut 29%, Cashew 25% Macadamia 17%) Egg: 38% Dairy: 30% Seafood: 16% (Fish-only: 62% of seafood-allergic group) Fruit: 16% (mostly kiwi) Lentils: 12% Sesame: 4% Others: chilli, pepper, yeast, wheat Conclusion(s): This audit shows strong adherence to national guidelines in areas like allergy-focused histories, diagnostic testing, and AAI provision. However, low WAAP issuance and inadequate follow-up highlight areas for improvement. Integrating WAAP templates into the EMR and involving allergy-trained staff can improve care consistency. Appointing a dedicated allergy dietitian and specialist nurse within general paediatrics will enhance patient education, staff training, and follow-up. These measures will better align practice with national standards and improve outcomes for children with food allergies. Further studies with larger cohorts are needed to identify barriers and strengthen guideline adherence.
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Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology