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Immunology and Allergy Services in Scotland

APPENDIX IV

EXTRACTS FROM STANDARDS OF CARE FOR GOOD ALLERGY PRACTICE

Out-Patient Facilities:

Hospitals should have designated areas for adult and paediatric allergy clinics organised by appropriately trained staff

Allergy consultations are often very time-consuming and therefore a well-organised appointments system is needed. For follow-up visits it is recommended that no doctor should see more than four patients in an hour. There must be sufficient weekly out-patient sessions to allow consultants to cover the workload. Patients should be seen by, or have their cases discussed with, a consultant at the first visit and on regular occasions when follow-up is needed.

Facilities should be made available for skin testing, spirometry (including peak flow measurements) and advice on the avoidance of allergens, instruction in self-administration of adrenaline, and facilities for allergen injection immunotherapy with an appropriate observation area.

Where appropriate, facilities should also be available for patients to have a chest x-ray at the time of the clinic visit and for radiographic film to be available for the consultation.

The support of an allergy clinic nurse is strongly recommended, to assist in obtaining an allergy history, perform skin tests and give effective advice on environmental control.

The services of qualified adult and paediatric dietitians should also be available, especially in clinics which deal with many cases of food allergy. Dietitians give detailed advice on exclusion diets and assess the adequacy of patients' diets.

Special facilities at regional centres should include facilities for the measurement of non-specific bronchial hyperresponsiveness (for example, by means of inhalation) and challenge chambers for use with occupational agents (and occasionally common aeroallergens).

Testing Facilities:

Skin test solutions must be standardised and should have a UK product licence.

Facilities should be available for open exclusion and reintroduction of food for allergy diagnosis as well as double-blind, placebo-controlled tests to identify or disprove food tolerance by giving suspected foods in disguised forms.

Allergists should have access to routine haematology and biochemistry services as well as certain immunological tests. If immunology tests are not available at each District General Hospital then facilities should exist to refer them to an appropriate regional centre with consultant (or equivalent) immunologist advice and CPA (UK) Ltd accreditation.

Paediatric Allergy:

Allergic diseases are particularly important in children, and paediatricians should always be involved in the diagnosis and management of children referred for specialist care. However, although allergy is included as part of their general paediatric training, they may in individual cases decide to consult with, or refer a child to, an adult allergy specialist.

The Royal Colleges give detailed recommendations on the use of specific allergen injection immunotherapy (hyposensitisation) and require the availability of appropriate facilities and staff trained in resuscitative techniques.

Adapted from: The Royal College of Physicians / Royal College of Pathologists. Good Allergy Practice. The Royal College of Physicians. London, 1994.

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