The following Nottinghamshire Area Prescribing Committee guidance supports health professionals working within Nottinghamshire to implement the NICE guidance, but it is also a useful tool for those outside the area. ‘Guidance on the Management of Lactose Intolerance and Cow’s Milk Protein Allergy and the Prescription of Specialised Infant Formula’ 2012.
Up to date information relating to food allergy in infants and children for both patients and health professionals can be found on the news page.
Other useful tools for diagnosis and management of food allergies in primary care:
Walsh, J 2011. An allergy focused clinical history is key in diagnosis of food allergy. diagnosis of food allergy
Waddell, L 2011. Living with food allergy. JFHC 21 (4); 21-28 Living with food allergy
Ludman, S, Shah, N & Fox A, 2013. Managing cow's milk allergy in children BMJ; 347: f5424
Venter C, Brown T, Shah N, Walsh J and Fox A. Milk Allergy in Primary Care Guideline (MAP) 2013
FANS referral form
Diagnosing food allergy should be undertaken according to the principles of the NICE food allergy guidance
These principles comprise of:
- Recognising the broad range of possible presenting symptoms
- Taking an allergy focused clinical history
- Deciding from the history whether it is IgE (immediate) or non-IgE (delayed) mediated allergy
- Testing according to suspected mechanism (allergy tests or exclusion trials)
- Providing information and support
- Referring as appropriate
The online assessment (coming soon) form should be completed by the parent/ carer of their infant/ child with unresolved symptoms related to the gut, skin and/ or respiratory system. This assessment provides a thorough allergy focused clinical history
. The printout obtained following completion of the online tool will suggest whether food allergy is likely, whether the mechanism is IgE or non-IgE mediated allergy and therefore what type of allergy testing is indicated. It will also highlight the possible differential diagnoses of gastro-oesophageal reflux and lactose intolerance. To ensure patient safety, FANS insist that the results are discussed with the child’s GP or paediatrician before any recommendations are acted on.
If food allergy is indicated, the family will need dietary information and support from a dietitian, as outlined in the consultation
. To ensure that FANS are aware of all pertinent medical/ social factors, and a physical examination has been carried out as part of the overall allergy assessment process, a private medical referral to Dr Lisa Waddell, a highly experienced paediatric food allergy dietitian using the FANS referral form
can be printed off, faxed or posted. Alternatively, an NHS referral can be made to a local community paediatric dietitian.
The resulting printout is only as good as the initial information provided, and the tool will need to go through rigorous validation by research
. In the meantime, feedback
regarding the tool would be most welcome.
"Our mission is to provide a patient-centred service that supports early recognition,
diagnosis and treatment of food allergy in children, thereby enhancing quality of life"