**Now available**
The 2019 Edition 4 of Food Challenges for Children: A Practical Guide is available.
- Updated text
- New practical food challenge plans
- Guidelines and challenge plans for FPIES
- Access to all challenge plans as pdf
Order your updated copy today at: childrensallergy@uhl-tr.nhs.uk
Only £20
The paediatric allergy team provides a service that covers all aspects of allergic disease for children up to the age of 18 years (new referrals up to 16 years). Our multi-disciplinary team consists of an experienced multi-professional team including doctors, specialist nurses and specialist dietitians. We adopt a holistic approach in the management of allergic disorders and work to support and provide education for patients and families.
Our team understands the significant impact of allergic disease on children and their families. We aim to provide high quality care in a professional and friendly environment where families and children feel supported. This is reflected in the feedback that our service received in 2018, when 100% of our patients attending the clinic rated their overall satisfaction as being excellent or very good.
We offer advice and education on the following conditions:
- Food allergy
- Drug allergy
- Allergic rhinitis
- Allergic disorders of the gut
- Eczema and allergic conditions that affect the skin, such as urticarial and angioedema
Our services include:
1. Outpatient clinics:
- General outpatient clinics: The allergy team conducts three allergy one-stop clinics per week. Each patient will have access to a medical, nursing and dietetic consultation during the appointment , to ensure that all aspects of the medical problem have been addressed. The doctors will leadthemedical assessment, the nurses provide the skin prick diagnostic service and additional support, device training and spirometry as required and the dietitians focus on the dietetic assessment, advice and nutritional supplementation.
- Specialised outpatient clinics: In addition to the general outpatient clinics the team conducts a quarterly multiple food allergy clinic for selected patients, and a joint allergy-dermatology clinic twice a month for food allergic patients with challenging eczema that is supported by the dietititan and specialist dermatology nurse.
- Nurse-led diagnostic testing clinic: This clinic is for allergy testing for patients from allergy and other specialities such as ENT. Some referrals from GPs are also suitable for testing and confirmation of negative or positive allergic status.
- Satellite clinics: The allergy team also undertake outpatient clinics at Two Steeples Medical Centre twice a month.
Important information before coming to the outpatient clinic
2. Diagnostic challenges:
- Food challenges: Challenges are performed as outpatient procedures in the department’s day-care unit by an experienced team of nurses. The main aim of oral food challenges is to exclude the presence of allergy or confirm the development of tolerance to the tested food. There are approximately 350 food challenges performed each year.
- Certain challenges may require parents to bring in the food to be challenged where a recipe is provided prior to the challenge. This information is provided on the food challenge appointment letter (please see attachment).
- Drug challenges: The service also supports a small requirement to assess patients with suspected allergic reactions to drugs, primarily oral antibiotics, but also local anaesthetics, oral analgesics and vaccines.
3. Oral immunotherapy:
Our service has developed a novel milk and egg oral immunotherapy service under the leadership of the allergy dietitians. We are the first unit to provide oral immunotherapy for persistent milk and egg allergy in the UK and have more than 75 patients recruited for milk and approximately 20 patients for egg oral immunotherapy to date.
4. Sublingual and subcutaneous immunotherapy:
The service has a long-standing (since 1999) well-established immunotherapy programme for severe aeroallergen rhino conjunctivitis (principally for grass allergy, but also for tree, house dust mite, horse, cat and dog allergy). The majority of these patients are treated with sub-lingual immunotherapy (SLIT). We also provide nurse-led sub-cutaneous immunotherapy (SCIT) service for patients with bee or wasp anaphylaxis. Sub-cutaneous immunotherapy is also available for patients with severe hay fever.
5. Education and training:
Our team is involved in different areas of teaching:
- Specialist Allergy Nurses provide anaphylaxis training to child care providers primarily nurseries, child minders and after school clubs, charity volunteers, independent education and social care providers. Specialist Allergy Nurses have supported school nurses in the delivery of AAI training in schools by regularly holding formal training sessions throughout the year and assisting with any allergy concerns. Since September 2018, this is now provided by the Diana Children’s Community Training service with the continued support of Allergy Specialist Nurses. (telephone 0116-2955413; e-mail: FYPCLPTTrainingAdministration@leicspart.nhs)
- Supporting allergy education for ward staff, other disciplines (ENT, maternity) and education teams when requested including educating Junior trainees as part of the ST1 – ST3 educational programme. The nurses and dietitians also support the annual allergy study day.
- Presentations at national and international allergy conferences.
6. Resources/diet sheets
The Allergy Dietitians provide diet sheets to patients which are available on the Leicester Nutrition & Dietetic Service (LNDS) website for UHL healthcare professionals. These diet sheets are also jointly used by the Community Dietitians.
7. Network
We are part of the Midlands Paediatric Allergy Group (MPAG) which meets twice a year and has developed stronger links within the East and West Midlands
8. Research:
The Leicester Children’s Allergy Service has been involved in several research studies:
- University hospitals is running a national study in collaboration with the British Paediatric Surveillance Unit (BPSU), Allergy UK and FPIES UK on a rare condition called Food Protein Induced Enterocolitis Syndrome (FPIES), which started in 2019. This has been funded by MAARA.
- SNIFFLE 1 & 2 & 4(2013-2017)- Three multicentre studies looking at the safety of the intranasal flu vaccine in children with egg allergy.
- PRESTO (2015-). A multicentre study looking at the role of prebiotics and probiotics in an amino acid milk formula in helping children outgrow their IgE-mediated milk allergy.
- Collaboration with Dr Rebecca Knibb (Clinical psychologist at Aston University) and Dr Aaron Cortes (University of Santiago, Chile) researching psychological aspects of food allergy.
- Collaboration with Dr Sandra Woolley (Department of Engineering, University of Birmingham) in a project looking at methods to assess adrenaline auto-injector use training.
- Supervision of MSc Student (Allergy) research project on reintroduction of peanuts into diets after negative challenges and on Adrenaline auto - injector prescription and Rhinitis.
Publications from the team:
- Ball H, Luyt D. Home-based cow's milk reintroduction using a milk ladder in children less than 3 years old with IgE-mediated cow's milk allergy. Clin Exp Allergy. 2019 Feb 8.
- Stiefel G, Anagnostou K, Boyle RJ, Luyt D et al. BSACI guideline for the diagnosis and management of peanut and tree nut allergy. Clin Exp Allergy 2017; 47: 719-739.
- Luyt D, Ball H, Kirk K, Stiefel G. Diagnosis and management of food allergy in children. Paediatr Child Health. 2016; 26 (7): 287-91
- Luyt D, Vaughan D, Oyewole E, Stiefel G. Ethnic differences in prevalence of cashew nut, pistachio nut and almond allergy. Pediatr Allergy Immunol. 2016; 27 (6):651-54.
- Turner PJ, Southern J, Andrews NJ, Miller E, Erlewyn-Lajeunesse, on behalf of SNIFFLE Study Investigators. Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study. BMJ 2015; 351: h6291
- Turner PJ, Southern J, Andrews NJ, Miller E, Erlewyn-Lajeunesse, on behalf of SNIFFLE Study Investigators. Safety of live attenuated influenza vaccine in atopic children with egg allergy. J Allergy Clin Immunol 2015; 136: 376-81.
- Hernandez-Munoz L, Woolley S, Luyt D, Stiefel G, Kirk K, Makwana N et al. Evaluation of AllergiSense Smartphone Tools for Adrenaline Injection Training. IEEE J Biomed Health Inform. 2015 (Epub ahead of print).
- Anagnostou K, Stiefel G, Brough HA, du Toit G, Lack G, Fox A. Active management of food allergy. Arch Dis Child. 2015; 100 (4): 386-90.
- Ball H, Luyt D, Bravin K, Kirk K. Single nut or total nut avoidance in nut allergic children: outcome of nut challenges to guide exclusion diets. Pediatr Allergy Immunol. 2011 Dec;22(8):808-12
Information for GPs
We accept referrals for patients with the following medical problems:
- Adverse reactions to food or preservatives
- Anaphylaxis
- Drug adverse reactions
- Moderate to severe eczema in children less than 5 years that an allergy trigger is suspected
- Latex allergy
- Venom allergy
- Moderate to severe allergic rhinitis
- Moderate to severe atopic asthma
- Urticaria/angioedema
Useful websites for patients and families with allergy:
Useful websites for patients and families on adrenaline auto-injector devices:
Useful information for GP and Health Professionals:
Contact details:
Leicester Royal Infirmary
Infirmary Square
Leicester
LE1 5WW
Tel: 0116 258 6694
Fax: 0116 258 6694
Parking facilities:
Please visit the link below for more information on getting to the hospital:
https://www.leicestershospitals.nhs.uk/patients/getting-to-hospital/leicester-royal-infirmary/car-travel-and-parking/
We also have a multi-storey car park. Access to the car park is via the existing entry on Havelock Street, and is ‘pay on foot’. There are pay machines in the car park and users will be able to pay with cash and debit cards.
On call commitments:
The Allergy Consultant’s offers a 7 day a week 08h00 - 24h00 phone consultation service.
Meet the team:
- Dr David Luyt, Paediatric Allergy Consultant
- Dr Gary Stiefel, Paediatric Allergy Consultant
- Dr Mhorag Duff, Consultant Community Paediatrician
- Dr Konstantinos Kakleas, Paediatric Allergy Consultant
- Specialist Nurse Kerrie Kirk, Paediatric Allergy Nurse
- Specialist Nurse Sarah Faulkner, Paediatric Allergy Nurse
- Specialist Nurse Ruth O’Dowd, Paediatric Allergy Nurse
- Heidi Ball, Paediatric Allergy Dietitian
- Kristian Bravin, Paediatric Allergy Dietitian
- Priya Mistry, Paediatric Allergy Dietitian
