Compliance With NICE Guidelines for Children At Risk of Anaphylaxis In a Tertiary Allergy Centre Thaventhiran, P and Benjamin, L Children’s Allergy Service Evelina London  Background: Evelina London Children’s Allergy service see children with food allergies and co existing asthma/ or viral induced wheeze. As part of the atopic march children with food allergies are more likely to develop asthma putting them at greater risk of life threatening anaphylaxis, (Foong et al 2017). Week 38 is peak for asthma exacerbation and increase hospital admissions. As children return to school from summer holidays it is important to ensure they have up to date asthma management plans and allergy action plans, (Julious et al 2007). One in eleven children in the UK have asthma. Many with poorly controlled asthma. A child is admitted to hospital every twenty minutes due to asthma exacerbation. We therefore need to ensure in conjunction with the NICE guidelines that our patients receive an allergy action plan, asthma management plan and receive training on how to use adrenaline auto injectors and inhaler devices correctly, ( NRAD 2014). Twenty seven patients felt very confident to use their inhaler device and five patients felt confident. However only nineteen patients received their inhaler device training on the day, ( See figure 1). Up to date management plans were given to six patients and seventeen patients received an up to date allergy action plan, (See figure 2). Figure 1 Aims/ objectives: To see whether our patients with food allergies and asthma/viral induced wheeze are receiving an allergy action plan and asthma management plan. To see whether our patients are receiving adrenaline auto injector device training and inhaler device training. To see whether our patients and families feel confident to use adrenaline auto injector device and inhaler devices. Figure 2 Conclusion We need to improve on providing inhaler device training and asthma management plans. We must ensure all our patients who use an inhaler device are trained with appropriate device and technique checked regularly. Although patients have reported they feel confident the appropriate technique may not be correct. Asthma management plans must be given out on every face to face consultation to reduce asthma exacerbations and risk of anaphylaxis. To improve this asthma management plan will be included on our SPT form check list. Potential future recommendations could be an asthma management plan in form of apps. To reduce language barrier to have asthma management plans available in different languages. Method: In September 2018 forty patients with a confirmed food allergy and diagnosed asthma/or viral induced wheeze attending a new or follow up outpatient consultation were given a questionnaire. Thirty three questionnaires were returned. Results: Out of thirty three patients twenty four had experienced symptoms of anaphylaxis. Nineteen patients had their adrenaline device prescribed by GP. Twelve patients had their auto adrenaline device prescribed by the allergy service. When asked about the level of confidence eighteen patients felt confident to administer an adrenaline auto injector. Eleven patients felt very confident. Three patients were unsure on the use of their device. References: Foong, R., du Toit, G. and Fox, A. (2017). Asthma, Food Allergy, and How They Relate to Each Other. Frontiers in Paediatrics, 5. Why asthma still kills: the National Review of Asthma Deaths (NRAD) Confidential Enquiry report. Royal College of Physicians. London; 2014. Available from: http://www.rcplondon.ac.uk/sites/default/files/why-asthma-still-kills-full-report.pdf Julious SA, Osman LM, Jiwa M. Increases in asthma hospital admissions associated with the end of the summer vacation for school-age children with asthma in two cities from England and Scotland. Public Health 2007;121:482–484.