Compliance with NICE guidelines for children at risk of anaphylaxis in a tertiary allergy centre Prabalini Thaventhiran Deputy Clinical Nurse Specialist Children’s Allergy Service, Evelina London

Overview Background Method Results and findings Conclusion and implementation into practice

Background Food-induced anaphylaxis is most common in the 0–5 age group, but death from anaphylaxis in this age group is rare. Teenagers and young adults risk-taking behaviours. In the UK Fatal Anaphylaxis Registry, 22% of cases did not have a prior diagnosis of asthma. Around 50% of children with food allergies have asthma: the vast majority will never have a severe allergic reaction. Largest allergy service in the UK – 4000 new patients per year and 3000 follow up patients per year. 2300 day cases in the nurse led service. Joint allergy/ resp clinic Anagnostou K, Turner PJMyths, facts and controversies in the diagnosis and management of anaphylaxis Archives of Disease in Childhood Published Online First: 16 June 2018. doi: 10.1136/archdischild-2018-314867 Smith, P., Hourihane, J. and Lieberman, P. (2015). Risk multipliers for severe food anaphylaxis. World Allergy Organization Journal, 8(1), pp.1-6.

Objectives Are patients with food allergies and asthma/viral induced wheeze receiving an allergy action plan and asthma management plan? Are patients are receiving adrenaline auto injector device training and inhaler device training? Do patients and families feel confident to use an adrenaline auto injector device and inhaler devices?

Method 40 Questionnaires were handed to new and follow up patients. Period of 4 weeks in September 2018 33 questionnaires returned.

Participant selection Inclusion criteria Exclusion criteria Patients with a diagnosed food allergy and confirmed asthma diagnosis or episodes of viral induced wheeze. New and follow up patients Non IgE mediated Chronic urticaria Drug allergy

Results and Findings 83% response rate 24 patients had experienced symptoms of anaphylaxis

Patients receiving training

Patients receiving up to date asthma management plans and allergy action care plans

Level of confidence Confidence vs perception technique

Conclusion and implementation Improvement needed in 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. Language barrier ? Apps?

Questions?