Consultant physicians working with patients 5th edition - FSEM

Consultant physicians working with patients
� Most allergy diagnosis is done by skin testing. An
immunology laboratory service is required.
� A paediatrician is identified as a contact where
physicians dealing with adults provide paediatric
allergy services.
� Other specialists include community paediatricians
and nurses (for children at risk of anaphylaxis) and
occupational health physicians (for occupational
allergies and vaccination reactions).
Working with GPs and GPs with a special interest
(GPwSIs)
There is no formal GPwSI curriculum in allergy, but a
small number of GPs work in allergy departments.
Extensive GP liaison occurs as a result of referrals and
shared care.
Other specialty activity beyond local services
There are regional and national services for drug allergy
and anaphylaxis during anaesthesia. Joint ENT/allergy
clinics exist for selected patients.
5 Delivering a high-quality service
What is a high-quality service?
Consultant allergists should have completed the allergy
training programme (allergy CCT). A minimum of two
full-time consultant allergists are required with
appropriate support staff.
The following resources are recommended for
outpatient, day-case and inpatient settings.
Outpatient services
� a comprehensive, high-volume service able
to diagnose and manage all types of allergic
disease
� skin-prick test primary investigation
� defined and integrated clinic facilities for
outpatients and day cases
� immediate access to drugs and equipment for
treatment of anaphylaxis.
Day-case investigation and immunotherapy
� agreed protocols and approach to diagnosis
� sufficient caseload to ensure expertise and
continuing standards of care; dedicated sessions for
drug challenge and immunotherapy at least weekly
� facilities to store and prepare drugs and conduct
challenge tests
� team approach.
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Inpatients
� rapid consultation service.
Work to maintain and improve the quality of care
Service developments to deliver improved patient
care
� Nut allergy managed in specialist allergy clinics
reduces morbidity.
� ENT surgery can be avoided by treatment of rhinitis
by allergists.
� Immunotherapy reduces chronic disease, drug use
and improves quality of life.
� Challenge testing enables diagnosis of drug and food
allergy.
� Liaison with community paediatricians improves
care for children at risk of anaphylaxis.
� A single consultation with an allergist is more
effective than multiple referrals to organ-based
specialists.
� Development of new therapies, eg anti-IgE, and
desensitisation for peanut allergy.
Education and training
The allergist may act as educational supervisor for
allergy trainees and has a role in the education and
support of colleagues in primary care and other
specialist services in their region. The centre will
network with these other providers to enhance allergy
provision in the region. This encompasses clinical
governance, professional self-regulation, and
continuing professional development (CPD).
Research – clinical studies and basic science
There is a strong tradition of academic allergy in the
UK. Most allergy centres have developed through
academic funding. Academic allergists make an
important contribution to allergy within NHS trusts
through service delivery, service development, guideline
development, clinical research and training. Basic and
clinical allergy research in the UK is internationally
recognised for excellence and has led to improvements
in patient care.
Specialty and national guidelines and audit
Table 1 lists some useful guidelines and audits for this
specialty.
A national audit of venom immunotherapy revealed
variable practice; BSACI guidelines were subsequently
produced. 7 An audit of asthma deaths suggested allergy
was a cause but that this had not been addressed in life.
C○ Royal College of Physicians 2011