Quality standard
Quality statement 4: Referral to secondary or specialist care
Quality statement 4: Referral to secondary or specialist care
Quality statement
Children and young people are referred to secondary or specialist allergy care when indicated by their allergy‑focused clinical history or diagnostic testing.
Rationale
When indicated for children and young people, referral to secondary or specialist allergy care can lead to a confirmed diagnosis and can help to avoid prolonged anxiety about which foods are safe. It will also reduce the risk of further allergic reactions and nutritional problems because of inappropriate care.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements and written clinical protocols to ensure that children and young people are referred to secondary or specialist allergy care if indicated by their allergy‑focused clinical history or diagnostic testing.
Data source: Local data collection.
Process
Proportion of children and young people who are referred to secondary or specialist allergy care if their allergy‑focused clinical history or diagnostic testing indicates a need for a referral.
Numerator – the number in the denominator who are referred to secondary or specialist allergy care.
Denominator – the number of children and young people who have an allergy‑focused clinical history or diagnostic testing that indicates a need for a referral to secondary or specialist allergy care.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (primary, community and secondary care providers) ensure that there are local arrangements for children and young people to be referred to secondary or specialist allergy care if this is indicated by their allergy‑focused clinical history or diagnostic testing. Liaison between primary care and local allergy services can establish agreed local pathways of care.
Healthcare professionals (such as GPs) refer children and young people to local secondary or specialist allergy care if this is indicated by their allergy‑focused clinical history or diagnostic testing.
Commissioners commission services with agreed local pathways to refer children and young people to secondary or specialist allergy care if this is indicated by their allergy‑focused clinical history or diagnostic testing.
Children and young people are offered a referral to a specialist if their symptoms or results of tests suggest that specialist opinion is needed to diagnose food allergy and find out the best treatment for them.
Source guidance
Food allergy in under 19s: assessment and diagnosis. NICE guideline CG116 (2011), recommendation 1.1.17
Definitions of terms used in this quality statement
Indications for referral to secondary or specialist allergy care
Based on the allergy‑focused clinical history, referral to secondary or specialist allergy care should be considered in any of the following circumstances:
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The child or young person has:
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faltering growth in combination with one or more of the gastrointestinal symptoms described in recommendation 1.1.1 of the NICE guideline on food allergy in under 19s
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not responded to a single‑allergen elimination diet
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had 1 or more immediate systemic reactions
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had 1 or more severe delayed reactions
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confirmed IgE‑mediated food allergy and concurrent asthma
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significant atopic eczema where multiple or cross‑reactive food allergies are suspected by the parent or carer.
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There is:
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persisting parental suspicion of food allergy (especially in children or young people with difficult or perplexing symptoms) despite a lack of supporting history
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strong clinical suspicion of IgE‑mediated food allergy but allergy test results are negative
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clinical suspicion of multiple food allergies.
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[NICE's guideline on food allergy in under 19s, recommendation 1.1.17]
Secondary or specialist allergy care
Children and young people for whom referral is indicated need to be seen by allergy specialists with appropriate competencies. These will include professionals working in specialist allergy services and secondary care professionals who have expertise in food allergy in children and young people. [Expert opinion]
Selecting the right allergy clinic is important because not all allergy clinics offer comprehensive services for food allergy and some see adults or children only. Details of local allergy services are available from the British Society for Allergy and Clinical Immunology find a clinic search or from the NHS website service search.