Quality standard
Quality statement 3: Specialist assessment for venom immunotherapy
Quality statement 3: Specialist assessment for venom immunotherapy
Quality statement
People who have a systemic reaction to wasp or bee stings are referred to a specialist allergy service to assess whether venom immunotherapy would be suitable. [2016]
Rationale
Venom allergy from bees and wasps accounts for approximately a quarter of adult cases of anaphylaxis of known cause. Venom immunotherapy can reduce the risk and severity of systemic reactions. Ensuring that people who could benefit from venom immunotherapy are assessed for this treatment will help improve uptake and reduce the incidence of venom-induced anaphylaxis.
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.
Process
Proportion of people who have a systemic reaction to a wasp or bee sting who are referred to a specialist allergy service to assess whether venom immunotherapy would be suitable.
Numerator – the number in the denominator who are referred to a specialist allergy service to assess whether venom immunotherapy would be suitable.
Denominator – the number of people presenting with a systemic reaction to a wasp or bee sting.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
Outcome
a) Prescriptions of venom immunotherapy.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from prescribing systems.
b) Incidence of venom-induced anaphylaxis.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
What the quality statement means for different audiences
Service providers (such as primary care providers, emergency departments and specialist allergy services) ensure that there are agreed local pathways in place for people who have a systemic reaction to a wasp or bee sting to be referred to a specialist allergy service to assess for possible venom immunotherapy. Venom immunotherapy should be offered when suitable as part of the local pathway.
Healthcare professionals (such as GPs and emergency department staff) refer people who have a systemic reaction to a wasp or bee sting to a specialist allergy service for assessment. Healthcare professionals at specialist allergy services assess for and offer venom immunotherapy if it is suitable.
Commissioners ensure that specialist allergy services are in place that can offer venom immunotherapy, and that there are agreed local pathways for people who have a systemic reaction to a wasp or bee sting to be referred to these services for assessment and treatment.
People who have a severe reaction to a wasp or bee sting are offered an appointment at a specialist allergy service to check if they would benefit from treatment (called venom immunotherapy) that can reduce the risk of future reactions to wasp or bee stings.
Source guidance
Definitions of terms used in this quality statement
Specialist allergy service
A service consisting of healthcare professionals with the skills and competencies needed to accurately investigate, diagnose, monitor and provide ongoing management of, and patient education about, suspected anaphylaxis. The service should be age appropriate if possible. [Adapted from NICE's guideline on anaphylaxis, recommendation 1.1.9]
Details of local allergy services are available from the BSACI 'find a clinic' search, including information on services with expertise, particularly in food, drug or venom allergies, or from the NHS website allergy service finder. [Expert opinion]
Assessment for venom immunotherapy
A number of criteria are evaluated before giving venom immunotherapy to identify whether the treatment is safe and appropriate. Assessment criteria for venom immunotherapy are provided in NICE's technology appraisal guidance on Pharmalgen for the treatment of bee and wasp venom allergy and BSACI's guideline on the diagnosis and management of Hymenoptera venom allergy. [Expert opinion]
Venom immunotherapy should be carried out only by allergy specialists with experience and knowledge in this field and in centres undertaking venom immunotherapy in significant numbers of patients and where the team has expertise in treating anaphylaxis. [BSACI's guideline on the diagnosis and management of Hymenoptera venom allergy]
Equality and diversity considerations
When referring people to a specialist allergy clinic, any potential difficulties in access, such as travelling distance, disability or financial barriers, should be taken into account.