Quality standard

Quality statement 6: Specialist allergy investigation

Quality statement 6: Specialist allergy investigation

Quality statement

Infants and young children with moderate or severe atopic eczema that has not been controlled by optimal treatment are referred for specialist investigation to identify possible food and other allergies.

Rationale

Infants and young children with moderate or severe atopic eczema have an increased likelihood of food and other allergies. Food allergies can cause a range of symptoms, including anaphylaxis, and can trigger or exacerbate atopic eczema. The most common food allergies for infants and young children with atopic eczema are to cows' milk, hens' eggs and nuts.

Specialist investigation can provide accurate identification of common food and other allergies; advice on dietary avoidance of allergens and choice of infant formula; and improved condition management strategies.

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 for infants and young children with moderate or severe atopic eczema that has not been controlled by optimal treatment to be referred for specialist investigation to identify possible food and other allergies.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from referral pathways.

Process

The proportion of infants and young children with moderate or severe atopic eczema that has not been controlled by optimal treatment who are referred for specialist investigation to identify possible food and other allergies.

Numerator – the number of infants and young children in the denominator who are referred for specialist investigation to identify possible food and other allergies.

Denominator – the number of infants and young children with moderate or severe atopic eczema that has not been controlled by optimal treatment.

Data source: No routinely collected national data for this measure has been identified. 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 ensure that there are local arrangements for infants and young children with moderate or severe atopic eczema that has not been controlled by optimal treatment to be referred for specialist investigation to identify possible food and other allergies.

Healthcare practitioners ensure that infants and young children with moderate or severe atopic eczema that has not been controlled by optimal treatment are referred for specialist investigation to identify possible food and other allergies.

Commissioners ensure that they commission services with local arrangements to offer infants and young children with moderate or severe atopic eczema that has not been controlled by optimal treatment referral for specialist investigation to identify possible food and other allergies.

Infants and young children (under 5 years) with moderate or severe atopic eczema that has not improved after treatment are referred to a specialist to find out whether they have any allergies that may be causing their eczema.

Source guidance

Atopic eczema in under 12s: diagnosis and management. NICE guideline CG57 (2007, updated 2023), recommendations 1.4.1.2, 1.4.1.5, 1.4.1.7, 1.4.1.8, 1.7.1.3 and 1.7.1.5

Definitions of terms used in this quality statement

Infants and young children

NICE's guideline on atopic eczema in under 12s refers to a possible diagnosis of food allergy in infants and young children. The consensus of the quality standard Topic Expert Group is that this refers to children aged under 5 years. [Adapted from NICE's guideline on atopic eczema in under 12s, recommendation 1.3.1.1 and expert opinion]

Moderate or severe atopic eczema

NICE's guideline on atopic eczema in under 12s defines moderate and severe atopic eczema as follows:

  • Moderate: areas of dry skin, frequent itching, redness (with or without excoriation and localised skin thickening).

  • Severe: widespread areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation).

[Adapted from NICE's guideline on atopic eczema in under 12s, recommendation 1.2.1.1]

Optimal treatment

Optimal treatment for atopic eczema for infants and young children refers to the stepped-care plan. [Adapted from NICE's guideline on atopic eczema in under 12s, recommendation 1.5.1.1]

Specialist investigation

Referral for investigation into suspected food allergies may be to either a paediatric allergist or paediatric dermatologist, depending on the local availability of services. Other associated allergies (such as those to pollens or house dust mite) can also be investigated at the same time. Access to specialist allergy nurses and dietitians would normally be through the allergy team rather than a direct referral by a GP. [Expert opinion]