Summary of guidance relevant to general practice published in March 2011
- Food allergy in children
- Alcohol dependency
- Update to patient information on diarrhoea and vomiting in children
Diagnosis and assessment of food allergy in children and young people in primary care and community settings
The most common foods to which children and young people are allergic include cow's milk; fish and shellfish; hen's eggs; peanuts, tree nuts and sesame.
Food allergy should be considered if the child has one or a combination of the following, including:
- skin conditions such as eczema or acute urticaria
- respiratory complaints such as sneezing or shortness of breath
- gastrointestinal problems such as vomiting, difficulty swallowing or constipation
- anaphylaxis and other allergic reactions
- and also in those who are not adequately responding to treatment for atopic eczema, gastro-oesophageal reflux disease and chronic constipation.
An allergy-focused clinical history, tailored to the presenting symptoms and age of the child or young person should include:
- a family history of allergies, an
- assessment of the symptoms, and
- feeding history as an infant. A
- physical examination with particular attention to growth and physical signs of malnutrition.
IgE-mediated allergy (usually rapid onset) should be diagnosed using a skin prick test and/or blood tests for specific IgE antibodies to the suspected foods and likely co-allergens.
Non-IgE-mediated food allergy is suspected (generally characterised by delayed and non-acute reactions) introduce trial elimination of the suspected allergen (normally for 2-6 weeks) and reintroduction after the trial.
Alternative methods of diagnosis such as hair analysis and kinesiology are not recommended.
Refer to secondary care if the child has ongoing problems including faltering growth, vomiting, abdominal pain, loose or frequent stools, or constipation.
Support tools to help put this guidance into practice
We have produced a slide set , which you might find helpful when discussing this guideline in a practice meeting; a baseline assessment tool which can help to identify where you might need to change your clinical practice and audit support , including audit criteria and data collection sheets, to enable you to assess how well you are delivering the improvements NICE recommends.
You can also find a podcast about this guidance, on the NICE website, where Dr Adam Fox, Consultant in Paediatric Allergy at Guys and St Thomas' Hospital discusses the incidence and treatment of food allergies.
For full information about this guidance, and support from NICE for putting the guidance into practice, see www.nice.org.uk/guidance/CG116
Alcohol use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence
This guidance mainly applies to secondary care services and specialists, but GPs should be able to correctly assess patients' alcohol dependence into categories of mild, moderate and severe, and use validated screening questionnaires in adults and young people, aged 10-17, and using formal assessment tools such as AUDIT-C.
For full information about this guidance, and all the support tools from NICE, go to http://www.nice.org.uk/guidance/CG115
Please note that an amended version of the Understanding NICE guidance document (information for patients) is now available for the CG 84, Management of acute diarrhoea and vomiting due to gastroenteritis in children under 5. This version enhances the advice to parents and carers relating to action required when a child has bilious (green) vomit.
The amended version can be found on the NICE website here.
This page was last updated: 24 May 2011