Introduction

This quality standard covers the diagnosis, assessment and management of food allergy in children, young people and adults. Children and young people are those aged under 19. For more information see the food allergy and anaphylaxis topic overview.

NICE quality standards focus on aspects of health and social care that are commissioned locally. Areas of national policy, such as national training standards, are therefore not covered by this quality standard.

Why this quality standard is needed

Food allergy has been defined as 'an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food'[1]. It can be classified into IgE‑mediated and non‑IgE‑mediated reactions (although some responses can involve both types). IgE‑mediated reactions (difficulty swallowing or feeling sick or vomiting) are often immediate and have a rapid onset whereas non‑IgE‑mediated reactions (redness and itchiness of the skin or heartburn) are generally characterised by delayed reactions. Food allergy can be difficult to diagnose and is often confused with food intolerance (a non‑immune reaction that can be caused by metabolic, pharmacological, toxic and undefined mechanisms).

Food allergy is one of the most common types of allergy and is a major health problem in Western countries. This is because of the potential severity of the allergic reactions (which can be life threatening if not treated quickly) and a dramatic increase in their prevalence. The NICE guideline on food allergy in under 19s states that the prevalence of food allergy in children under 3 years in Europe and North America ranges from 6% to 8%.

The quality standard is expected to contribute to improvements in the following outcomes:

  • health‑related quality of life for people with food allergy and their families

  • recognition and diagnosis of food allergy.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experience and effectiveness of care – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

4b Patient experience of hospital care

4c Friends and family test

4d Patient experience characterised as poor or worse

i Primary care

ii Hospital care

Improvement areas

Improving people's experience of outpatient care

4.1 Patient experience of outpatient services

Improving access to primary care services

4.4 Access to i GP services

Alignment with Public Health Outcomes Framework

** Indicator is complementary

Indicators in italics in development

Table 2 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

1 Improving the wider determinants of health

Objective

Improvements against wider factors that affect health and wellbeing and health inequalities

Indicators

1.3 Pupil absence

1.9 Sickness absence rate

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

4.3 Mortality rate from causes considered preventable**

Alignment with NHS Outcomes Framework

** Indicator is complementary

Safety and people's experience of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to food allergy.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE Pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to people using services. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for food allergy specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole food allergy care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to people with food allergy.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality food allergy service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating people with food allergy should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with food allergy. If appropriate, healthcare practitioners should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.



[1] Boyce JA, Assa'ad A, Burks AW, et al. (2010) Guidelines for the diagnosis and management of food allergy in the United States. Journal of Allergy and Clinical Immunology 126: S1–58