Quality statement 1: Allergy‑focused clinical history

Quality statement

Children and young people with suspected food allergy have an allergy‑focused clinical history taken.

Rationale

Food allergy can be difficult to diagnose. An allergy‑focused clinical history is a key first step in the diagnosis and can help distinguish between IgE‑ and non‑IgE‑mediated reactions. It can help healthcare professionals decide which other tests are needed and how the food allergy should be managed.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that children and young people who present with signs or symptoms of suspected food allergy have an allergy‑focused clinical history taken.

Data source: Local data collection.

Process

Proportion of children and young people presenting with suspected food allergy who have an allergy‑focused clinical history taken.

Numerator – the number in the denominator who have an allergy‑focused clinical history taken.

Denominator – the number of children and young people presenting with suspected food allergy.

Data source: Local data collection.

Outcome

Identification of food allergy.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (such as primary care providers, emergency services and walk in centres) ensure that healthcare professionals can recognise the signs and symptoms of food allergy in children and young people and can take an allergy‑focused clinical history.

Healthcare professionals (such as GPs, dietitians, primary care nurses with training and skills in allergy, health visitors, emergency services staff) recognise the signs and symptoms of food allergy in children and young people and take an allergy‑focused clinical history as a key step towards diagnosis.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which healthcare professionals are able to recognise the signs and symptoms of food allergy in children and young people and take an allergy‑focused clinical history.

What the quality statement means for patients, service users and carers

Children and young people with signs and symptoms of food allergy (and their parents or carer if appropriate) are asked about symptoms and lifestyle to try to find out if they have a food allergy and what should happen next.

Source guidance

Food allergy in under 19s: assessment and diagnosis (2011) NICE guideline CG116, recommendation 1.1.3

Definitions of terms used in this quality statement

Allergy‑focused clinical history

An allergy‑focused clinical history should be taken by a healthcare professional with the appropriate competencies (either a GP or other healthcare professional such as a dietitian, primary care nurse or health visitor) and should be tailored to the presenting symptoms and age of the child or young person. It should include:

  • what the suspected allergen is

  • any personal history of atopic disease (asthma, eczema or allergic rhinitis)

  • any individual and family history of atopic disease (such as asthma, eczema or allergic rhinitis) or food allergy in parents or siblings

  • cultural and religious factors that affect the foods eaten

  • details of any foods that are avoided and the reasons why

  • who has raised the concern and suspects a food allergy

  • an assessment of presenting symptoms and other symptoms that may be associated with food allergy (see recommendation 1.1.1 in the NICE guideline on food allergy in under 19s), including questions about:

    • age when symptoms first started

    • speed of onset of symptoms after contact with the food

    • duration of symptoms

    • severity of reaction

    • frequency of occurrence

    • setting of reaction (for example, at school or home)

    • reproducibility of symptoms on repeated exposure, including whether common allergenic foods such as milk, eggs, peanuts, tree nuts, soy, wheat and seafood are usually eaten without symptoms happening

    • what food and how much exposure to it causes a reaction

  • details of any previous treatment, including medication, for the presenting symptoms and the response to this

  • any response to eliminating and reintroducing foods

  • the child or young person's dietary history, whether they were breastfed or formula-fed and the age of weaning

  • details of the mother's diet if the child is currently being breastfed.

[Adapted from NICE's guideline on food allergy in under 19s, recommendation 1.1.3]

Suspected food allergy

Recommendations 1.1.1 and 1.1.2 in the NICE guideline on food allergy in under 19s give details of the signs and symptoms that should lead healthcare professionals to suspect food allergy in a child or young person.

The NICE clinical knowledge summary on cows' milk protein allergy in children and the British Society of Allergy and Clinical Immunology's cow's milk allergy guideline give further guidance on when to suspect cows' milk allergy.

[Expert opinion]