Quality statement 4: Referral to secondary or specialist care

Quality statement

Children and young people are referred to secondary or specialist allergy care when indicated by their allergy‑focused clinical history or diagnostic testing.

Rationale

When indicated for children and young people, referral to secondary or specialist allergy care can lead to a confirmed diagnosis and can help to avoid prolonged anxiety about which foods are safe. It will also reduce the risk of further allergic reactions and nutritional problems because of inappropriate care.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that children and young people are referred to secondary or specialist allergy care if indicated by their allergy‑focused clinical history or diagnostic testing.

Data source: Local data collection.

Process

Proportion of children and young people who are referred to secondary or specialist allergy care if their allergy‑focused clinical history or diagnostic testing indicates a need for a referral.

Numerator – the number in the denominator who are referred to secondary or specialist allergy care.

Denominator – the number of children and young people who have an allergy‑focused clinical history or diagnostic testing that indicates a need for a referral to secondary or specialist allergy care.

Data source: Local data collection.

Outcome

a) Identification of food allergy.

Data source: Local data collection.

b) Children and young people with food allergy who feel, or whose families feel, able to manage their condition.

Data source: Local data collection.

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

Service providers (primary, community and secondary care providers) ensure that there are local arrangements for children and young people to be referred to secondary or specialist allergy care if this is indicated by their allergy‑focused clinical history or diagnostic testing. Liaison between primary care and local allergy services can establish agreed local pathways of care.

Healthcare professionals (such as GPs) refer children and young people to local secondary or specialist allergy care if this is indicated by their allergy‑focused clinical history or diagnostic testing.

Commissioners (clinical commissioning groups and NHS England) commission services with agreed local pathways to refer children and young people to secondary or specialist allergy care if this is indicated by their allergy‑focused clinical history or diagnostic testing.

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

Children and young people are offered a referral to a specialist if their symptoms or results of tests suggest that specialist opinion is needed to diagnose food allergy and find out the best treatment for them.

Source guidance

Food allergy in under 19s: assessment and diagnosis (2011) NICE guideline CG116, recommendation 1.1.17

Definitions of terms used in this quality statement

Indications for referral to secondary or specialist allergy care

Based on the allergy‑focused clinical history, referral to secondary or specialist allergy care should be considered in any of the following circumstances:

  • The child or young person has:

    • faltering growth in combination with one or more of the gastrointestinal symptoms described in recommendation 1.1.1 of the NICE guideline on food allergy in under 19s

    • not responded to a single‑allergen elimination diet

    • had 1 or more immediate systemic reactions

    • had 1 or more severe delayed reactions

    • confirmed IgE‑mediated food allergy and concurrent asthma

    • significant atopic eczema where multiple or cross‑reactive food allergies are suspected by the parent or carer.

  • There is:

    • persisting parental suspicion of food allergy (especially in children or young people with difficult or perplexing symptoms) despite a lack of supporting history

    • strong clinical suspicion of IgE‑mediated food allergy but allergy test results are negative

    • clinical suspicion of multiple food allergies.

[NICE's guideline on food allergy in under 19s, recommendation 1.1.17]

Secondary or specialist allergy care

Children and young people for whom referral is indicated need to be seen by allergy specialists with appropriate competencies. These will include professionals working in specialist allergy services and secondary care professionals who have expertise in food allergy in children and young people.

[Expert opinion]

Selecting the right allergy clinic is important because not all allergy clinics offer comprehensive services for food allergy and some see adults or children only. Details of local allergy services are available from the British Society for Allergy and Clinical Immunology or from the NHS website service search.

Equality and diversity considerations

When referring children and young people to specialist allergy clinics, any potential difficulties in access such as, travelling distance, disability or financial barriers should be taken into account.