Quality statement 3: Specialist assessment for venom immunotherapy

Quality statement

People who have a systemic reaction to wasp or bee stings are referred to a specialist allergy service to assess whether venom immunotherapy would be suitable.

Rationale

Venom allergy from bees and wasps accounts for approximately a quarter of adult cases of anaphylaxis of known cause. Venom immunotherapy can reduce the risk and severity of systemic reactions. Ensuring that people who could benefit from venom immunotherapy are assessed for this treatment will help to improve uptake and reduce the incidence of venom‑induced anaphylaxis.

Quality measures

Structure

Evidence of local arrangements and written protocols to ensure that people who have a systemic reaction to wasp or bee stings are referred to a specialist allergy service to assess whether venom immunotherapy would be suitable.

Data source: Local data collection.

Process

Proportion of people who have a systemic reaction to a wasp or bee sting who are referred to a specialist allergy service to assess whether venom immunotherapy would be suitable.

Numerator – the number in the denominator who are referred to a specialist allergy service to assess whether venom immunotherapy would be suitable.

Denominator – the number of people presenting with a systemic reaction to a wasp or bee sting.

Data source: Local data collection.

Outcome

a) Prescriptions of venom immunotherapy.

Data source: Local data collection.

b) Incidence of venom‑induced anaphylaxis.

Data source: Local data collection.

c) People feel able to manage their condition after treatment for anaphylaxis caused by a wasp or bee sting.

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 departments and specialist allergy services) ensure that there are agreed local pathways in place for people who have a systemic reaction to a wasp or bee sting to be referred to a specialist allergy service for assessment for possible venom immunotherapy. Venom immunotherapy should be offered when suitable as part of the local pathway.

Healthcare professionals (such as GPs and emergency department staff) refer people who have a systemic reaction to a wasp or bee sting to a specialist allergy service for assessment. Healthcare professionals at specialist allergy services assess whether venom immunotherapy is suitable for people referred to them and offer venom immunotherapy if it is suitable.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission specialist allergy services that can offer venom immunotherapy, and that there are agreed local pathways in place for people who have a systemic reaction to a wasp or bee sting to be referred to these services for assessment and treatment.

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

People who have a severe reaction to a bee or wasp sting are offered an appointment at a specialist allergy service to check if they would benefit from treatment (called venom immunotherapy) that can reduce the risk of future reactions to bee or wasp stings.

Source guidance

Definitions of terms used in this quality statement

Specialist allergy service

A service consisting of healthcare professionals with the skills and competencies needed to accurately investigate, diagnose, monitor and provide ongoing management of, and patient education about, suspected anaphylaxis. The service should be age‑appropriate if possible.

[Anaphylaxis: assessment and referral after emergency treatment (NICE guideline CG134) recommendation 1.1.9]

Details of local allergy services are available from the British Society for Allergy and Clinical Immunology (BSACI) including information on services with expertise in particular allergies, such as food, drug or venom allergies or from NHS Choices. The BSACI website can also be used to find allergy services with appropriate expertise to deal with a particular allergy (for example food, drug, venom allergy).

[Expert opinion]

Assessment for venom immunotherapy

A number of criteria are evaluated before giving venom immunotherapy, to identify whether the treatment is safe and appropriate. NICE's guidance on pharmalgen for the treatment of bee and wasp venom allergy (TA246) and the British Society for Allergy and Clinical Immunology's guidelines on the diagnosis and management of hymenoptera venom allergy provide criteria for assessment for venom immunotherapy.

[Expert opinion]

Venom immunotherapy should be carried out only by allergy specialists with experience and knowledge in this field and in centres undertaking venom immunotherapy in significant numbers of patients and where the team has expertise in treating anaphylaxis.

[Diagnosis and management of hymenoptera venom allergy (2011) British Society for Allergy and Clinical Immunology (BSACI) guidelines]

Equality and diversity considerations

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