Paediatric Allergy Service

We currently have multi-disciplinary allergy clinics Monday to Friday located both at Starlight Outpatients in Homerton Hospital, Hackney and the Sir Ludwig Guttman Centre, Stratford. Furthermore, we have additional nurse-led clinics and dietician clinics running regularly. 

Our team also run transitional clinics with our adult allergy colleagues in order to offer optimum care for the adolescent age group with more complex allergy conditions and thereby providing continuation of care throughout this service.

Before the appointment

Any children 16 years and under must be accompanied by their parent or guardian. Antihistamine medications such as piriton, cetirizine, loratadine and fexofenadine should be stopped at least 3 days before attending the appointment as they will affect allergy tests and may cause incorrect results. Please note that some cough and cold medicines may also contain antihistamine. All other medications such as inhalers, nasal sprays, eye drops, creams etc can be continued. Please bring all regular medications with you to the clinic. 

We request that you also bring photographs of any visible symptoms such as skin rash, swelling or hives to the appointment as this will help us to take a more accurate history. You should also make note of the foods, medicines or other products that you think may be causing allergic reactions so that the team can perform accurate testing. 

During the appointment

Please ensure that you arrive on time for the appointment. Our patients usually see multiple members of the team on the day so the appointment can last up to 2 hours. You will initially have a consultation with the doctor who will take a detailed history of allergy symptoms and what may be triggering them. This is usually followed by an allergy test which helps to formulate a diagnosis. The two main types of tests are:

Skin prick tests: an allergy test which can tell us how likely your child is to be allergic to specific allergens (foods, pollens or other substances). It is a very safe procedure usually carried out by the clinical nurse specialist. We place tiny drops of extract allergen solution (or fresh foods) onto the skin of the forearm and touch the skin gently with the tip of a small lancet. This may feel a little sharp but is usually not painful. If testing is positive, the skin will develop a raised itchy wheal within 15 minutes. The size of the wheal is then measured and interpreted. There may be the odd occasion where we do not have a certain food available- in this case the team may request that you bring a small quantity of that particular food for testing. 

Blood tests: can be used to measure the level of antibodies produced by the body’s immune system against many specific allergens. This can be useful if skin prick testing is not possible. In some cases, we may decide to carry out a blood test as well as skin prick testing to make a more detailed assessment. Blood tests are carried out by trained professionals. We will offer cold spray to numb the area of skin before the blood test.

Once testing is completed the team will offer advice, such as allergy management on how to recognise and treat both mild-moderate and severe reactions (anaphylaxis). This includes education on how to take antihistamines and the use of adrenaline auto-injectors (e.g. EpiPen). Please note that not every child with a food allergy will be prescribed an adrenaline autoinjector, as this depends on certain risk factors which will be assessed by the doctor on the day. We also provide information on allergen avoidance, asthma education, use of inhalers/ spacers, management of allergic rhinitis, use of nasal sprays and eczema management. 

For children who have allergic asthma, our service runs a weekly clinic with the respiratory nurse who will carry out extra investigations including spirometry (lung function tests) and Fractional Exhaled Nitric Oxide (FeNO), which measures the amount of inflammation in an airway. 

Following this, the allergy dietician may provide dietary support to children and their families, such as: advice on avoidance of foods that your child is allergic to, offering information on having a balanced diet to maintain nutritional needs and where appropriate home introduction of foods that your child is not allergic to. 

After the appointment

If food allergies are identified, the child and their family will be supplied with an Allergy Action Plan to give to the nursery/ school. Our team will also write a letter to the GP with details of the consultation, treatment plan and medications that will need to be supplied. Occasionally, parents/carers may also be given a prescription (FP10) for any medications required and these can be dispensed by any pharmacy outside the hospital. 

Following the consultation, the doctor will decide if another appointment is needed. If children require further investigations or treatment such as an allergy challenge or immunotherapy, the allergy team will liaise with our admin team to organise an appointment for this. We would highly recommend that all personal information such as correspondence address, phone numbers, email address and GP details are verified with the Outpatients reception team on the day of the appointment. 

If you need to cancel or reschedule the appointment, please call our bookings team as soon as possible.

Immunotherapy treatment

Immunotherapy is a desensitisation treatment that we offer to children who have severe, troublesome allergic rhinitis where optimal medical treatment has not worked. Any child who is referred to our immunotherapy service will be assessed by the allergy consultant and clinical nurse specialist to see if they are suitable. Currently we run immunotherapy clinics every Monday afternoon in Starlight Outpatients. 

We offer immunotherapy for the following specific allergens:

•    house dust mite
•    grass pollen
•    tree pollen

Immunotherapy is administered either by a subcutaneous injection or sublingually (orally under the tongue). The benefits for each route will be explained by our team and ultimately the choice in treatment will be one that is suitable for the child and their family. The immunotherapy is initiated in our clinic and does require regular visits to the hospital over a course of 3 years to achieve maximum benefit from the treatment. 

There are some common side-effects to immunotherapy, such as itching and swelling on the arm (subcutaneous) and tingling of the mouth/ tongue (sublingual). This is usually treated with antihistamines and is quite manageable. On extremely rare occasions, immunotherapy could result in more serious reactions which would be managed by our very experienced team in the hospital. 

To experience the full benefits from immunotherapy, it is very important that the child and family remain compliant throughout the course of treatment. For more information, please visit our Patient Leaflets section.

Omalizumab treatment

Omalizumab is an anti-IgE treatment that we offer to children who have persistent chronic spontaneous urticaria (hives) and angioedema (swelling), where optimal medical treatment has not worked. Currently we run Omalizumab clinics alongside our Immunotherapy service every Monday afternoon in Starlight Outpatients.

Chronic spontaneous urticaria and angioedema are hives and swelling that are caused by an immune response. There are certain triggers that can also cause flare ups including: hot/ cold temperatures, pressure on the skin or strenuous exercise. Usually this is treated with regular antihistamine and in some cases other immunosuppressive medications. However, for those children who symptoms do not improve with this treatment, they may be referred to our Omalizumab service. 

Omalizumab is a pre-filled subcutaneous injection that is administered every 2-4 weeks. It works by targeting certain antibodies of the immune system (immunoglobulin IgE) and suppressing it to help reduce hive and swelling symptoms. Usually, treatment is administered for at least 16 weeks, where the allergy team will then re-review your child to see if the treatment continues or stops. 

There are some common side-effects to Omalizumab including headaches or localised pain/ swelling where we give the injection. In rare occasions there is also a risk of mild-moderate and severe allergic reactions, which the team will treat appropriately.

To experience the full benefits from Omalizumab, it is very important that the child and family attend all hospital appointments. The child will also be given an urticaria activity score diary, which must be completed whilst at home.

A food/ drug challenge is the gold standard procedure to confirm if a child is allergic to a certain food/ medicine. This involves the child and their parent/carer attending Starlight Inpatient Ward for half a day and having that food/medicine under hospital supervision. Currently the team runs allergy challenges on alternate Monday and Tuesday mornings. 

For food challenges the team generally gives multiple portions of food (starting off with a small amount and increasing every 20 minutes). For drug challenges this may be done as a single dose or multiple incremental doses (similar to a food challenge). 

There are many benefits to carrying out a challenge, including:

•    safely finding out if your child can have that food or medicine
•    if the child passes a food challenge, then their diet becomes less restrictive 
•    reducing the concern around having an allergic reaction

There is a risk that your child may have an allergic reaction during the challenge, which is why we carry it out in hospital. This includes:

•    the more common mild-moderate symptoms, such as rash, hives, stomach-ache, vomiting, sneezing or a runny nose. In this case the child would not eat anymore of the challenge food and will be given antihistamine to treat this
•    in rare cases, allergic reactions may be more severe i.e. anaphylaxis. This includes coughing, wheezing, difficulty in breathing, becoming sleepy or floppy. In this case, the team would treat with an adrenaline autoinjector, e.g. EpiPen. 

If the child has any allergic reaction, they will need to stay longer in the hospital until they are well enough to go home. This usually does not involve an overnight stay. 

For more information, please visit our Patient Information section.

Consultants
Dr Rajiv Sood- Consultant Paediatrician & Allergist; Lead for Paediatric Allergy
Dr Tammy Rothenberg- Consultant Paediatrician & Allergist
Dr Sanjay Wazir- Consultant Paediatrician with interest in Allergy; Associate Medical Director
Dr Lucia Re Ferre- Consultant Paediatrician with interest in Allergy, Clinical Lead for Acute General Paediatrics

Nurses
Yvette Oppong-Kwarteng - Clinical Nurse Specialist
Juli Khatun- Clinical Nurse Specialist
Joyce D’Cruz- Paediatric Nurse with interest in Allergy 

Dieticians
Yvonne Polydoru- Paediatric Allergy Specialist Dietitian
 

Useful websites

Allergy UK
Anaphylaxis Campaign
Asthma UK
National Eczema society 
Itchy Sneezy Wheezy
Allergy Support group
Beat Anaphylaxis

Patient leaflets

Children's health - Food-Challenges
Immunotherapy Allergy UK.pdf