First ever single guidance published for investigating and managing nut allergy

June 5, 2017

New comprehensive guidance for the diagnosis and management of peanut and tree nut allergy has been developed, which for the first time brings together the latest research and expert views into a single robustly written document. Patients will benefit from receiving the latest evidence based advice, including better understanding of risk assessment in order to reduce accidental reactions and manage reactions more effectively.

The guideline has been in the development process for five years and has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) the UK's leading organisation for healthcare professionals caring for patients with allergy. The guideline will be published in the journal Clinical & Experimental Allergy on Friday 2nd June, 2017.

How large a problem is nut allergy for people today?

Nut allergy is common in the UK and across the developed world, affecting at least 1 in 50 children and 1 in 200 adults. The majority do not outgrow their nut allergy, so the number of affected adults will increase. Nut allergy is the commonest cause of severe and . The fear of this has a significant psychological impact on patients and their families.

What resources are currently available?

The majority of health care professionals who look after nut allergic patients have received no formal training for this task. Nut allergy is a relatively new condition and medical education has yet to catch up, hence the care given to patients is inconsistent.

How will patients benefit from the new guideline?

This guideline brings together the latest research and expert views on all key aspects of the subject for the first time into a single robustly written document. Healthcare professionals can use the advice to raise the care of their patients to a national standard. Patients will benefit from receiving the latest evidence based advice, including better understanding of risk assessment to reduce accidental reactions, and the ability to manage reactions more effectively.

Dr Andrew Clark, Chair of the Standards of Care Committee of the BSACI said: "The Standards of Care Committee (SOCC) are excited about the forthcoming publication of the new nut allergy guideline. This guideline provides practical advice on all key areas, from diagnostic algorithms to treatment advice, and discussion of cutting edge issues such as component testing, precautionary labelling, challenges, early-life introduction and immunotherapy. This continues our pipeline of highly successful published guidelines, written by experts in the field, using rigorous NICE-accredited processes."

This guideline contains the latest thinking on all the key areas that healthcare professionals face every day when managing patients with nut allergy. Healthcare professionals can feel confident that it represents an exhaustive review of all the relevant literature, backed up by an expert writing group represented by key opinion leaders in the field.

Dr Shuaib Nasser, President of the BSACI said: "Nut allergy is a global disease affecting 2% of children and 0.5% of adults in the UK. The allergy is life-long in the majority and requires skilled management and advice. The British Society for Allergy and Clinical Immunology Standards of Care Committee have developed the first ever guideline for the investigation and management of children and adults with suspected nut allergy. The guidance has been written by experienced allergy experts and should provide a valuable resource for all those managing people with nut allergy both in the UK and worldwide."

Key guideline highlights:

  • Robust, up-to-date educational package based on extensive literature review, expert consensus and wide healthcare professional and public consultation. Allergy UK and the Anaphylaxis Campaign were consulted during preparation of the guideline ensuring a patient-centred approach.
  • Diagnostic algorithms and a detailed discussion of the utility of diagnostic tests will help diagnose accurately. This is essential to avoid patients being unnecessarily labelled nut allergic, but also helps individualise patient management for those at risk of future reactions.
  • The role of food challenges in diagnosis and exclusion of are defined, and an example challenge protocol is provided.
  • Comprehensive management plans including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication are described in detail.
  • The emerging area of peanut and nut IgE component testing is discussed, and advice is provided on the optimal tests to select.
  • More detailed advice than ever before is provided on counselling on everyday living, including reading ingredients labels, eating out and on holiday, avoiding one or all nut types, and avoiding nuts in school.
  • Key cutting edge areas are discussed in detail including early-life prevention, testing of siblings and immunotherapy.

Explore further: Expert panel issues clinical guidelines to prevent peanut allergy

More information: G. Stiefel et al. BSACI guideline for the diagnosis and management of peanut and tree nut allergy, Clinical & Experimental Allergy (2017). DOI: 10.1111/cea.12957

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