The Allergy Team

Most allergy clinics are in the larger hospital departments and may be run by several members of staff which can include:

• Paediatricians - children's doctors
• Allergists / immunologists - doctors who specialise in allergy / immunology, but not in paediatrics
• Paediatric allergists - specialists of allergy in children
• Allergy nurses - may carry out allergy tests and give information on allergy management
• Dietitians - advise on nutrition

The effects of allergy can often lead to symptoms which need to be treated before, or while, the underlying cause is investigated. For this reason, the doctors in an allergy clinic may seek out advice and opinions from other specialist doctors such as:

• Ear, Nose and Throat specialists
• Dermatologists - skin specialists
• Respiratory doctors - specialists in airway management
• Gastroenterologists - digestive specialists

It is important to remember that at the centre of the team managing your child’s allergy are you and your child. Your roles are vital in not only keeping up treatments, but also keeping track of how well symptoms are being controlled. Thinking ahead, and taking responsibility with your child for managing their allergies, will improve a child’s quality of life and also help them develop coping mechanisms and find ways of minimising symptoms.

GPs (General Practitioners)

GPs are central to our lives when it comes to our health. They should be the first person you speak to about allergy in children and, when seeking diagnosis and treatment, they are the people who can refer you to a specialist at an allergy clinic. GPs are also there to continue monitoring symptoms and treatments, and can provide help if symptoms increase and you need medical advice quickly.

Allergy symptoms can be elusive, and may no longer be apparent when you see the GP. Remember, you are best placed to outline what these symptoms are, how they affect your child and any ideas you might have about what is causing them. After all, you spend more time with them than anyone else. You might feel uncomfortable pushing for such information to be listened to if it appears that there is nothing ‘wrong’ with your child whilst actually at the consultation with the GP. Make a note of the symptoms when they happen and anything you feel is having an impact on your child’s quality of life, e.g. sleepless nights, irritation. If you notice a skin rash as part of the allergy, take a photograph (for instance, on your mobile phone) rather than trying to describe what it looks like.

There are allergy services available for all children, whatever their age, and all children, even small babies, can be allergy tested. Some GPs may not be aware of all the allergy clinics or services available. Allergy UK advisors can provide you with the details of your nearest allergy clinics and appropriate specialists. You can then take this information with you and ask your GP to refer you to one of these centres. This may be quite important if local facilities are not well equipped for dealing with allergy or complex needs.

Diagnosis and treatment can make a big difference to a child’s quality of life. These things should spur you on to get the help you and your child may need. Contact Allergy UK for more advice about gaining a referral for allergy diagnosis.

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Practice nurses

Most GP surgeries now hold regular asthma, eczema or child health clinics and these are usually run by the practice nurses with help from healthcare assistants. These clinics are held to support you and your child as well as for monitoring treatments. Staff may do health checks on your child’s general health and development to make sure that symptoms are not affecting these and that treatments are effective. Practice nurses can be very useful to answer questions if you are unsure about anything, and can also give training in how to use adrenaline auto-injector pens.

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Health visitors

Health visitors are trained nurses who work in the community with parents to keep children healthy; they run clinics and make home visits. All children are allocated a health visitor team at birth, and your health visitor can usually be contacted via your GP practice. As well as offering advice when a baby is born, about feeding, diet and skin care for instance, they can also support you in making decisions up to the time your child is five years old. They can be a valuable source of advice on whether treatments are working for your child or whether you need to return to your GP. If you are having difficulty in establishing treatment routines with your child, a health visitor can offer intensive support, visiting you as often as you need. Health visitors can play an important role in increasing the confidence of you and your child by knowing that there is someone ready to help you during this tricky time, and can also be available to you and your family as your child grows.

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Dietitians

If your child is diagnosed with an allergy to a major food group, you may need a referral to a dietitian for help. If this is not offered to you, ask for such a referral from your GP.

Dietitians are not the same as nutritionists. Dieticians study for a science degree in their subject and many have post-graduate qualifications and specialise in a certain area, just like doctors. Nutritionists are often self-taught and have an interest in ‘alternative’ or ‘complimentary’ therapies relating to food and food supplements.

When we think of a food allergy, we normally think about what foods a person cannot eat. Dietitians are incredibly knowledgeable and creative, and focus on helping you discover and use foods that your child CAN eat. This is important so that children do not end up on a very restricted diet which might not provide all they need for growth and development. Dietitians can give you valuable information and advice about menu planning, snacks and how to obtain special products, all of which can make a big difference to your child’s diet. They know more about what is on offer by way of replacement foods available on prescription (such as wheat-free pastas or egg substitutes) than other healthcare professionals. Using these can increase the variety and interest of a child’s diet. They will also make sure that the food your child can eat will provide all they need to grow and develop normally. For example, children with cows’ milk allergy may need calcium supplements; your dietitian will help decide whether this is needed.

You may also meet dietitians when visiting a specialist allergy clinic for testing if a food allergy is suspected. They are there to help supervise tests, such as challenge tests, and to advise people on links between diet and allergy and how to successfully navigate a new diagnosis of food allergy.

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Paediatricians

Paediatricians are doctors who have chosen to specialise in children’s health and so have an in-depth knowledge of children’s physiology from infants to teenagers. They are ideally placed to know how a child’s body responds to symptoms and medication and how children’s health and development changes from birth onwards. They can take this information into account when assessing a child’s condition and will understand from a child’s point of view, what impact symptoms can have.

Paediatricians often specialise in a particular area such as allergy. Your child may be referred to a paediatrician rather than a paediatric allergist.

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Paediatric allergists / immunologists

Allergists are central to the diagnosis and first steps to treatment on offer to your child. They work in hospitals alongside other specialists who have insight into aspects of allergy. This means that by being referred to an allergist, your child will have access to a range of different treatment options as well as a definitive diagnosis. With this diagnosis and treatment regimes, symptoms can be controlled effectively.

You may only see a hospital allergist a few times after diagnosis, but each time they will monitor and assess your child’s health and treatments. They are at the cutting edge of the latest research and ideas about allergy and its treatment so they are best placed for setting up the latest treatments and medications for your child.

If possible, ask to see a paediatric allergist, since these doctors specialise only in children’s allergies. Paediatric allergists have knowledge of how to understand and put children at their ease to get the best information from them about their condition, and also to encourage them to accept treatments. Since they are qualified in both child health and allergy, they are best equipped to prescribe and recommend treatments with a full and up-to-date understanding of issues around child health and development.

They usually work for the NHS in the larger teaching hospitals, but unfortunately there are very few of these in the country. Contact the Allergy UK helpline for more details of where these specialists are and how you can be referred to them.

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Allergy nurses

Allergy nurses work alongside allergists and immunologists who diagnose the allergic conditions. They often carry out the allergy tests that the allergist has specified, and can talk you and your child through the test as they do it. Skin prick testing and the measurement of peak flow (measuring the efficiency of breathing) are often performed by nurses.

The allergy nurse will be able to explain how to administer any medication, and is a good person to ask for advice if you find that any of the medication is difficult to use. They will often work with children to make sure that they are able to use inhalers correctly to ensure that they are being effective as a treatment, as well as providing instruction on how to administer adrenaline with an adrenaline auto-injector pen.

If there is anything that the allergist has said to you that you don’t understand, often the allergy nurse will be able to explain things further, and if you want advice on how to keep a symptom or treatment diary, then they will be able to help.

An allergy nurse will also talk to you about any worries you may have on how to manage the treatment plan that you have been set for your child. In addition, they can also advise on appropriate measures that you might take to try to reduce allergens around the home or avoid them elsewhere. They can often be contacted between appointments if you have a query or need additional support or advice. Most clinics will give you a contact telephone number.

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Other medical specialists

With certain allergies, it may be helpful to call on the expertise of other healthcare professionals. These can include:

• Ear, Nose and Throat (ENT) specialists
• Dermatologists – skin specialists
• Respiratory doctors – specialists in airway and breathing
• Gastroenterologists - digestive specialists

This may mean that you child needs to attend more than one clinic (for example dermatology and allergy clinic if they have allergies and a skin condition).