Allergy service

We accept referrals from GPs and general paediatricians via the NHS e-Referral Service.

At the children’s allergy clinic, we offer expert advice, assessment, access to diagnostic testing and practical help from our multidisciplinary team.

We try and see your child in a ‘one stop clinic’, which includes taking a full health history, examination, allergy tests, providing education and seeing a dietitian when needed.

Your journey through our department is likely to take time, so please allow two to three hours for your appointment.

Allergy test results for most patients are available and discussed with you during the first appointment.

After a diagnosis has been made, we will provide an individual allergy management plan for you and your child, which will be shared with your GP. You can choose to share this plan with your child’s school, nursery or childcare provider. 

At the appointment, you will also meet our nurses who are trained in allergy and respiratory disease. They provide:

• diagnostic procedures (skin prick testing) 
• training in the use of inhalers, nasal sprays and adrenaline auto injectors, such as an EpiPen
• asthma and eczema management
• allergen avoidance information and management of allergic reactions
• support during day case admissions for food challenges
• appropriate on-going educational support and programmes

Research

Research is very important in improving the care of children with allergies, and we often undertake allergy research within the department.

The details of any research will be explained to you if you are interested. Taking part in research is completely voluntary and your child will get the same care if you choose not to take part.

The allergy nurse will often perform skin allergy testing on your child. Please note, this is not a blood test and no needles or syringes are used.

The test involves very superficial pin pricking of the skin, with minimal pain. The test is well tolerated by most children.

In order that your child can have allergy testing (skin prick testing), please stop all antihistamine medication four days prior to your clinic appointment if possible.

Please bring the following to the appointment:

1. Any medicines that your child is taking.
2. Any letters from any other clinics or specialists.
3. Your child’s health record (red book).
4. A small sample of any fruits or vegetables to which your child may be allergic.
5. Any photos or mobile phone images of rashes etc.

For more information about allergy testing prior to your appointment, please call the allergy nurses:

Barnet Hospital: 020 8216 4906
Royal Free Hospital: 020 7830 2001

A food challenge test is the best way to confirm a food allergy or to see if your child has outgrown a food allergy. 

Small amounts of the challenge food are given at set times. We begin by offering a very small amount of the food.

If no reactions are observed your child will be given increasing amounts of the food over a period of time, until a standard portion size is eaten.

If any reaction is seen the challenge will be stopped and appropriate medication given.

Challenge tests are always performed under close supervision of specialist nurses.

How long will a food challenge take?

A food challenge usually lasts approximately four to five hours, however, it may take longer particularly if your child has difficulty eating the challenge food or has a reaction.

It is therefore best to make provision for the entire day and make alternative arrangements for siblings to be collected from school. A parent will need to be present for the duration of the challenge.

What should I bring?

Please remember to bring the food to be 'challenged’ as specified in your appointment letter.

For egg and milk challenges, we have some recipes you can try further down this page.

Your child should have a light breakfast on the morning of their appointment, and you may bring drinks, snacks or a packed lunch but please ensure that you only bring foods that your child has safely eaten before. 

No other foods are to be consumed in the early stages of the challenge.

Your healthcare professional will advise regarding when your child may have snacks/lunch.

Feel free to bring any books, games or magazines for your child to entertain themselves. We also have many toys/activities that can be provided by our play specialists.

What happens after a food challenge?

If a reaction has occurred, a doctor will decide when your child is well enough to go home.

Very rarely a child will experience a delayed reaction, this may include an eczema flare or gastrointestinal symptoms. You will be given information on how to respond to a delayed reaction prior to going home.

Antihistamines and other medication

Your child should stop taking any antihistamine medicines five days prior to the food challenge. Antihistimines include:

• zirtek (cetirizine)
• piriton (chlorphenamine)
• clarityn (loratidine)

Antihistamines can also be found in some cough medicines and ‘cold remedies’. These should also be stopped prior to the challenge. Please check the medicine label.

It is not necessary to stop asthma inhalers or nasal sprays that are regularly taken.

Please contact the allergy nurses if you need any more information prior to the challenge day:

Barnet Hospital: 020 8216 4906
Royal Free Hospital: 020 7830 2001

Sponge fairy cakes

Ingredients

(Makes eight fairy cakes)

• 125g/4oz self-raising flour
• 125g/4oz margarine (use milk-free margarine if milk allergy)
• 125g/4oz caster sugar
• 1 or 2 medium eggs (depending on the allergy team’s specific recommendations for your child)

Method

1. Preheat the oven to 180C/350F/Gas 4. 
2. Cream the margarine and the sugar together until light and fluffy.
3. Add the whisked egg to the mixture. Slowly fold in the self-raising flour
4. Add a small amount of milk (soya/rice milk where necessary) if the mixture appears too thick.
5. Spoon the mixture into paper cases sitting in a bun tin.
6. Cook for approximately 15 minutes until risen and bouncy to touch.

Recipe variation

Wheat-free: use 125g/4oz wheat-free self-raising flour such as Dove’s Farm or Orgran instead of wheat flour

Chocolate flavour: replace 28g/1oz flour with cocoa powder*

Strawberry flavour: add a few drops of strawberry flavouring* and red food colouring*

Icing can be made as an accompaniment and not spread on the cakes before the food challenge:

• Chocolate: 75g/3oz icing sugar + 3 teaspoons cocoa powder*
• Strawberry: 75g/3oz icing sugar + 2 drops of strawberry flavouring* and 2 drops of red food colouring*

Add a few drops of water to make a smooth and glossy paste.

*Only use cocoa powder and/or strawberry flavouring and red food colouring if you child has previously eaten and tolerated them.

Our paediatric asthma service sees children and young people for the diagnosis and management of asthma and viral induced wheeze (where the chest becomes wheezy and feels tight when the child has a cough, cold or chest infection).

Holistic care is provided by doctors and nurses for the physical aspects of asthma and the emotional and social impact on the child and their family.

We see children and young people to diagnose asthma, treat those with difficult and poorly controlled asthma and consider alternative diagnoses for those with chronic respiratory symptoms.

Diagnosing and monitoring your asthma

We carry out several tests to diagnose and monitor asthma, as follows:

• Peak flow: blowing as hard as you can into a handheld device to see how quickly you can blow air out of your lungs. This test is only suitable for children older than six years of age.
• FeNO (fractional exhaled nitric oxide): to measure the levels of nitric oxide in your breath. High levels could be a sign that you have inflamed airways. This test is only suitable for children older than six years of age.
• Spirometry: a breathing test that measures the amount (volume) of air you can blow out of your lungs. This test is only suitable for children older than five years of age.
• Skin prick tests for aeroallergens, such as pollens, moulds, dust mites and animal fur.

As part of your care, you will be given an asthma action plan and a six to 12-monthly review as required.

For children with difficult to manage asthma, we liaise and have shared care with Great Ormond Street Hospital and Royal Brompton Hospital. We also work with adult respiratory services to ensure a smooth transition to adult services for our patients.