Aims Allergic disease is common: 25% of patients registered in General Practice (GP) are affected, and 11% have multiple allergic conditions. We previously found that only 7% of GP referral letters to paediatric allergy services reflected complexity of allergic disease, leaving many children undertreated. Following the implementation of the RCPCH Allergy Care Pathways as part of the Itchy-Sneezy-Wheezy Project from 2010 (www.itchysneezywheezy.co.uk), we hypothesised, that local referral practice may have changed.
Methods Retrospective survey of 100 successive GP referral letters to a paediatric allergy clinic between March and August 2013, recording referral reason, pre-/co-existing allergic diagnoses, and any treatment offered. Findings from the first clinic letter also reviewed, diagnoses and treatments recorded. Comparison between referral and first clinic letter.
Results Overall, 106 main referral reasons were identified in 100 letters. Referral reasons included: Food allergy (55/100; 55%), eczema (16%), other allergy (11%), rash (8%), urticaria (4%), asthma (2%), allergic rhinitis (2%) and gastrointestinal problems (2%). GP referral letters suggested that 63% of patients had one allergic condition, 29% had two, 7% had three and 1% had more than three allergic conditions.
At first allergy assessment diagnoses included: Food allergy (71% vs. 55% mentioned in GP referral letter), eczema (57% vs. 16%), allergic rhinitis (30% vs. 2%), asthma (15% vs. 2%), gastrointestinal problems (20% vs. 2%) and other allergy (40% vs. 11%); non-allergic findings 13% vs 1%.
Higher disease complexity was found in clinic: Only 21% of patients had one, 25% had two, 33% had three and 21% had >3 allergic conditions. Multiple food allergies were diagnosed in 49/100 (49%); 32/49 had ≥3 food allergies.
Conditions appeared undertreated prior to referral, with 56% of patients not having received treatment (13% left clinic without medication).
Overall analysis indicated that 31% of GP referral letters reflected complexity of allergic disease, whereas 69% did not.
Conclusion Compared with previous results, allergic co-morbidities are better recognised but conditions still appear undertreated (based on information given in referral letters and medication prescribed from clinic). The improved local training and awareness following the Itchy-Sneezy-Wheezy Project may have resulted in this benefit, but more awareness and training are required.
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