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The RCPCH care pathway for food allergy in children: an evidence and consensus based national approach
  1. Adam T Fox1,2,
  2. Kate Lloyd3,
  3. Peter D Arkwright4,
  4. Debi Bhattacharya5,
  5. Trevor Brown6,
  6. Philip Chetcuti7,
  7. Mandy East8,
  8. Jackie Gaventa9,
  9. Rosie King10,
  10. Ana Martinez11,
  11. Rosan Meyer12,
  12. Ami Parikh13,
  13. Michael Perkin2,
  14. Neil Shah14,
  15. David Tuthill15,
  16. Joanne Walsh16,
  17. Lisa Waddell17,
  18. John Warner18 on behalf of the Science and Research Department, Royal College of Paediatrics and Child Health
  1. 1Paediatric Allergy, St Thomas' Hospital, London, UK
  2. 2Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3Science and Research Department, Royal College of Paediatrics and Child Health, London, UK
  4. 4Paediatric Allergy, University of Manchester, Royal Manchester Children's Hospital, Manchester, UK
  5. 5Pharmacy, NHS Norfolk, Norwich, UK
  6. 6Paediatric Allergy, The Ulster Hospital, Dundonald, Belfast, UK
  7. 7Paediatrics, Leeds Children's Hospital, General Infirmary at Leeds, Leeds, UK
  8. 8Anaphylaxis Campaign, Farnborough, UK
  9. 9GOSH in Haringey, London, UK
  10. 10Department of Allergy, Southampton University Hospital NHS Trust, Southampton, UK
  11. 11Dermatology, Great Ormond Street Hospital, London, UK
  12. 12Dietetics, Imperial College NHS Healthcare Trust, London, UK
  13. 13Paediatric A&E, Royal London Hospital, London, UK
  14. 14Paediatric Gastroenterology, Great Ormond Street Hospital, London, UK
  15. 15Department of Paediatrics, Children's Hospital for Wales, University Hospital of Wales, Cardiff, UK
  16. 16Primary Care, Roundwell Medical Centre, Norwich, UK
  17. 17Nottingham Community Nutrition and Dietetic Service, CitiHealth, NHS Nottingham City, Nottingham, UK
  18. 18Department of Paediatrics, Imperial College, London, UK
  1. Correspondence to Adam T Fox, Paediatric Allergy, St Thomas' Hospital, London SE1 7EH, UK;{at}


Aims The Royal College of Paediatrics and Child Health (RCPCH) Science and Research Department was commissioned by the Department of Health to develop national care pathways for children with allergies; food allergy is the second pathway. The pathways focus on defining the competences required to improve the equity of care received by children with allergic conditions.

Method The food allergy pathway was developed by a multidisciplinary working group and was based on a comprehensive review of the evidence. The pathway was reviewed by a broad group of stakeholders including the public and approved by the Allergy Care Pathways Project Board and the RCPCH Clinical Standards Committee. The National Institute of Health and Clinical Excellence simultaneously established a short guideline review of community practice for children with food allergy; close communication was established between the two groups.

Results The results are presented in two sections: a pathway algorithm and the competences. The entry points are defined and the ideal pathway of care is described from initial recognition and confirmed diagnosis through to follow-up.

Conclusions The range of manifestations of food allergy/intolerance is much more diverse than hitherto recognised and diagnosis can be problematic as many patients do not have classical IgE mediated disease. The pathway provides a guide for training and development of services to facilitate improvements in delivery as close to the patient's home as possible. The authors recommend that this pathway is implemented locally by a multidisciplinary team with a focus on creating networks.

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  • Funding This project was funded by the Department of Health.

  • Competing interests TB: MSD-UK, GSK, ALK-Abello, MEAD Johnson, Danone (Nutricia), Astra-Zeneca, Allergy NI, Schering Plough; ME: Anaphylaxis Campaign; AF: SHS International (from 2007), Danone, Mead Johnson, Lactofree, MSD, Schering-Plough, Meda, GSK, Phadia, Dorling Kindersley, ALK-Abello, Anaphylaxis Campaign, Allergy UK, Nestle, Allergy Therapeutics,, MyFoodFacts; JG: Allergy UK, Nestle Nutrition Institute UK; NS: Nutricia; DT: Nutricia, SMA; JW: Novartis, Danone, Mead Johnson, Airsonette, Merck, Allergy Therapeutics, GSK, AstraZeneca.

  • Provenance and peer review Not commissioned; not externally peer reviewed.