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The RCPCH care pathway for children with venom allergies: an evidence and consensus based national approach
  1. Nicola Brathwaite1,
  2. George du Toit2,
  3. Kate Lloydhope3,
  4. Louise Sinnott4,
  5. Debra Forster5,
  6. Moira Austin6,
  7. Christine Clark7,
  8. David Tuthill8,
  9. Jane Lucas9,
  10. John Warner10 on behalf of the Science and Research Department, Royal College of Paediatrics and Child Health*
  1. 1Paediatric Allergy, Department of Child Health, Kings College Hospital NHS Foundation Trust, London, UK
  2. 2Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3Science & Research Department, Royal College of Paediatrics and Child Health, London, UK
  4. 4North West Specialised Commissioning Team, Warrington, UK
  5. 5Children's Respiratory Service, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
  6. 6Anaphylaxis Campaign, Farnborough, UK
  7. 7Pharmacist, Manchester, UK
  8. 8Department of Paediatrics, Children's Hospital for Wales, Cardiff, UK
  9. 9Division of Infection Inflammation and Immunity, NIHR Respiratory Biomedical Research Unit, Sir Henry Wellcome Laboratories, School of Medicine, University of Southampton, Southampton, UK
  10. 10Department of Paediatrics, St Mary's Hospital Campus, Imperial College, London, UK
  1. Correspondence to Dr Nicola Brathwaite, Consultant Paediatric Allergist, Paediatric Allergy, Department of Child Health, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; nicola.brathwaite{at}


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

Method The RCPCH venom allergy pathway was developed by a multidisciplinary working group and was based on a comprehensive review of 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.

Results The pathway results are presented in four parts: evidence review, mapping, external review and core knowledge documents. The entry points are defined and the ideal pathway of care is described from self-care through to follow-up. The evidence highlighted that venom immunotherapy is safe and effective for bee and wasp allergy and that there are real quality of life benefits for patients. The review also highlighted the value of measuring serum tryptase after reactions.

Conclusions The venom allergy 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 should be implemented locally by a multidisciplinary team with a focus on creating networks between primary, secondary and tertiary care to improve services for children with allergic conditions.

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  • * Research and Policy Division, Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH, UK.

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

  • Competing interests GdT: Allergy Therapeutics and Nutrition SHS; DT: Nutricia, SMA; CC: Stiefel, Galderma, Almirall, Leo; JL: ALK; JW: Novartis, Danone, Airsonelte, Merck, Allergy Therapeutics, GSK, AstraZeneca, Airso.

  • Provenance and peer review Commissioned by Department of Health, UK; externally peer reviewed.