Clinical Allergy

COVID-19/Coronavirus

This is a fast moving situation and we will try and update this website with relevant new information as it becomes available. All non-urgent outpatient clinics and much day-case activity (e.g. Omalizumab injections/allergy desensitisation/allergy challenges) have been cancelled due to the coronavirus pandemic. Depending on the availability of staff due to redeployment to other departments and sickness, we may be able to provide a limited service. This will generally be over the phone, video call or in exceptional circumstances in person. If patients have had an appointment cancelled then patients can expect to receive a new appointment after normal services resume. Patients should please contact the department on 0117 4148392 or 0117 4148393, or at allergyandimmunology@nbt.nhs.uk if they feel that their medical problem is urgent.

Information on allergies/COVID-19 is available from a patient organisation called Allergy UK at https://www.allergyuk.org/. The BSACI (British Society for Allergy and Clinical Immunology) have made recommendations for modifications to adult allergy services during the COVID-19 pandemic which is accessible at https://www.bsaci.org/announcements/modifications-for-adult-allergy-services-during-covid-19-pandemic and our actions in relation to our service are in keeping with this advice. Information for patients on Omalizumab from the British Association of Dermatologists may be found at https://www.bad.org.uk/shared/get-file.ashx?itemtype=document&id=6659.

Please access the government coronavirus website for general information and recommendations on coronavirus at https://www.gov.uk/coronavirus.

Clinical Allergy Service

We run regular Adult Allergy (and Immunology/Immunodeficiency) clinics on Tuesday mornings, Thursday afternoons, and all day Friday seeing patients referred (see Patient Referral Pathways) to our service with suspected or confirmed allergic disease. Criteria and advice for whom to refer can be found on the Remedy website at https://remedy.bnssgccg.nhs.uk/media/1337/immunology-referral-guidance.pdf. We see patients in our Adult Allergy service with the following conditions:

  • Anaphylaxis
  • Uncontrolled rhinitis (e.g. hayfever)
  • Bee or wasp allergy
  • Drug and anaesthetic allergy
  • Food allergy
  • Urticaria and/or angioedema
  • C1 esterase inhibitor deficiency (Hereditary Angioedema)

Please note we do not see patients for:

  1. “Patch testing” (e.g. for eczema, contact hypersensitivity) – please refer to Dermatology.
  2. Lactose or food “intolerance” as we do not have expertise in these conditions.
  3. Myalgic encephalomyelitis (ME), chronic fatigue, or fibromyalgia as we do not have expertise in these conditions.
  4. Mast cell activation disorders as we do not have expertise in the management of these conditions.

Our service also performs:

  • Sublingual and subcutaneous desensitisation
  • Omalizumab injections for chronic spontaneous urticaria
  • Drug and food allergy challenges
  • Drug desensitisation

Alert: Emerade autoinjectors recall

The below message is relevant to patients and for carers of patients who carry an Emerade adrenaline autoinjector. We have also written to all GP practices we have on our database and patients for whom we have a record of having prescribed an adrenaline autoinjector in approximately the last 5 years.

This alert refers to two drug alerts which have been raised by the Medicines and Healthcare products Regulatory Agency (MHRA) on 4th March 2020 and 7th April 2020, about the Emerade 150, 300 and 500 microgram pre-filled adrenaline autoinjectors. These can be viewed at:

Testing of all strengths of Emerade autoinjectors (150, 300 and 500 mcg doses) indicate that approximately 13% of pens need higher than normal force to activate, implying a higher risk of activation failure than was previously understood. The two recent drug alerts recommend recall of all 150 and 300 mcg Emerade autoinjectors and replacement with an alternative adrenaline autoinjector brand (e.g. Jext or Epipen). Patients should contact the prescriber of their Emerade autoinjector to arrange this. GPs should inform patients of this alert and arrange for replacement of their Emerade adrenaline autoinjectors. 500mcg Emerade autoinjectors are not to be recalled at this time due to a lack of supplies of alternative brands – please see paragraph below. Appropriate training in alternative adrenaline autoinjectors should be provided (in person, with product instructions leaflet, or online (on the manufacturer’s website)). Obtaining a ‘trainer pen’ free of charge from the manufacturer website is encouraged. Old 150 and 300 mcg Emerade autoinjectors should be returned to pharmacies after obtaining alternatives, but patients should not break self-isolation to do so.

If patients carry a 500 mcg Emerade autoinjector then patients should continue to carry two in-date autoinjectors of this type at all times. Patients should avoid exposing Emerade autoinjectors to temperatures higher than 25oC, as these temperatures are thought to contribute to autoinjector failure. If a 500mcg Emerade autoinjector does not activate then patients should immediately use their second Emerade autoinjector. Patients can tell if an Emerade autoinjector has activated as the needle cover (plastic tube) will extend to cover an activated needle following administration – see ‘500mcg patient letter’ link below. If patients are not improving and a second dose is needed, then patients should keep trying to use the failed Emerade autoinjector. When 500mcg Emerade autoinjectors expire then consideration should be given to replacement with an alternative brand, with appropriate training in use.

Patient information may be obtained at the following links for Emerade autoinjectors:

 

Last updated 13/05/2020