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News - March 2011

Contents

NICE releases advice on diagnosis of food allergy in children

Food allergies are a major paediatric health problem in western countries. In the UK, there is considerable variation in current practice for allergy care, with no agreed treatment pathways, referral criteria, or service models. NICE has published a guideline on food allergy in children and young people, with the aim of improving consistency in the assessment and diagnostic process of this disorder.

Food allergy in children can manifest itself in a range of symptoms and particular attention should be paid to those that are persistent and which involve different organ systems. If food allergy is suspected, an appropriately trained healthcare professional should take an allergy centred clinical history that is tailored to the presenting symptoms and age of the patient. This should include:

  • personal and family history of atopic disease and food allergy
  • assessment of the symptoms
  • details of any foods that are avoided and reasons why feeding history as an infant.

Special consideration should be given to growth, physical signs of malnutrition, and signs indicative of allergy related co‑morbidities during a physical examination.

Diagnosis of IgE‑mediated food allergy involves a skin prick test and/or blood tests for specific IgE antibodies to the suspected foods and likely co‑allergens. If non‑IgE‑mediated food allergy is suspected, a trial elimination of the suspected allergen (4–6 weeks) and reintroduction can be tried.

The following methods are not recommended for use in the diagnosis of food allergy:

  • the vega test
  • applied kinesiology
  • hair analysis.

It is important to provide age‑appropriate information to the child and their parent or carer based on the:

  • type of allergy suspected
  • risk of severe allergic reaction
  • potential impact of the suspected allergy on other healthcare issues
  • diagnostic process (e.g. elimination diet, initial food reintroduction procedure).

The NICE recommendations also provide guidance on when a child or young person should be referred to secondary or specialist care.
www.nice.org.uk

Guideline on alcohol-use disorders published by NICE

Alcohol dependence and harmful drinking are associated with many physical and psychological problems and can also be linked to increased criminal activity and domestic violence. Over 1 million people are dependent on alcohol yet only 6% of them are receiving treatment. This can partly be attributed to healthcare and social care professionals not identifying those in need of treatment, and assisted withdrawal treatments being inadequate. In response to this, NICE has released Clinical Guideline 115 on Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, to help address the variations that exist in clinical practice.

The guideline recommends that all relevant healthcare and social care professionals identify people who could be misusing alcohol through clinical interviews and assessment tools such as the AUDIT and SADQ. These will help healthcare professionals make an accurate diagnosis of the severity of the condition and allow the appropriate treatment options to be offered.

The guideline also includes recommendations on:

  • working with and supporting families and carers
  • assessment in specialist alcohol services
  • drug regimens for assisted withdrawal
  • special considerations for children and young people who misuse alcohol.

The guideline is one of three pieces of NICE guidance addressing alcohol-related problems and should be read in conjunction with Public Health Guidance 24 and Clinical Guideline 100.
www.nice.org.uk

Guideline on management of early RA published by SIGN

SIGN has published a new guideline on Management of early rheumatoid arthritis. Early diagnosis and treatment of this condition can reduce disease progression and help affected patients to maintain a good quality of life. The guideline defines early rheumatoid arthritis (RA) as ≤5 years from symptom onset. Principles of management include:

  • patient education
  • multidisciplinary teamworking
  • early treatment
  • assessment of disease activity (using a standardised scoring system such as disease activity score [DAS] or DAS28) treat to target.

A key message from the guidance is that patients with suspected inflammatory joint disease should be referred to a specialist as soon as possible. The SIGN guideline makes a number of recommendations on the pharmacological management of early RA including:

  • prescription of non-steroidal anti-inflammatory drugs at the lowest dose compatible with symptom relief
  • the use of low-dose oral corticosteroids in combination with disease modifying anti-rheumatic drugs (DMARDs) for the short-term relief of signs and symptoms, and in the medium- to long-term to minimise radiological damage
  • methotrexate and sulfasalazine as the DMARDs of choice because of their more favourable efficacy and toxicity profiles.
    www.sign.ac.uk

New online resource for GPs launched by NICE

A new section has been added to the NICE website to help professionals in general practice get more out of evidence and guidance provided by NICE. It was created with the help of GPs, practice managers, and practice nurses. This online resource has been specifically created to support the use of evidence-based medicine, to help deliver high-quality primary care, and improve patient outcomes. A section on how NICE can help GP consortia is also included.

Users can quickly access relevant guidance, information, and advice to ensure that the practice team is up-to‑date, and find out how to further their CPD.
www.nice.org.uk/gp

Consultation begins on future QOF indicators

NICE has opened its consultation on potential new clinical and health improvement indicators for the 2012/13 quality and outcomes framework (QOF). Potential new indicators include those relating to asthma, cardiovascular disease, obesity, and smoking. Anyone wanting to comment on any of the 29 indicators out for consultation are encouraged to do so through the NICE website. The feedback from the consultation along with the results from the piloting scheme will be considered by the independent QOF Advisory Committee in June 2011.
www.nice.org.uk

NICE does not recommend bevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer

Individuals who are receiving this drug combination should have the option to continue therapy until they/their clinicians consider it appropriate to stop.
www.nice.org.uk

Guidance on the use of pazopanib as a first-line treatment option for people with advanced renal cell carcinoma has been published by NICE

To be eligible for this therapy, patients must meet the criteria as detailed in Technology Appraisal 215.
www.nice.org.uk

NICE has published Technology Appraisal 216, which recommends the use of bendamustine as an option for the first-line treatment of chronic lymphocytic leukaemia

(Binet stage B or C) in patients for whom fludarabine combination chemotherapy is not appropriate.
www.nice.org.uk

The Department of Health has finalised its list of 'never events'

Serious, largely preventable patient safety incidents that should not occur if the relevant preventative measures have been implemented by healthcare providers.
www.dh.gov.uk

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