Children's Allergy Service on the NHS

Michelle Berriedale-Johnson inspects the new state-of-the-art allergy clinic at the Evelina Children?s Hospital overlooking the Thames

Despite its very 21st century appearance the Evelina Childrens Hospital - part of Guy’s and St Thomas’ Hospital Trust - is nearly 150 years old. It was founded by Baron Ferdinand de Rothschild in the 1860s in memory of his young wife, Evelina who died in childbirth having gone into premature labour following a railway accident. Their child was stillborn.

When the original 30 bed Evelina Hospital for Sick Children opened in 1869, it (like its successor) ‘encompassed the very latest design concepts’. These included two ‘very handsome wards with nine large windows arranged in swing compartments so that abundant provision is afforded for the most perfect ventilation ... and four fireplaces so that at any time the ward can be divided into four smaller rooms if this is deemed advisable’. Until his death in 1898 the baron remained an enthusiastic patron of the hospital which, by then, was treating over 1,000 patients a year - which it continued to do throughout the 20th century.

The New Evelina
The new hospital, which opened in 2005, is also revolutionary in design terms in that not only does it incorporate state-of-the-art facilities and a massive atrium, which rises over four floors to give spectacular views over London, but that children were involved in the design from the first. This means that the whole hospital has a very child-friendly air - although some of the ‘design features’ can present practical problems to the nursing staff - such as the fun, snaking corridors, which make wheeling beds from ward to ward somewhat problematic!

The new hospital serves south London and most of south-eastern England and, quite apart from allergy, has specialist services in paediatric and neo-natal intensive care, cardiology and cardiac surgery for babies and children and fetal cardiology, specialist surgery for cleft lip and palate, and paediatric renal, metabolic and neurological services. These include a ‘retrieval system’ for seriously ill babies and children - the hospital’s own medical staff ‘collect’ the sick children so that the child patients have expert care from the moment the ambulance arrives.

The Children’s Allergy Service
The new children’s allergy service at the Evelina is a first for the Evelina but also a first in the UK. Not only is it a dedicated children’s allergy clinic (not, as happens in so many clinics, a respiratory, dermatology or gastroenterological clinic which also ‘does’ allergy) but it is also a dedicated children’s allergy research unit.

Housing both the clinic and the research facility under one roof is ideal as it enables an integrated approach to allergy research and allergy treatment, which has to be beneficial for both.

The Paediatric Allergy Team
The Evelina team is led by Professor Gideon Lack and his colleagues, Drs Adam Fox and George du Toit. All three had previously worked at the paediatric allergy unit at St Mary’s Hospital in Paddington which has, over the last decade, become renowned for its paediatric allergy services.

They are joined by five paediatric specialist nurses, two specialist dietitians including Hasita Prinja who has been working with paediatric allergy since 1995 and a group of international research allergists.

Who and what does the clinic treat?
The clinic covers all of the following areas:
• Anaphylaxis - to food, to insect or venom sting, to latex and reactions that have no clear cause
• Dermatological allergy - eczema, angiodema and acute and chronic urticaria
• Respiratory and ENT allergy - asthma, chronic rhinosinusitis, moderate to severe allergic rhinoconjunctivitis and vocal cord dysfunction
• Drug allergy - evaluation of reactions to antibiotics, vaccines and anaesthetics
• Immunotherapy - poorly controlled rhinitis and anaphylaxis to wasp and bee sting
• Gastroenterological problems (reflux, proctocolitis etc) where a food allergy is suspected.

Although the hospital primarily serves its immediate community in south London and south-east England it can, and is anxious to, take referrals from anywhere in the country if no adequate service is available locally. Referral information for both patients and their GPs is available from the clinic - see below.

The new clinic opened in May 2006 and was already buzzing by July. However, the team hope that they will be able to expand the facility to meet the rapidly increasing demand and thus keep waiting lists down to a maximum of seven weeks.

What about St Mary’s
The move of some of the St Mary’s allergy team to the Evelina does not, fortunately for those who live north of the Thames, signal the winding down of the St Mary’s service. This is currently in the hands of paediatric allergist Dr Helen Cox who has been joined by Professor John Warner from Southampton.

St Mary’s has a huge referral base built up over 12 years so will remain a very important centre for paediatric allergy.

The first research project to be based in the new unit is The LEAP Study - a seven-year clinical research study that aims to determine the best strategy to prevent peanut allergy in young children. This is funded jointly by the American National Institutes of Health (NIH) and the UK Food Standards Agency.

The majority of children have their first allergic reaction to peanut between 14 and 24 months of age. Children suffering from eczema or who are allergic to egg are at highest risk - these children have a 20% chance of going on to develop a peanut allergy.

The LEAP study will enrol 480 of these high-risk children between the ages of 4 and 10 months. Each child will be randomly assigned to an avoidance group (they will avoid the consumption of peanut-containing foods until they reach the age of three) or to a consumption group (they will eat a peanut snack three times per week). All the children will receive allergy testing, dietary counselling, physical examinations and blood tests.

The proportion of each group that develops peanut allergy by 5 years of age will be used to determine which approach - avoidance or consumption - works best for preventing peanut allergy.

The Future
It is encouraging that despite the government’s failure to invest the kind of money that allergy sufferers would like into allergy training at both primary care and consultant level, those trusts that can afford to do so are investing their own funds into allergy services.

It was the Guy’s and St Thomas’ Charitable Trust which provided the vast majority of the funds for the allergy clinic and for the hospital; King’s College paid for, and own, the clinical trials unit. Would that other hospital trusts would follow where the Evelina has led.

For more information on the Children’s Allergy Services call 020 7188 3300
email: or click here for the Paediatric Allergy Unit at Guys and St Thomas hospital

First published in 2007


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