Allergy, immunology and infection
- RCPCH Allergy Care Pathways
- NICE Anaphylaxis
- SIGN/BTS Management of Asthma
- SIGN Antibiotic Prophylaxis in Surgery
- NICE: Bacterial Meningitis
- SIGN Bronchiolitis in Children
- NICE Chronic Fatigue Syndrome
- RCPCH Chronic Fatigure Syndrome
- NICE Coeliac Disease
- NICE Atopic Eczema in Children
- NICE Prophylaxis Against Infective Endocarditis
- Public Health Laboratory Service Exclusion Policies for the Control of Communicable Diseases in Schools and Preschools
- SIGN Management of Meningococcal Disease
- BTS Community Acquired Pneumonia
- NICE Respiratory Tract Infections
- SIGN Management of Sore Throat and Tonsillectomy
- SIGN Management of Sore Throat and Tonsillectomy (2010 Update)
- NICE Tuberculosis
RCPCH Allergy Care Pathways
The RCPCH has developed care pathways for children with allergic conditions following the Department of Health publication on the "Review of allergy services" (2006). These can be dowloaded below.
- Food allergy
- Drug allergy
- Venom allergy
- Latex allergy
Further information including leaflets and videos for families can be found here:
This guideline concerns assessment with a view to confirming an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode. The patient groups covered by the guideline are adults, young people and children who receive emergency treatment for suspected anaphylaxis.
The College asks members to note that:
The scope of the guideline covers confirmation of an anaphylactic reaction in an emergency setting and subsequent referral. As such the scope is quite narrow and excludes longer-term management of children who have experienced an anaphylactic episode (e.g. management through diet). Management of associated co-morbidities with anaphylaxis, such as asthma are also not included in the scope of the guideline. NICE however do refer readers to their related Food Allergy in Children and Young People guideline for information on allergy diagnosis and assessment.
Date of Publication: December 2011
Date of Endorsement: March 2012
The guideline is accompanied by algorithms covering the management of children in general practice, emergency departments and hospital and includes a template of a personal asthma action plan, case studies, educational studies and equality impact assessment tools.
- The guideline does not offer advice on steroid replacement dosage in the event of severe inter-current illness as part of a management plan if the child is being maintained on doses known to be associated with a risk of adrenal insufficiency.
- The following recommendation is based on expert opinion: 'Children aged <3 years are likely to require a face mask connected to the mouthpiece of a spacer for successful drug delivery'.
This guideline covers risk factors for surgical site infection, benefits and risks of antibiotic prophylaxis, indications for surgical antibiotic prophylaxis and recommendations on the administration of intravenous prophylactic antibiotics for adults. Recommendations for common surgical procedures in children are also included.
The guideline is accompanied by a quick reference guide, case studies, educational slides and 'Be In Control' materials. It includes evidence tables, occupational asthma record forms and an equality impact assessment form.
- NICE have updated the quick reference guide to reflect the action required when meningococcal meningitis is confirmed in children older than 3 months. Please see the NICE website for further information.
- Recommendation 1.4.45 has been amended from:
'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 0.25mg/m2 four times daily) should be used only when directed by a paediatric intensivist.'
'In children and young people with shock that is unresponsive to vasoactive agents, steroid replacement therapy using low-dose corticosteroids (hydrocortisone 25mg/m2) four times daily) should be used only when directed by a paediatric intensivist.'
The guideline covers the prevention, diagnosis, investigation, treatment and management of bronchiolitis in children. It focuses on the clinically diagnosed condition of bronchiolitis in infants aged less than 12 months and also considers a specific group up to 24 months of age: those born prematurely (less than or equal to 37 weeks of gestational age) and those with congenital heart disease or underlying respiratory disease.
The guideline covers the diagnosis, treatment and management of mild to severe chronic fatigue syndrome/myalgic encephalitis (CFS/ME) in adults and children over the age of five, including the transition of care from child to adult services. It is particularly relevant for healthcare professionals who have direct contact with and make decisions about the care of people with CFS/ME in primary and secondary care, in specialist centres and teams, those working in occupational health services, social services, educational services and the voluntary sector.
The guideline is accompanied by a quick reference guide, information for parents/carers, slides highlighting the key messages, costing tools, audit support and implementation advice. It includes key priorities for implementation and audit criteria.
- The guideline covers an area for which good quality research is lacking. Many of the recommendations are consensus based (modified RAND/UCLA appropriateness method). They apply to both children and adults, but children are somewhat overlooked.
- The NICE guideline recommends that all children and young people with symptoms suggestive of CFS/ME should be referred to a paediatrician for assessment. The RCPCH guideline is of the view that in "'mild' or early cases, an informed and experienced GP would be able to diagnose and manage the patient without referral to a paediatrician". However, recommendations in both guidelines are consensus based. There are also differences between the two guidelines in the list of routine tests.
This guideline covers management of children and young people up to the age of 18. It covers epidemiology, clinical features and diagnostic criteria for children with CFS/ME, recommendations on making a diagnosis, management, treatment interventions, educational needs and the transfer of care to adult health services.
The guideline covers the recognition and assessment of coeliac disease in adults and children. It provides recommendations to help alert practitioners to the presence of coeliac disease, including symptoms, clinical signs and types of presentation or conditions.
- The guideline recommends that people with positive serological results from any tTGA or EMA test should be offered a referral to a gastrointestinal specialist for intestinal biopsy to confirm or exclude coeliac disease. Members should note the resource implications of implementing this guideline.
The guideline covers the assessment, diagnosis and management of atopic eczema in children from birth until 12 years and provides information and education for children, parents and their carers. It is particularly relevant to all healthcare professionals who are involved in the care of children who have atopic eczema, those responsible for commissioning and planning healthcare services; and, children with atopic eczema and their families.
The guideline is accompanied by a quick reference guide, information for parents/carers, slides highlighting the key messages, costing tools and implementation advice. It includes audit criteria and key priorities for implementation.
This guideline covers the use of antimicrobial prophylaxis against infective endocarditis before an interventional procedure for adults and children. It is particularly relevant for healthcare professionals who have direct contact with patients within primary health and dental care, secondary care and community settings. The target population is adults and children with known underlying structural cardiac defects, including those who have previously had infective endocarditis.
The guideline is accompanied by a quick reference guide, information for patients/parents/carers, slides highlighting the key messages, costing tools and an online educational tool. It includes audit criteria and key priorities for implementation.
Public Health Laboratory Service/Department for Education and Employment/ Department of Health: Incubation Periods, Periods of Infectiousness and Exclusion Policies for the Control of Communicable Diseases in Schools and Preschools
The guideline covers the optimal control of communicable diseases, including accurate information on incubation periods, periods of infectiousness and the effectiveness of exclusion. The authors collected the available evidence for a wide range of infections and infestations and produced evidence-based guidelines for their control in schools and preschools.
- The recommendation that "parenteral antibiotics (either benzylpenicillin or cefotaximine) should be administered in children as soon as IMD is suspected and not delayed pending investigations" is a Grade D recommendation and based upon expert opinion. Evidence from a systematic review by Hahne et al suggested that the use of parenteral antibiotics is inconsistent and that results are inconclusive. SIGN have amended the guideline to include this reference; however, the grading has not been altered as the recommendation is in line with advice from the Health Protection Agency.
This guideline addresses the management of community acquired pneumonia (CAP) in infants and children in the UK. It does not cover neonates or infants with respiratory syncytial virus bronchiolitis. The specific management of children with pre-existing respiratory disease or that of opportunistic pneumonias in immunosuppressed children is not addressed.
The guideline is accompanied by a quick reference guide, information for patients, slides highlighting the key messages and audit tools and includes care pathways, audit criteria and key priorities for implementation.
This guideline presents evidence-based recommendations for the management of acute and recurring sore throat and indications for tonsillectomy. The guideline considers only tonsillectomy for recurring sore throat and does not address tonsillectomy for suspected malignancy nor as a treatment for sleep apnoea, peritonsillar abscess, or other conditions. The published literature is mainly concerned with a paediatric population and there is little evidence concerning the management of recurring sore throats in adults.
This guideline covers the diagnosis of primary cases of tuberculosis, identifying secondary cases, treating active disease, controlling latent infection and preventing further transmission. It is particularly relevant to healthcare professionals, people with or at risk from TB and their carers, patient support groups, commissioning organisations and service providers.
The guideline is accompanied by a quick reference guide, information for the public, slides highlighting the key messages and costing tools and includes key prioritised for implementation and audit criteria.
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