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

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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.

• Anaphylaxis
• Food allergy
• Asthma/Rhinitis
• Eczema
• Urticaria/Mastocytosis/Angio-oedema
• Drug allergy
• Venom allergy
• Latex allergy

Further information including leaflets and videos for families can be found here:

www.rcpch.ac.uk/allergy

 

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NICE Anaphylaxis

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.

RCPCH Notes:

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

Full guideline

Appendices

NICE guideline

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SIGN/British Thoracic Society: British Guideline on the Management of Asthma (2009 Update)

This guideline covers the management of asthma in adults and children. The 2009 Update includes updated sections on pharmacological management, the management of acute asthma and asthma in pregnancy.

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.

Date of Publication: April 2009
Date of Endorsement: June 2010

Full Guideline (PDF 2.05MB)
Quick Reference Guide (PDF 1.23MB)

RCPCH notes:

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

• 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'.

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SIGN Clinical Guideline: Antibiotic Prophylaxis in Surgery

 

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 includes key priorities for implementation, and is accompanied by a quick reference guide, an algorithm and information for patients/carers.

Date of Publication: July 2008
Date of Endorsement: April 2009

Full guideline (PDF 785 KB)
Quick reference guide (PDF 192 KB)

RCPCH notes: This document does not include a table of antibiotic half lives.

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SIGN/BTS: British Guideline on the Management of Asthma

 

This guideline covers comprehensive advice on asthma management for patients of all ages in primary and secondary care for all health professionals involved in the care of people with asthma.

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.

Date of Publication: February 2003
Date of Endorsement: February 2003

Full guideline (PDF 1.77 MB)
Quick reference guide (PDF 1.10 MB)

RCPCH notes: Please note that this guideline has been superseded by the 2009 Update.

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NICE: Bacterial Meningitis and Meningococcal Septicaemia in Children

 

The guideline covers the diagnosis and management of bacterial meningitis and meningococcal septicaemia in children and young people under 16 years in primary and secondary care.

The guideline is accompanied by a quick reference guide, parent/carer version, audit tools and algorithms.

Date of Publication: June 2010
Date of Endorsement: June 2010

Full guideline (PDF 5.75 MB)
NICE Guideline (Revised) (PDF 294 KB)
Press Release (PDF 47 KB)

RCPCH Notes:

Please note that since publication of the guideline:

• 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.'

To:

'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.'  

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SIGN: Bronchiolitis in Children

 

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 is accompanied by a parent leaflet, quick reference guide and includes key points for audit, research recommendations and local resource implications.

Date of Publication: November 2006
Date of Endorsement: April 2008

Full guideline (PDF 1.79 MB)
Quick reference guide (PDF 590 KB)

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NICE: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

 

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.

RCPCH comments:
The RCPCH welcomes the publication of this guideline but asks Members to note the following:

• 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.

Date of Publication: August 2007
Date of Endorsement: June 2008

Full guideline (PDF 848 KB)
NICE guideline (PDF 337 KB)

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RCPCH: Chronic Fatigue Syndrome/Myalgic Encephalopathy in Children and Young People

 

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 includes an executive summary and research priorities.

More information on the guideline

Date of Publication: December 2004
Date of Endorsement: December 2004

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NICE: Coeliac Disease

 

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 is accompanied by a quick reference guide, costing tools, audit support and a slide set, and includes key priorities for implementation.

Date of Publication: April 2009
Date of Endorsement: August 2009

Full guideline (PDF 410 KB)
Quick reference guide (PDF 186 KB)
Key Messages (PDF 128 KB) - Presented by Dr Adrian Thomas, Consultant Paediatric Gastroenterologist, at the RCPCH Annual Conference 2010

RCPCH comments:

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

• 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.

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NICE: Atopic Eczema in Children

 

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.

Date of Publication: December 2007
Date of Endorsement: April 2008

Full guideline (PDF 2.43 MB)
NICE guideline (PDF 191 KB)

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NICE: Prophylaxis against Infective Endocarditis

 

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.

Date of Publication: March 2008
Date of Endorsement: May 2008

Full guideline (PDF 562 KB)
Quick Reference  (PDF 53 KB)
College response (PDF 45 KB)

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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.

Date of Publication: April 2001
Date of Endorsement: April 2001

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SIGN: Management of Invasive Meningococcal Disease in Children and Young People

 

This guideline covers best practice in the recognition and management of meningococcal disease in children and young people up to 16 years of age.

The guideline is accompanied by a quick reference guide and information for parents and carers and includes key audit criteria.

Date of Publication: May 2008
Date of Endorsement: April 2009

Full guideline (PDF 528 KB)
Key Messages (PDF 537 KB) - presented by Dr Jack Beattie, Consultant Paediatrician, at the RCPCH 2009 Spring Meeting.

RCPCH Comments:

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

• 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.

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British Thoracic Society: Community Acquired Pneumonia in Childhood

 

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.

Date of Publication: December 2002
Date of Endorsement: December 2002

Full guideline (PDF 872 KB)

RCPCH notes: This guideline is due for review by the British Thoracic Society.

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NICE: Respiratory Tract Infections

 

This guideline covers the treatment of adults and children, 3 months or older, with respiratory tract infections (RTIs) for which immediate antibiotic prescribing is not indicated.

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.

Date of Publication: July 2008
Date of Endorsement: January 2009

Full guideline (PDF 628 KB)
Quick reference guide (PDF 150 KB)
Key Messages (PDF 28.1KB) - Presented by Dr Nicky Coote, Consultant Paediatrician, at the RCPCH 2009 Spring Meeting

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SIGN: Management of Sore Throat and Indications for Tonsillectomy

(2010 Update)

The guideline covers the diagnosis of acute of recurrent sore throat, as well as pain management, antibiotic use, indications for surgical management and postoperative care in children and adults.

The guideline is accompanied by a quick reference guide, patient information leaflets and a CPD training manual.

Date of Publication: April 2010
Date of Endorsement: July 2010

Full guideline (699 KB)
Quick Reference Guide (207 KB)

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SIGN: Management of Sore Throat and Indications for Tonsillectomy

 

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.

The guideline includes recommendations for audit and further research, example patient information leaflets, list of antibiotics, and an example proforma for assessment of symptoms.

Date of Publication: January 1999
Date of Endorsement: January 1999

RCPCH notes: This guideline has been updated by SIGN and was published in April 2010.

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NICE: Tuberculosis: Clinical Diagnosis and Management of Tuberculosis and Measures for its Prevention and Control

 

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.

Date of Publication: March 2006
Date of Endorsement: May 2008

Full guideline (PDF 1.04 MB)
NICE guideline (PDF 623 KB)

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