Guidelines endorsed by RCPCH - Allergy, immunology and infection

The College reviews high quality guidelines and standards produced and published by other organisations against the RCPCH Standards for Endorsement. We believe the following publications will be of interest to paediatricians working in allergy, immunology and infection.

The following have been endorsed or supported by the College:

Endorsed guidelines

Allergy Care Pathways (RCPCH)

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
 

Anaphylaxis (NICE)

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 (PDF, 870KB, 94 Pages)
 

Antibiotics for Early Onset of Neonatal Infection (NICE NCC-WCH)

This clinical guideline offers evidence-based advice on the use of antibiotics to prevent and treat early-onset neonatal infection (infection with onset within 72 hours of birth). It includes a review of the risk factors for infection, clinical indicators of possible infections and investigation before starting antibiotics. The guideline covers recommendations about choice of antibiotics, duration of course and therapeutic monitoring.  
 
This guideline is particularly relevant to healthcare professionals who work within the acute and primary healthcare sectors who have direct contact with postnatal women and their babies, those responsible for commissioning and planning healthcare services, public health and trust managers and women who have recently given birth, their partners, families and other carers.
 
RCPCH Notes:
 
This national clinical guidance is very welcomed. The guideline presents recommendations for practice within the limit of current evidence. Much of the guideline is consistent with current practice and many elements of good practice are highlighted. However, There is a lack of evidence for some of the recommendations which have therefore been reached by consensus expert opinion.
 
Date of Publication: August 2012
Date of Endorsement: August 2012 (badged September 2014)

Full Guideline (PDF, 172KB, 39 Pages)
 

Antimicrobial stewardship (NICE)

This quality standard covers the effective use of antimicrobials (antibacterial, antiviral, antifungal and antiparasitic medicines) to reduce the emergence of antimicrobial resistance (loss of effectiveness of antimicrobials).

It covers all settings, all formulations of antimicrobials (oral, parenteral and topical agents) and is for health and social care practitioners, organisations that commission, provide or support the provision of care, as well as people using antimicrobials and their carers.

RCPCH notes:

The College endorses the quality standards and notes that the document would have benefitted from specifying the route of administration and by adding a reminder that sometimes more than one microbiological sample (or none) might be need to be collected. The option of offering back-up (delayed) prescribing in Primary care would have been preferred to be suggested as a last resort and only in situations where the doctor has a clear opinion as to a likely bacterial cause of an illness that may not be self-limiting.

Date of Publication: April 2016 
Endorsed on: August 2016

Full Quality Standard (PDF, 177KB, 39 Pages)
 

Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use (NICE)

Awareness of antimicrobial resistance is important in ensuring the antimicrobial medicines are used when needed but that use is reduced without an increase in harm when use is not indicated. Resistance to all antimicrobials is increasing and, combined with a lack of new medicines, there is an increasing risk in the future that infections may not be able to be treated.
 
There have been several initiatives and guidance published to attempt to tackle the growing concern of appropriate use of antimicrobials and antimicrobial resistance; however, prescribing is still variable. 
 
This medicines practice guideline is needed to consider the evidence for effective interventions, in particular for changing prescriber and patient behaviour when using antimicrobials and for minimising antimicrobial resistance. 
 
Date of Publication: August 2015
Endorsed on: September 2015
 
Quality standard (PDF, 197KB, 50 Pages)
 

Atopic Eczema in Children and Young People (2013 Update) (NICE)

This quality standard covers children from birth up to the age of 12 years with atopic eczema. The areas of care considered were diagnosis and assessment, management and treatment, treatment of infected eczema and referral in primary and secondary care.

Date of Publication: September 2013
Date of Endorsement: October 2013

Full quality standard (PDF, 188KB, 40 Pages)
 

Atopic Eczema in Children (NICE)

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

NICE guideline (PDF, 191KB, 29 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (2012 Update) (NICE)

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

This quality standard covers the diagnosis and management of children and young people (younger than 16 years) with bacterial meningitis or meningococcal septicaemia.

Date of Publication: June 2012
Date of Endorsement: July 2012

Full quality standard (PDF, 257KB, 50 Pages)
 

Bacterial Meningitis and Meningococcal Septicaemia in Children (NICE)

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.

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.'  

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

Full guideline (PDF, 5.75MB, 275 Pages)
NICE Guideline (PDF, 294KB, 45 Pages)
Press Release (PDF, 47KB, 6 Pages))
 

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (NICE)

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 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 guidance (PDF, 337KB, 52 Pages)
 

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

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
 

Drug allergy - diagnosis and management (NICE)

This quality standard covers the diagnosis and management of drug allergy in adults, young people and children.
 
Diagnosing drug allergy can be challenging and there is considerable variation in management and in access to specialist drug allergy services. This can lead to under diagnosis, misdiagnosis and self-diagnosis. This variation may be caused by a lack of local drug allergy centres or awareness of available services. Some people are never offered a referral to specialist services and stay in primary care. Others have their drug allergy managed in other disciplines. Only a small proportion of people are treated in specialist allergy centres.
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • patient experience of care
  • patient safety incidents reported
  • mortality from causes considered preventable
  • patient exposure to unnecessary broad-spectrum antibiotics
  • antibiotic prescribing and antimicrobial resistance rates.
Date of Publication: July 2015
Endorsed on: September 2015
 
Full Quality Standard (PDF, 206KB, 40 Pages)
 

Feverish illness in children (NICE)

This quality standard the assessment and initial management of unexplained feverish illness in infants and children (from birth to 5 years).

Feverish illness is very common in young children (under 5), with between 20 and 40% of parents reporting such an illness each year. Fever is the most likely reason for a child to be taken to the doctor and the second most common reason for a child being admitted to hospital.
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • Mortality in infants and children under 5 years
  • Morbidity in infants and children under 5 years
  • Number of emergency admissions to hospital of infants and children under 5 years
  • Parent and carer experience of services.
Date of Publication: July 2014
Endorsed on: February 2015
 
Full quality standard (PDF, 196KB, 32 Pages)
 

Management of Invasive Meningococcal Disease in Children and Young People (SIGN)

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.

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.

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

Full guideline (PDF, 528KB, 53 Pages)
Key messages (PDF, 537KB, 25 Pages)
 

Management of Sore Throat and Indications for Tonsillectomy (SIGN)

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 (PDF, 699KB, 44 Pages)
Quick reference guide (PDF, 207KB, 2 Pages)
 

Paediatrics Allergy Action Care Plans (BSAC)

The plans have been designed to facilitate first aid treatment of anaphylaxis, to be delivered by people without any special medical training or equipment apart from access to an adrenaline auto injector (AAI). They may also be used to provide a framework for management of anaphylactic reactions to health professionals who are less familiar with this aspect of clinical care.

Date of Publication: September 2013
Date of Endorsement: October 2013

Personal plan for individuals prescribed EpiPen (PDF, 324KB, 1 Page)
A generic plans for individuals assessed as not needing AAI (PDF, 188KB, 1 Page)
Personal plans for individuals prescribed
 

Prophylaxis Against Infective Endocarditis (NICE)

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, 562KB, 107 Pages)
Quick Reference  (PDF, 53KB, 2 Pages)
College response (PDF, 45KB, 1 Page)
 

Respiratory Tract Infections (NICE)

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, 628KB, 121 Pages)
Quick reference guide (PDF, 150KB, 2 Pages)
Key messages (PDF, 28.1KB, 20 Pages)
 

Sickle cell acute painful episode (NICE)

Acute painful sickle cell episode (also known as painful crisis) is an acute condition that occurs in people with sickle cell disease. In these people red blood cells behave differently under a variety of conditions, including dehydration, low oxygen levels and elevated temperature. Changes in any of these conditions may cause the red blood cells to block the small blood vessels, restricting blood flow. This damages the tissue, which causes pain. 

This quality standard covers the management of sickle cell acute painful episode in people in hospital from the time of presenting to hospital until the time of discharge.
 
Date of Publication: April 2014 
Endorsed on: October 2015
 
Full Quality Standards (PDF, 207KB, 39 Pages)
 

Transition from children’s to adults' services for young people using health or social care services (NICE)

Transition occurs during the period when young people and their families are thinking about their hopes for the future. If people are likely to have care and support needs when they are 18, they need information and advice so that they can make the necessary plans. Despite this, there is evidence that the transition process is variable, with previous good practice guidance not always being implemented.
 
This clinical guideline focuses on young people passing through transition to adult services with health and/or social care needs. 
 
It covers the period before, during and after a young person moves from children's to adults' services, and aims to help young people and their carers have a better experience of transition by improving the way it’s planned and carried out.
 
Date of Publication: February 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 1,710KB, 218 Pages)
NICE Clinical Guideline (PDF, 173KB, 31 Pages) 
 

Vaccine update in under 19s (NICE)

This quality standard covers increasing vaccine uptake among children and young people aged under 19 in groups and settings that have low immunisation coverage. It describes high-quality care in priority areas for improvement.
 
RCPCH notes:

The RCPCH asks its members to note that the quality standard does not provide a quality statement regarding routine vaccination of premature neonates. 

 
Date of Publication: March 2017
Endorsed on: March 2017
 
Full Quality Standard (PDF, 118KB, 22 Pages)
 

Supported guidelines

Guidelines for Management of Children with Infections Attending Schools and Day Care Facilities (HPA/RCPCH)

This guidance covers the inclusion and exclusion of children in day care settings, nurseries and schools in order to minimise the risk to other children and reduce the disease transmission, for 36 infectious diseases. It is based upon available evidence and expert consensus. The guidance is accompanied by professional fact sheets and public fact sheets.

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

  • The guideline has not been externally peer reviewed by RCPCH Members prior to publication and thus the College standard that the guideline adequately addresses comments made during consultation could not be assessed.

Date of Publication: August 2009
Date of College Support: July 2009

Full guideline (PDF, 173KB, 6 Pages)
 

Management of HIV in Pregnancy (RCOG)

This guideline covers the management of HIV in pregnant women in the UK.  It contains recommendations on antenatal HIV screening, interventions to prevent disease progression and prevent mother-to-child transmission of HIV, antenatal care of women with HIV and antenatal complications, as well as management of delivery, postpartum care, pre-pregnancy management and care of the neonate.

The guideline is accompanied by an executive summary and patient information.

Date of Publication: June 2010
Date of College Support: October 2010

Full guideline (PDF, 371KB, 28 Pages)
 

Surgical Site Infection (NICE)

This guideline covers the prevention and treatment of surgical site infection in adults and children undergoing surgical incisions through the skin, including minimal invasive surgery.

The guideline is accompanied by a costing report, slide set, quick reference guide, parent/carer version and audit support and includes audit criteria.

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

  • The guideline presents recommendations relating to the prevention and treatment of surgical site infection, however the Guideline Development Group did not include paediatric representation.

Date of Publication: October 2008
Date of College Support: September 2009

Full guideline (PDF, 5.9 MB, 168 Pages)
NICE guideline (PDF, 213 KB, 28 Pages)