Paediatric Allergy

Introduction

The UK has the highest prevalence of allergic disease in the world. The Paediatric Allergy Department, part of the Evelina London Children’s Hospital at Guy’s and St Thomas’ NHS Foundation Trust, is situated in the centre of London and it is the one of the largest providers of specialist allergy care for children in Europe.

As well as having a reputation for clinical excellence, the allergy department also runs an internationally renowned programme of clinical and laboratory research. Our large faculty of paediatric allergists have a long tradition of active involvement in post graduate allergology education for doctors from around the world, using the most innovative teaching methods.

The Visiting Professional Programme offers an unrivalled opportunity to benefit from world class clinical research and educational opportunities, to enable you to develop your allergology practice, in the heart of one of the world’s greatest cities.

Programme aims

The clinical observership is aimed at those doctors who wish to learn more about the diagnosis, treatment and management of a wide range of allergy conditions.

It will update you on the latest clinical practice and provide ‘hands on sessions’ in clinics and in our day case wards. There are further opportunities to see the ongoing work in our dedicated Clinical Trials Unit, where large, interventional studies are ongoing as well as in our laboratories.

As well as paediatric allergy clinics, there are numerous opportunities to observe the work of other specialist departments such as the dermatologists at the St John’s Institute of Dermatology, who work closely with our department.

There are also many unique joint clinics held with specialist consultants from the Evelina London Children’s Hospital, such as the joint Allergy/Gastroenterology clinics, joint allergy / respiratory, joint allergy/ENT and joint allergy/dermatology clinics. A key element of the observership is to consider how the knowledge and skills acquired whilst here can be applied back at work in your own setting.

A Certificate of Attendance will be awarded to visitors upon the end of their programme.

Format

The clinical observership is delivered in the work place and participants will receive guidance and direction from Dr Kate Swan, Lead for the Paediatric Allergy Visiting Professionals Programme, for the duration of their stay. The visiting professionals will be provided with a programme for the first couple of weeks and then encouraged to tailor their experience to attending areas that are of specific interest to them. They will be provided with information regarding all the available clinics, day cases and research activity and will welcome to observe practice in those areas. They will have access to trust email and will be given the details of the members of faculty with whom to communicate about observing in their specific areas. We find that this self-directed approach to learning is better than a didactic approach. Some visiting professionals become involved in research projects or audits and tailor their time to that; others want to spend more time learning about day case procedures and some prefer to see more clinics. A unique focus of this programme is the opportunity for participants to be totally integrated with the delivery of allergy services at the hospital.

Participants will also be included in the ongoing educational activities of the allergy department such as multidisciplinary team meetings and grand rounds as well as the programmes of the Allergy Academy. The Allergy Academy hosts around fifteen educational events each year ranging from intensive three day courses to study days with international key opinion leaders.

Who can apply

This programme is intended primarily for non U.K. doctors, with an interest in paediatric allergy. This includes allergologists, paediatricians, pulmonologists, ENT surgeons, dermatologists, gastroenterologists or general practitioners. Delegates are expected to have worked in a hospital setting.

Programme duration

We are able to offer clinical observerships for overseas doctors for any duration. However, it is best to stay for at least six weeks to take advantage of all there is on offer but we are happy to discuss shorter attachments as well. We do not usually have people for more than 12 months but it is sometimes possible to extend the time beyond a year if desired. As we have a number of visiting doctors at any one time, as well as ongoing commitments to training the King’s College London medical students, it is important that we have a clear understanding of exactly which areas of allergy you are most interested in.

These include:

• Clinical allergology (Paediatric)
• Clinical research
• Laboratory research

Clinical observerships may be tailored, if possible, to your specific requirements, therefore, if you have a specific interest in a particular area e.g. food allergy, drug allergy or allergen immunotherapy then simply let us know.

The clinical observerships are run by the Department of Paediatric Allergy. Allergy Services are divided into the Paediatric Allergy service at St Thomas’ Hospital and Adult Allergy service at Guy’s Hospital. This observership is only for paediatric allergy; the adult allergy service run their own separate programme. However, there is usually the opportunity to arrange some time observing on the adult side if desired. The Academic Department of Allergy is fully integrated into the clinical service and is part of King’s College London. Clinical lead for Paediatric Allergy is Dr Helen Brough. Professor Lack heads the department.

Paediatric Allergy service

The Department of Paediatric Allergy was set up in 2006 in response to demand. The research component of the paediatric service is based in a dedicated eight bedded Clinical Research Facility near to the main department in the South Wing of St Thomas’ Hospital. It is the site of numerous large interventional studies focussing on allergy prevention and treatment.

The clinical area is dedicated exclusively to Paediatric Allergy. The Children’s Allergy Service is an integrated clinical and academic unit led by Professor Gideon Lack.

There are currently nine consultant Paediatric Allergists in the department – Professor Gideon Lack, Dr Adam Fox, Prof George du Toit, Dr Susan Chan, Dr Helen Brough, Dr Kate Swan, Dr Tom Marrs, Dr Alexandra Santos and Dr Marta Krawiec.

The department is a Royal College of Paediatrics and Child Health designated National Grid training centre for trainees in Paediatric Allergy and there are usually 1 to 2 National Grid Specialist Trainees attached to the department. In 2007 the service was chosen for inspection by the House of Lords Science and Technology Committee as an example of high quality specialist care. The service was recognised by GALEN in 2012 as a Centre of Outstanding Excellence and it was also chosen as one of 5 international centres to form the ‘Centres of Excellence’ educational programme by the Serono Symposia International Foundation.

The Children’s Allergy Service can be broadly divided into clinical and academic components although every effort has been made to ensure that the two elements of the service closely interlink.

The clinical service is a based in a custom built space, opened in 2009, which houses clinical and academic staff. The clinical area is dedicated exclusively to Paediatric Allergy. It has been specifically designed so that there are sufficient rooms for trainees to work alongside consultants in a multidisciplinary environment.

All clinics run with a dedicated specialist dietician as well as specialist nursing support that provides allergy testing, management advice, education and support.

Day case food and drug challenges as well as immunotherapy are carried out in a dedicated, newly renovated area (Elizabeth Day Care Unit). Minor day attendee activity, such as vaccinations for children at risk of allergic reactions, are carried out in the general paediatric day care ward (Arctic) in the Evelina London Children’s Hospital.

Around 26 General Paediatric clinics are held weekly, within the department. All clinics are consultant led, but may be run by the specialist trainees, and are supported by nurses and specialist paediatric dieticians.

Skin prick testing, lung function testing, exhaled nitric oxide measurement, adrenaline auto-injector training and allergen avoidance advice are all available for patients during their visit.

For more complex patients, there are monthly specialist clinics in drug allergy and urticaria as well as monthly joint Allergy/Dermatology clinic, joint Allergy/Respiratory clinics, joint Allergy/Gastroenterology clinic and joint Allergy/ENT clinics. There is also a twice monthly Severe Difficult Asthma and Allergy Service clinic.

The psychology team have separate clinics throughout the week as well as a specialist joint psychology dietetic clinic for the many children with aversive feeding habits. They also run patient workshops for group therapy relating to anxieties about having allergies. The dietitians also run their own dietitian clinics as well as performing skin prick tests, diagnosing allergies and providing dietary advice.

In response to the findings from the LEAP and EAT studies, an Early Introduction Service has also commenced and runs weekly.

The service also has unique expertise in Drug Desensitisation where the Evelina Children’s Hospital High Dependency Care facilities are used for drug desensitisation protocols. This service is led by Prof George Du Toit.

The Paediatric Allergy Clinical Research Facility, newly opening in summer 2019, is a dedicated ward which will have 8 beds for patients participating in our world leading clinical research including follow on studies for the Learning Early About Peanut studies, Enquiring About Tolerance study and Basophil Activation Test studies. It has been the site for peanut oral immunotherapy studies and many others in the pipeline. There is plenty of opportunity to observe this frontline, clinical research and it is possible to get involved in sideline projects from time to time.

Example Timetable

Fees

A course fee per week will be applied; this fee excludes accommodation and travelling expenses. To find out the fee amount please email vpp@gstt.nhs.uk.

Please note

Clinicians are able to offer bursaries or discounted placements on an individual basis. This is at the discretion of the Directorates of GSTT and does not affect the terms and conditions of the Visiting Professional Programme agreements.

Why Paediatric Allergy?

Dr Kate Swan explains what to expect from the Paediatric Allergy Visiting Professional Programme