The Allergy Service

The Allergy service

The Allergy Service at Nottingham University Hospitals is based at QMC campus and manages patients with allergic problems and urticaria and angioedema.

We are a regional centre for adults with allergy. The regional catchment areas mainly include Nottinghamshire and Derbyshire but we also see patients from Lincolnshire and Leicestershire.

Adult out-patient Allergy clinic appointments are held in Clinic 2 at QMC Campus

The adult Allergy Service manages patients with the following conditions:

Seasonal or perennial (all year round), allergic rhinitis not controlled with over the counter medications and those prescribed by the GP
A previous anaphylactic reaction
Urticaria (nettle rash) and/or angioedema (swelling) that meet the criteria set out by the Notts APC guidelines
Suspected food allergy
Ongoing food allergy that requires re-assessment or a change of management
Suspected drug allergy causing problems with medical management
Anaphylaxis or serious allergic reaction occurring under general anaesthetic

Referrals

Patients are seen in the allergy department following a referral from a GP, other doctor or specialist.

GPs and other doctors can refer through the ERS or by sending a referral letter to the Clinical Immunology and Allergy Department at the Queens Medical Centre. All referrals for suspected anaphylaxis during general anaesthesia must include a completed AAGBI and copies of the anaesthetic notes.

For internal referrals with in the Trust, use referral form on CareFlow named ‘Clinical Immunology and Allergy – Request for outpatient review’ found in the orders section.

Preparing for your clinic appointment

It is very important that you read the instructions in your appointment letter

If you are attending an adult allergy appointment, allergy skin tests may be carried out

In order for these tests to be effective it is important that you do not take anti-histamine tablets for 72 hours prior to your clinic visit.

Antihistamines include – Cetirizine/Zirtec, Loratidine/Clarityn, Chlorphenamine /Piriton, Fexofenadine/Telfast, Levocetirizine/Xyzal, Desloratidine/ Neo-Clarityn, Acrivastine/ Benadryl, Hydroxyzine and Ketotifen. This list is not exhaustive and antihistamines can be available with other brand names.

If you are concerned that stopping anti-histamines will make you unwell and/or you feel unable to do so, or if you feel unsure if any of the medications you take need to be stopped before your appointment , please telephone the department on: 0115 970 9130 to speak to one of the nurse specialists who can advise you.

When you come to your appointment, please bring:

Your appointment letter.
A list of your medications, including how much you take and how often.
Glasses or hearing aids that you use.
Your up to date mobile phone number (if you wish to receive text reminders in the future).

In order for us to test your allergy you may also have been asked to bring “offending foods” i.e. foods, drinks or substances that you feel may have caused allergic reactions to clinic for skin prick testing.

If you are a carer or assisting a patient with dementia, please tell reception when you arrive.

Getting to your appointment

Parking is limited at our hospitals. Please use public transport if you can.

The Medilink bus stops at the 'Park and Ride' at Queens Drive or Wilkinson Street and drops off at the QMC and City Hospital. Many local bus services stop at QMC and City Hospital. There is a small charge for this service.

The tram stops at QMC. You can use the tram if you are coming from the city centre. Other areas along the tram routes include Beeston, Chilwell, Hucknall and Hyson Green.

We have a very limited number of Blue Badge (disabled) parking spaces at each site.

Finding the clinic

All Allergy clinics are held in Clinic 2 at QMC campus.

Clinic 2 is on the Central route on B Floor in between the X-ray department and the Tram bridge exit

Blood tests are performed in the phlebotomy situated near the main entrance

If you are unable to find the clinic please ask a member of staff or volunteer for directions

Arranging medical transport

If a medical condition prevents you from using public or private transport, please ring the following non-emergency transport providers a few days before your appointment:

If you are registered with a GP in:

• Nottinghamshire – call Arriva Transport Solutions on: 0345 266 9662

• Derbyshire – call East Midlands Ambulance Service on: 0300 300 3434

• Leicester, Leicestershire and Rutland - call Thames Ambulance Service on: 0345 241 3012

• Lincolnshire – call Thames Ambulance Service on: 0808 164 4586

• North and North East Lincolnshire – call Thames Ambulance Service on: 0808 164 3030

Changing your appointment

If this is your first appointment in the Allergy Department you need to cancel or change your appointment you will need to contact us on: 0115 849 3392

If you do change this appointment, it might not be possible to change this again and you may be referred back to your GP.

If you need to change the time or date of a follow-up appointment with us for the same condition please telephone the department secretaries on: 0115 970 9130

What to expect at your appointment

When you arrive for your appointment at clinic 2 please check in at the reception and take a seat

Shortly after your arrival you will be called by one of the clinic staff who may ask to weigh you before directing you to an area where you can wait to be seen

At your appointment you may be seen by a consultant, a registrar (experienced junior doctor) or nurse specialists. All staff are trained and experienced in carrying out consultations in allergy.

The doctor or nurse will ask you questions about your symptoms and about your medical history. If allergy is suspected an allergy test may be performed, this may be a skin prick test and/ or a blood test.

Skin Prick Testing

Skin Prick testing (SPT) is an accurate way to test possible allergic substances to see if they cause an allergic reaction. It can be used to test for food and aeroallergen (substances in the air e.g. pollen) allergies.

In some cases, diagnosis can be made based on the clinical details and a SPT is not required to make a diagnosis.

Most SPTs are carried out using commercially prepared liquid allergens. If you think you have been asked to bring a food, beverage or substance to clinic for skin testing then this should not be mixed with any other products, for example sauces. It should also be individually packaged. For example, bring a whole piece of fruit rather than a pre-prepared fruit salad. If the food is usually eaten cooked, such as chicken, please bring a cooked sample.

Diagnosis of food allergy may be possible in a single clinic visit. In some cases however it may be necessary to wait for blood tests and/or to carry out an oral challenge with the food. This involves consumption of a food in increasing amounts, in a controlled environment, with medical supervision.

Skin prick testing is carried out on the inner forearm as follows:

1. A small amount of the allergen solution liquid is dropped onto the skin Skin Prick Testing image 1

2. The location of each droplet is marked on the skin with a pen and the skin under the drop of allergen is then pricked with a lancet. This is felt as a small scratch or prickle and is not usually painful

Skin Prick Testing image 4

3. The droplets are blotted away with a tissue

Skin Prick Test image 3

4. The skin prick test will start to work immediately and may cause itch or irritation to the skin. It is important that you do not scratch the test area as this can make the test difficult to interpret.

5. After approximately 15 mins the nurse or doctor will be able to read the test result on the skin. Positive results appear as a small itchy wheal on the skin which can be measured with a ruler and recorded in the medical notes

Skin Prick Test image 4

Following the skin-prick testing the doctor or nurse will interpret the test results and explain these to you.

Diagnosis

It is often possible to make an allergy diagnosis during the first clinic appointment but sometimes it may be necessary to wait for blood test results and/or to refer you on to a further clinic for more testing.

Drug Allergy

The Allergy Service provides diagnostic testing and future prescribing advice for some forms of drug allergy.

You may be referred to the Allergy Clinic if you have suspected drug allergy or have had a suspected allergic reaction whilst under general anaesthetic.

At your first appointment, a detailed history will be taken and you may be asked to have a blood test. A final diagnosis is usually not made at this time.

Testing will be performed at a later appointment and include allergy skin testing and/or a drug challenge (receiving the medication in a controlled environment with medical supervision).

At the end of your assessment, advice will be given about drugs you can have in the future, as well as ones you need to avoid.

Immunotherapy

The Allergy Service provides Immunotherapy, also known as desensitisation to pollens, house dust mite, wasp venom and bee venom.

People who have allergic rhinitis and have little or no relief despite full, early treatment with steroid nasal spray, higher dose anti-histamines and eye drops may benefit from immunotherapy.

Immunotherapy is an effective and lasting treatment for allergy which is given by subcutaneous injection (under the skin) to the upper arm or as a tablet taken sublingually (under the tongue). The usual course of this treatment is 3 years and involves multiple hospital appointments during this period.

Injectable Immunotherapy must be given in a designated allergy clinic and although each injection only takes a few seconds, patients must remain in the clinic for 1 hour after the injection in order to observe for any side-effects.

Sublingual tablet immunotherapy is used for pollen allergies and house dust mite allergy and requires a tablet to be taken under the tongue daily at home for 3 years, with the first dose administered in clinic under supervision.

Immunotherapy is not suitable for all people, particularly those with other medical problems, poorly controlled or severe asthma or people with multiple allergic problems.

Omalizumab

The Allergy Service provides Omalizumab injections for those with urticaria and angioedema that fail to respond despite optimum treatment stipulated in the Notts APC guidance and meet the severity criteria through assessment of patient symptom scores. These injections are given once a month with a typical course comprising six injections followed by reassessment of symptoms.