Most people interested in the subject will by now have registered the publication last month of the new NICE guidelines for the assessment and diagnosis of food allergy in children. They are relatively limited in objective and scope but, as Dr Adam Fox from the Childrens’ Allergy Service at St Thomas’ who helped write the guidelines, said to us last year, NICE guidelines are taken very seriously by the medical fraternity so the fact that they exist at all will be a significant boost to awareness of food allergy, especially in primary care.
The guidelines cover the clinical history which should be taken for each supposedly food-allergic child, what information the doctor should be seeking, the tests that can be used to diagnose IgE-mediated and non-IgE-mediated allergy, when referrals on to specialist care should be made and the value of alternative diagnostic tests.
Unfortunately, and inevitably, most of the coverage of the publication of the guidelines focused on ‘bashing’ alternative tests – yet again. But as we all know only too well, the only reason people turn to sometimes dodgy alternative tests is because most GPs have, until now, been totally unable to help, assuming that they even acknowledged that an allergic problem existed.
Let us hope that that the NICE guidelines will at least succeed in alerting a greater number of general practitioners to the existence of food allergy and how they should set about dealing with it. As Dr Joanne Walsh, a GP involved in drafting the advice, told BBC News Health, she now sees several children a week with suspected allergic reactions. Some are babies just a couple of weeks old. By gradually eliminating, and reintroducing different foods, she can help parents manage the allergy without the need for hospital visits. “There’s nothing more rewarding than a parent coming back and saying it’s like having a different child.”
Mind you, despite Dr Fox’s and Dr Walsh’s optimism, some recent research in Germany suggests that in all too many cases, guidelines are not really worth the paper they are printed on. To quote from a Science Daily report:
In the current edition of Deutsches Ärzteblatt International, Ute Karbach and her coauthors investigated the relationship for physicians between knowing the guidelines and acting in compliance with them. Data on 437 physicians’ knowledge of the guidelines was collected by a questionnaire sent out by post and physicians’ compliance with the guidelines was analysed on the basis of patient data they supplied.
Only 40% of the primary care physicians surveyed had knowledge of the cardiovascular guidelines; 60% of them show room for improvement.
Nevertheless, the evaluation showed that there was no significant difference between the treatment given by physicians who had adequate knowledge of the guidelines and treatment given by those whose knowledge of the current guideline recommendations was less good.