Beyond the clinician: Allied Health Professionals in allergy care

European Academy of Allergy and Clinical Immunology calls for improved food allergy labelling to protect consumers with food allergies

September 24, 2018

Published by patients on October 15, 2018

Allied Health Professionals are increasingly involved in allergy care and prevention, therefore we must standardise and foster their competencies in this field.

When your child is diagnosed with a food allergy, one of the first questions that you will ask yourself is “what will I feed him/her?” and you will seek the advice of a dietitian.

If you are at risk of an anaphylaxis attack, a trained nurse will explain how to administer auto-injectors with adrenaline.

And when dealing with the emotional burden of having an allergy, a psychologist can guide you through coping strategies and day to day management.

While your doctor will, in most cases, be your first point of contact, allergic conditions are broad-ranging and so are the professions involved in their effective care. Such a multi-disciplinary approach will result in better care given from those with the most appropriate skill set.

To reach improved treatment and support, Allied Health Professionals (AHPs), such as nurses, dietitians, psychologists, physician assistants, pharmacists and others, are increasingly working at the forefront of healthcare.

The rising prevalence of allergic diseases has in many countries been successfully supported by a more prominent role for AHPs. In turn, the support of AHPs in the treatment of allergy has been shown to greatly improve patients’ lives.

“I can’t thank the Emergency services and medical staff enough. I owe them my life. When the paramedics arrive, it’s a relief I can’t explain. I admire all medics they devote their lives to helping people like me, without them I may not be here,” says Jo Keeling, former Police Officer for the Hamsphire Constabulary, who suffered a severe anaphylactic reaction to latex and was immediately attended to by ambulance staff.

“I strongly feel that the psychological processing of the issues and implications of an allergy/coeliac diagnosis is vital to ongoing adherence and well being,” says Hazel Jacklin, coeliac disease sufferer, about the importance of counselling post-diagnosis.

It is imperative that patients receive the best quality of communication and timely care that they deserve. Therefore, all AHPs that deal with allergy services should have the required competencies. Although AHPs are highly trained – increasingly at post-graduate level – their competencies vary considerably from country to country. There is currently no international agreement as to the essential competencies for all AHPs working with allergic patients.

In order to address this issue, the AHP Interest Group of the EAACI has established a task force to consider the role of AHPs in allergy, understand the differences between countries, the competencies required and what the educational needs are in this sector. The ‘EAACI AHPs Competencies Document’ that has resulted from the task force’s efforts paves the way for standardized quality allergy pathways that enhance patient experience.

“This paper goes a long way towards reassuring patients that those involved in the care of their allergy problems have a depth and breadth of knowledge and competencies to enable them to fill their role,” says Dermot Ryan from the Allergy and Respiratory Research Group, University of Edinburgh.

Who are the AHPs involved in the diagnosis and management of allergic disease?

Specialist Nurses	Patient training and education: nurses provide a patient-centred and holistic education and support for self-care (e.g. in the management of atopic dermatitis, or self-administered adrenaline in an anaphylactic attack) Precision medicine: many nurses across the world are involved in the implementation of precision medicine treatments for allergy and asthma. Research: several nurses participate in, or lead research in management of allergic diseases. Prescription: in some countries nurses hold prescribing qualifications, which allow them to take a more pronounced role in supporting patients.
Allergy Specialist Dietitians	Diagnosis: an allergy focused diet history is key to a diagnosis of food allergy and is analysed by dietitians. Evaluation: Dietitians are trained to evaluate dietary habits and collect detailed information about nutritional intake, BMI and growth. Nutritional management: dietitians can also assess nutritional intake, status, growth in children and unintended weight loss. Nutritional management is vital for food allergic children who have lower intakes of nutrients and total energy. The poor nutritional quality of exclusion diets can also result in obesity in allergic children. Dietary counselling results in a significant improvement in nutrition for children with food allergy. Prescribing an elimination diet and re-introduction: dietitians can provide advice on avoiding specific foods that are allergic triggers. Prescribing an elimination diet ensures an accurate diagnosis is made and the correct management plan implemented. A dietitian also reviews the continued need for dietary exclusion and enables possible re-introduction of those foods. Prevention and management: dietitians play a role in providing information for the prevention and management of food allergy and other allergic conditions such as asthma and atopic dermatitis. Research: dietitians are also involved in and/or lead allergy research.
Psychologists	Coping: psychologists empower the allergy sufferer and their family by applying coping strategies to support emotional wellbeing.
Pharmacists	Consultation: pharmacists are frequently consulted regarding suitable medications for individual allergy patients, having a knowledge on hypersensitivity reactions, which drugs can be used to treat them, and which are contraindicated. Advice: community pharmacists are often asked to provide advice or medications for allergic conditions, having an insight as to whether appropriate treatment has been prescribed Training: pharmacists ensure proper training is received on the correct use of adrenaline devices, nasal sprays and inhalers.
Speech and Language Therapists	Overcoming aversion: patients with food allergy are often diagnosed in infancy. The negative experience with specific foods can often lead to feeding difficulties and an aversion to feeding utensils. Speech and language therapists are vital in combatting these feeding difficulties.
Respiratory Therapists and Physiotherapists	Management: respiratory therapists and physiotherapists have an important role to play in the management of asthma and have been shown to improve outcomes and reduce the cost of care.