Specialist allergy and clinical immunology

We treat conditions that may be caused or made worse by allergy including asthma and allergic rhinitis (e.g.  hay fever), allergic conjunctivitis (eye allergy), anaphylaxis (severe allergy), wasp and bee venom allergy, food allergy, acute and chronic urticaria (hives), angioedema (skin swellings), allergic eczema, adverse reactions to drugs, vaccines and anaesthetics and some immunological diseases.

In addition we are one of the few centres in the UK to offer a dedicated service in medical rhinology and we are also able to manage non-allergic rhinitis, chronic rhinosinusitis, chronic cough, nasal polyps and impaired sense of smell.  We also deal with upper airway manifestations of systemic diseases such as vasculitis and immunodeficiency. 

The service is provided by a team of specialist physicians, an allergy specialist dietitian and a team of nurses led by a clinical nurse specialist in allergy. 

Because not all medical conditions are caused or made worse by allergy, we do not offer allergy tests without a face-to-face consultation.  Each patient is questioned about their symptoms and past medical history and this information helps the clinician to decide what type of examination is indicated and if additional medical tests are required. 

When the assessment interview suggests that allergy, autoimmunity or immunodeficiency may be involved, carefully selected clinical and laboratory tests are used either to confirm or to exclude it.  Provocation testing (supervised exposure) to foods or medications is occasionally needed when there is disagreement between the tests and the clinical history.

Examples of medical conditions characterised by allergy:

• Asthma
• Allergic rhinitis (e.g. hay fever)
• Allergic conjunctivitis (eye allergy)
• Eczema and contact dermatitis (skin allergy)
• Urticaria (hives or nettle rash) and angioedema (skin swellings)
• Anaphylaxis (severe allergy) due to foods, drugs, bee or wasp venoms (stings)
• Oral and gastrointestinal food allergy (allergy in the mouth and intestine)
• Adverse reactions to drugs including vaccines, anaesthetics and biologics (modern, powerful drugs used to treat many chronic conditions such as arthritis, multiple sclerosis or asthma)
• Anaphylaxis (severe allergy) to insect stings
• Primary immunodeficiency diseases e.g. Hyper-IgE syndromes (characterised by eczema, food allergies & recurrent skin and respiratory tract infections)
• Mastocytosis (disorder of mast cells)

The service also receives regular referrals of patients who suspect food intolerance in the mistaken belief that we will be able to offer them a reliable test which will help them to know if a change of diet might help.  Unfortunately, the lack of a scientifically validated form of testing limits our ability to advise such patients.  In certain cases, and depending on the case summary provided by the referring doctor, we may suggest re-referral to a more appropriate service without necessarily agreeing to see the patient.

The same applies to patients with suspected contact dermatitis who are likely to require contact (‘patch’) testing.  They should not be referred to the allergy service but directly to a dermatology (diseases of the skin) service where this form of testing is undertaken. 

Patients referred to the service with suspected clinical immunological problems (for example recurrent infections) will be seen in our clinics.  We will also advise on the management of upper airway symptoms in patients with diagnosed immunological problems.

We maintains links with other specialties for the purpose of co-operation and patient cross-referral and are closely linked with the rhinology service at the Royal National ENT and Eastman Dental Hospitals where two of our consultants, Dr Kariyawasam  (adult) and Dr Rotiroti (adults and children) are also qualified as medical rhinologists.  A medical rhinologist is a specialist physician who specifically treats the nose and the upper airway. Dr Kariyawasam is the clinical lead and separate clinics are held (one in conjunction with a surgical rhinologist) for patients who require this service.

We also have links with the respiratory medicine service at UCLH where Dr Kariyawasam is part of the adult severe asthma service in conjunction with Professor Douglas Robinson. 

There is cross-referral to and from the dermatology service at UCLH concerning the management of allergic skin conditions. 

There is also cross-referral to and from the gastroenterology service in relation to the management of patients with food allergy affecting the gastro-enteric system.

We have access to an extensive immunology and allergy test repertoire through the accredited Health Service Laboratories (HSL). Dr Magdalena Dziadzio is a fellow of the Royal College of Pathologists (FRCPath) and experienced in immunology laboratory assays. She provides advice on the blood tests required to help diagnose allergy and immunological problems and in the interpretation of laboratory results.

We also offer a drug and anaesthetic allergy service to the other hospital specialities and also by direct referral from GPs.We receive referrals from our anaesthetists to investigate patients with suspected allergy to drugs used during general anaesthesia. We also see patients referred from other specialists such as infectious disease or microbiology to test for antibiotic allergy and from the rheumatologists when allergy to biologic drugs is suspected.

We also have links with the Royal London Hospital for Integrated Medicine where consultant general physician Dr Saul Berkovitz and consultant respiratory physician Dr Christian Hasford also provide an adult allergy service.

When you arrive, basic checks will be carried out and you will be asked to complete a short questionnaire.  You will be seen either by an allergy and/or immunology specialist physician or allergy clinical nurse specialist who will undertake an initial assessment.  If indicated, allergy skin prick and other tests may be done before or after this consultation.  Additional tests, for example allergy blood tests, may be requested and you may be offered an additional consultation with a specialist nurse or allergy specialist dietitian at the same attendance.  We may also recommend test vaccination to exclude some abnormalities in the immune system.

By the end of your appointment we hope to be able to answer the following questions:

• What is the underlying diagnosis?
• Is it caused by allergy?
• Can I solve the problem by avoidance?
• Do I need to change my diet?
• Are there any other self-management strategies?
• Is effective treatment available?
• How and when should I use an inhaler, nasal spray, tablets or adrenaline injector?
• Is desensitisation treatment available and would it be right for me?

Desensitisation (immunotherapy)

We are able to offer desensitisation to selected patients.  Some patients may be offered a three-year course of injections of a tiny, but gradually increasing, dose of the modified allergy-causing substance (allergen) for conditions such as treatment-resistant hay fever, severe bee or wasp sting allergy. 

Attending your appointment

If you are unable to attend your appointment, please let us know as soon as possible so that we can offer your appointment to someone else.  If you do not attend your appointment without telling us we will refer you back to your GP.  We take part in the education of medical students from University College London, junior doctors and other healthcare professionals who may sit in an outpatient clinic as part of their training.  This will only happen with your permission.  If you would not like trainees be present at your consultation, please tell the doctor or nurse. 

Nurses and dieticians

• Ms Rebecca McKenzie, Allergy Specialist Dietitian
• Mr John Dempster, Advanced Nurse Practitioner in Immunology and Allergy

Administration

• Ms Fiona Harvey, General Manager
• Ms Carol Merchant-Thompson, General Manager