title: The RCPCH care pathway for children with drug allergies: an evidence and consensus based national approach.
abstract: OBJECTIVE
  The Royal College of Paediatrics and Child Health (RCPCH) was commissioned by the Department of Health to develop a drug allergy pathway. It focuses on defining the competences to improve the equity of care received by children.
  
  
  METHODS
  The drug pathway was developed by a multidisciplinary working group and was based on a comprehensive review of evidence. The team decided to focus on IgE-mediated reactions as these have the greatest potential to be life-threatening.
  
  
  RESULTS
  The results are presented in four parts: evidence review, pathway mapping, external review and core knowledge documents. The evidence review found a high percentage of putative penicillin allergy is not confirmed by objective testing and that resensitisation to β-lactam drugs was infrequent. It also highlighted the importance of a detailed history and accurate diagnosis along with clear communication of test results to both family and primary care.
  
  
  CONCLUSIONS
  This pathway demonstrates the spectrum of drug allergy is varied and may differ for young children compared with older children and adults. The authors highlight the paucity of evidence to support allergy testing for most drugs, in children, other than supervised incremental provocation tests (when indicated). Acute presentations require emergency health professionals to address underlying allergic issues, including recognition and avoidance of potential drug allergy triggers. Non-acute presentations may include multi-system symptoms which may have a broad differential diagnosis; this document signposts to the relevant partners in the RCPCH care pathway portfolio. Management combines a care package including a definitive diagnosis, initiating treatments and ongoing education.
authors: Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK. georgedutoit@gmail.com
authors: George
authors: G
authors: du Toit
authors: Kate
authors: K
authors: Lloyd
authors: Louise
authors: L
authors: Sinnott
authors: Debra
authors: D
authors: Forster
authors: Moira
authors: M
authors: Austin
authors: Christine
authors: C
authors: Clark
authors: David
authors: D
authors: Tuthill
authors: Jane S
authors: JS
authors: Lucas
authors: Nicola
authors: N
authors: Brathwaite
authors: John
authors: J
authors: Warner
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D019091:Critical Pathways / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007223:Infant; D007231:Infant, Newborn; D010406:Penicillins / Q000009:adverse effects; D011369:Professional-Patient Relations; D012882:Skin Tests; D012955:Societies, Medical; D006113:United Kingdom; D047090:beta-Lactams / Q000009:adverse effects
chemical_list: D010406:Penicillins; D047090:beta-Lactams; D007073:Immunoglobulin E