Claudia Gore

Food challenges play an important role in the diagnosis and management of food hypersensitivity. Although the gold‐standard is the double‐blind, placebo‐controlled food challenge, an open challenge, where the challenge food is known to both the patient and the allergy team, is a practical and effective tool for use in daily clinical practice. A food challenge can help determine the presence or absence of a food allergy if the history and allergy tests are discordant, or if resolution of the allergy is expected. The outcome of a food challenge can result in either confident introduction or re‐introduction of foods or provide clarity on which foods or forms of the food need to be avoided. Challenges can be a positive or negative experience for individuals; to maximise the potential for positive impact, food challenges should be overseen by individuals with relevant knowledge, skills and experience, and take place in a suitable clinical area with appropriate access to emergency support and a pathway for admission to an inpatient facility. Challenge foods should be age‐specific, in an appropriate form (uncooked, cooked, baked, composite food), and given in incrementally increasing amounts until an age‐specific top or cumulative dose has been consumed. The decision to pause or stop a challenge should be based on international guidance and clinician judgement, but also consider an individual's symptom history and their preferences.

Background: Inconsistent documentation of known allergies in electronic patient records (EPRs) poses a major patient safety risk. Unlike drug allergies, food and non‐drug allergens lack standardised documentation frameworks. This study evaluated how such allergies are recorded across NHS Trusts and the extent of avoidable harm from exposures. Methods: We conducted a national cross‐sectional, study. Freedom of Information (FOI) requests were sent to all 209 public (NHS) hospital Trusts (December 2024) to collect data on allergy‐related incidents, EPR availability, training and governance. An online survey was distributed to British Society for Allergy & Clinical Immunology (BSACI) members (February 2025) to capture clinician experiences, challenges and suggestions. Quantitative data were analysed using non‐parametric statistics; qualitative data were analysed using thematic analysis. Results: Responses were received from 194 Trusts (93%), with 145 providing complete datasets (582 hospitals). Sixty‐one different EPR platforms were identified, with 44 Trusts operating multiple systems. Across a median 10‐year span, 12,385 allergy‐related incidents were reported: 7724 (62%) drugs and 1277 (10%) food/non‐drug allergens. Over half of Trusts (54%) lacked a dedicated incident‐reporting category for food/non‐drug allergens, suggesting underestimation. Trusts without EPRs reported 140% more incidents than those with EPRs ( p = 0.002). Those with in‐house allergy services, training and guidance recorded higher incident rates, consistent with enhanced recognition and reporting. The BSACI survey revealed challenges including poor EPR usability, limited coding options, weak alert systems and reliance on free text. Ninety percent of respondents supported national guidance on allergy documentation. Conclusion: Marked heterogeneity exists in NHS EPR systems and food/non‐drug allergy documentation practices. Trusts without EPRs experience higher reporting rates, while training and specialist services are associated with improved recognition. The absence of dedicated categories for food and non‐drug allergies contributes to systematic underreporting. These findings demonstrate how fragmented systems and inconsistent governance directly compromise allergy safety across UK hospitals.

Introduction: Adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self‐manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence‐based guideline on effective transition for AYA with asthma and allergies was published by EAACI.Aim: We herein summarize practical resources to support this guideline's implementation in clinical practice.Methods: For this purpose, multi‐stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality and were pragmatically rated for their evidence‐basis and user friendliness.Results: Resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace and wider community. Most resources were in English, web‐based and had limited evidence‐basis.Conclusions: This position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient‐centred tools to further assist evidence‐based transition care.

Background: The European Academy of Allergy and Clinical Immunology has developed a guideline to provide evidence‐based recommendations for healthcare professionals to support the transitional care of adolescents and young adults (AYA) with allergy and/or asthma. The goal of this work was to ensure that the draft recommendations are also important for patients.Methods: We surveyed patients aged 11–25 years with allergy and/or asthma and their parents across Europe between 17 February and 16 March 2020. The multilingual survey was distributed through national allergy and asthma patient organizations in Europe as well as through social media.Results: A total of 1210 responses from 24 European countries were collected. There were 415 (34.3%) AYA and 795 (65.7%) parents. The majority of AYA (72.3%) and parents (81.9%) were female. Patients had a history of asthma (61.1%), allergic rhinoconjunctivitis (54.1%), food allergy (53.8%), atopic eczema (42.6%) and anaphylaxis (28.8%). All recommendations achieved the median score of either ‘important’ or ‘very important’. The least supported recommendations were the use of joint clinics with both paediatric and adult physicians attending and the use of web‐based or mobile technologies for communication with the AYA. The most supported recommendation was checking that the AYA is knowledgeable and compliant with their prescribed medication. Qualitative analysis revealed conditional approval for some recommendations.Conclusions: There was agreement from patients and parents on the importance of the draft recommendations on transitional care for AYA with allergy and/or asthma and their parents. The recommendations now need to be implemented into clinical practice across Europe.

Objectives In the United Kingdom, atopic dermatitis (AD) affects 20% of children and topical corticosteroids (TCS) are a mainstay of AD treatment regimes. Many TCS have similar packaging despite significant differences in potency frequently leading to confusion, and along with misinformation and steroid phobia, potentially reducing treatment adherence. We aimed to evaluate parents' knowledge/concerns regarding TCS and explore benefits of/preference for a TCS‐labelling system. Method Hundred parents of children with AD attending paediatric dermatology and/or allergy appointments completed mixed‐methodology Survey 1 (knowledge‐quiz, TCS‐labelling options, feedback on what supports AD‐care). Thirty parents, adolescents, and healthcare professionals completed Survey 2. Qualitative/quantitative data was thematically/statistically analysed (SPSS v25) respectively. Results Parents preferred the traffic light system (green = mild, yellow = moderate, red = potent; n = 71/100) and reported significantly increased willingness and comfort in using TCS if a labelling system was used p ≤ 0.001). Knowledge regarding TCS potency was lacking: 62% (n = 46/74) of mild TCS‐users overestimated potency; 51% (n = 67/131) of potent TCS‐users underestimated potency. Common concerns were TCS‐related skin thinning, long‐term side effects and themes for improved AD‐care/support included: better information, written plans, access to advice, involvement of certain staff. Parents wanted accessible information in various formats: verbally, electronic resources, leaflets, and education sessions. Conclusions Parents of children with AD confirmed significant concerns and demonstrated poor knowledge regarding TCS use. Our findings suggest that a simple labelling system may improve TCS adherence. Future work to test refined label prototypes and evaluating their impact on adherence and correct use is needed.

Summary: Background: Children with severe, persistent atopic eczema (AE) have limited treatment options, often requiring systemic immunosuppression.Objective: To evaluate the effect of the temperature‐controlled laminar airflow (TLA) treatment in children/adolescents with severe AE.Methods: We recruited 15 children aged 2‐16 years with long‐standing, severe AE and sensitization to ≥1 perennial inhalant allergen. Run‐in period of 6‐10 weeks (3 visits) was followed by 12‐month treatment with overnight TLA (Airsonett^®, Sweden). The primary outcome was eczema severity (SCORAD‐Index and Investigator Global Assessment‐IGA). Secondary outcomes included child/family dermatology quality of life and family impact questionnaires (CDQLI, FDQLI, DFI), patient‐oriented eczema measure (POEM), medication requirements and healthcare contacts. The study is registered as ISRCTN65865773.Results: There was a significant reduction in AE severity ascertained by SCORAD and IGA during the 12‐month intervention period (P < .001). SCORAD was reduced from a median of 34.9 [interquartile range 28.75‐45.15] at Baseline to 17.2 [12.95‐32.3] at the final visit, and IGA improved significantly from 4 [3‐4] to 2 [1‐3]. We observed a significant improvement in FDQLI (16.0 [12.25‐19.0] to 12 [8‐18], P = .023) and DFI (P = .011), but not CDQLI or POEM. Compared to 6‐month period prior to enrolment, there was a significant reduction at six months after the start of the intervention in potent topical corticosteroids (P = .033). The exploratory cluster analysis revealed two strongly divergent patterns of response, with 9 patients classified as responders, and 6 as non‐responders.Conclusion and Clinical Relevance: Addition of TLA device to standard pharmacological treatment may be an effective add‐on to the management of difficult‐to‐control AE.

Summary: Background: Allergic disease has been associated with altered intestinal microbiota. Therefore, probiotics have been suggested as a potential treatment for eczema.Objective: We investigated whether dietary supplementation of infants with eczema at age 3–6 months with Lactobacillus paracasei CNCM I‐2116 or Bifidobacterium lactis CNCM I‐3446 had a treatment effect or altered allergic disease progression.Methods: Primary outcome included eczema severity (SCORing Atopic Dermatitis, SCORAD) 3 months post‐randomization. Secondary: SCORAD (other visits); infant dermatitis quality of life (IDQoL); gastrointestinal permeability; urinary eosinophilic protein X; allergen‐sensitization; allergic symptoms (age 12, 18, 36 months). A total of 208 infants aged 3–6 months with physician‐diagnosed eczema were recruited; 137/208 (SCORAD≥10, consuming ≥200 mL standard formula/day) were randomized to daily supplements containing L. paracasei or B. lactis or placebo for a 3‐month period, while receiving extensively hydrolysed whey‐formula (dairy‐free diet). There were two open observational groups, one group exclusively breastfed (n = 22) and the other, standard formula‐fed (n = 49). Trial number: ISRCTN41490500.Results: Eczema severity decreased significantly over time in all groups. No significant difference was observed between randomized groups after 12‐week treatment‐period (SCORAD‐score pre‐/post‐intervention: B. lactis 25.9 [95% CI: 22.8–29.2] to 12.8 [9.4–16.6]; L. paracasei 25.4 [22.1–29] to 12.5 [9.2–16.4]; placebo 26.9 [23.4–30.6] to 11.8 [9.6–14.3]; P = 0.7). Results were similar when analysis was controlled for allergen‐sensitization, or when only sensitized infants were analysed. No differences were found for secondary outcomes. No difference was observed in SCORAD‐score between randomized and observational groups.Conclusion and Clinical Relevance: We found no benefit from supplementation with B. lactis or L. paracasei in the treatment of eczema, when given as an adjunct to basic topical treatment, and no effect on the progression of allergic disease from age 1 to 3 years.