Children’s Health Ireland utilise the HSE City West Care Facility for a 6 week Allergy initiative, to reduce its waiting list for Oral Food Challenges by 474 patients

Children’s Health Ireland (CHI) are experiencing similar challenges to all hospitals living with COVID-19 in terms of insufficient space to manage our patient throughput as we adhere to public health measures on social distancing and infection prevention and control guidance.

CHI Allergy Team identified a unique opportunity to vastly reduce the current Day Case waiting list for patients requiring Food Challenges. The use of the City West facility, with the support of the HSE, allowed for an initiative to manage a high volume of patients over a six week period from 7 September 2020. During this period 474 children attended Food Challenge Clinic.

In Sept 2020, CHI had over 700 patients on their clinical immunology day case waiting list for drug and food challenges. Whilst constraints existed pre-COVID in terms of access to Day ward availability for these patients, this was compounded by the COVID-19 guidelines in place which resulted in a reduction in patient throughput on our acute hospitals.

Families whose children aged 2 to 18 years had been on waiting lists, some for up to four years, at CHI at Crumlin, Tallaght, Temple Street and Cork University Hospital, were invited to attend City West for a day for their food challenge. Dr Byrne, Consultant Allergist CHI explains that each of these families would had previously attended an allergy/general paediatric outpatient clinic at CHI, at which time an oral food challenge was advised for their child.

Prof Jonathan Hourihane, Consultant Paediatrician, CHI at Temple Street said ‘I am delighted we could avail of this great opportunity to reduce waiting lists across the two allergy clinics in Ireland. At their clinics in their hospitals, paediatricians who specialise in allergy can usually only carry out about four food challenges a week, with the City West facilities we’ve had the capacity to treat approximately 27 children each day’.

 “We expect that half of the children who attend for a Food Challenge will have an allergic reaction to the food and we want to show them that it’s not fatal. A lot of allergies go away and children can eat food safely here to see if they still are allergic or not.”

“Many children who are allergic to one food avoid other foods too.  Half of the children we will see will pass the challenge for the other foods they are avoiding. We want to reduce the foods they are avoiding to one food if possible. For example, a child with a peanut allergy might also avoid other nuts, shellfish and fish or a child that reacted to milk, might avoid, egg, shellfish, wheat and apples.”

Prof Hourihane says many children are also carrying adrenaline autoinjectors unnecessarily while they await a professional review of their allergies. “Studies have shown that half of children who carried adrenaline auto injectors were only allergic to milk or eggs and not peanuts,” he explains.

The success of this project was due to the commitment and drive of the cross agency, cross site, multi-disciplinary Allergy and general paediatric team of doctors and nurses. In addition, it was critical to this project and the continued safe and high quality care of our patients to ensure that we had daily Anaesthetic support on site to quickly manage any patients who displayed reactions at a level requiring airway support.  We had a very small number of patients who required admission and the safe clinical transport for each of these patients and their parent/guardian was facilitated by the BUMBLEance team.

CHI maintains a strong ethos of providing clinical teaching opportunities. As part of this project the Head of Paediatrics Department in RCSI invited a number of medical students to join us and work alongside our Consultant Allergists and General Paediatricians to take part in a unique teaching and education opportunity.  The team were also joined by a number of medical paediatric trainees and an Allergy Clinical Trainee from Belfast who have used their study leave in order to observe the clinical management of these patients and learn the techniques used by the CHI team.

 The general feedback from our patients and their families has been extremely positive. Our communications and wayfinding team have been excellent in ensuring that we made their experience in City West a more paediatric friendly environment and put systems in place to ensure the provision of a CHI experience off site. Parents have been very impressed with the facility and delighted to have this opportunity to complete the food challenges for our patients, a number of whom were waiting since 2017 and 2018.

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