September 23rd, 2022

I have worked within Barts Health as a Dietitian since I qualified, writes Charlotte Foster, where I have been privileged to work in an array of specialisms. Earlier this year, I recently started a new role as a Senior Specialist Dietitian in the St Bartholomew’s Allergy service.

I applied to the Guild for funding to enable me to attend a 4-day Allergy in Practice course, run by the Allergy Academy. Being new to Allergy, I was very keen to attend this course so that I could obtain a holistic understanding of allergy and food allergy and help to fast track my training and understanding in a new specialist area.

What did the course entail and what did you learn or find useful?

Three of the four days involved a series of lectures online, with the final day being an in-person practical day based at St Thomas’ Hospital. Days one and two focussed on the core elements immunology, taking an allergy focussed history, the methods of diagnosing allergies, interpreting test results and certain allergy diagnoses from urticaria, FPIES and drug allergies, as well as a lecture on research in allergy.

The third day was particularly useful for me as this had a strong focus on food allergy with lectures from different Dietitians working in other Allergy centres. I particularly enjoyed a lecture given from a Dietitian working in adult allergy based at Guys Hospital where she unpicked a lot about cofactors that can impact allergic reactions. The case studies discussed were very relatable to the clinical cases that I see in my practice.

At the end of each lecture there was opportunity to ask questions and also time set aside for clinical case discussions which was really valuable to consolidate theoretical knowledge.

The final day was a practical skills day. This was split into two sessions. The morning session focussed on skin prick testing and EpiPen training and demonstrations from dermatologists and specialist nurses on inhaler techniques. For me, the skin prick training and EpiPen training were particularly valuable and useful. I have since started to take on more responsibility with doing skin prick testing in my clinics to help with the diagnostic process.

The afternoon was spent in the simulation lab, whereby we were split into groups of different multidisciplinary professionals and we were asked to draw on all the knowledge we had acquired from the course to respond to a hypothetical clinical scenario. The scenario I was involved in was an adult coming in for a food challenge to peanut.

Shortly after the food challenge began he became clinically unwell and was having anaphylaxis. This simulation, although overwhelming, was a brilliant learning opportunity. It helped to draw all the theory I had gained into practice, from learning about how reactions can manifest to helping me to identify the signs of a clinically deteriorating patient and the treatment steps involved to stabilise them. It encouraged me that in high stress clinical situations (which can feel overwhelming as an allied health professional), there are always ways you can support your medical and nursing colleagues who will be doing the more “hands on” treatment.

How will the knowledge you have acquired from attending the course impact your practice as a Dietitian?

Attending this course has exceeded my expectations in terms of learning outcomes. The breadth of subjects covered and quality of teaching was outstanding. The course has given me a good foundation in understanding that this area of medicine is not always black and white when it comes to diagnosing patients (which can be hard to accept when you are learning). It has reinforced to me the importance of spending time with my patients to obtain detailed allergy focussed histories, the limitations of allergy testing and when it is appropriate to request biochemical tests and the essential need for effective multidisciplinary team working.

The practical element of the course with skin prick testing and the patient simulation has been particularly impactful. I have already been practising skin prick testing on my colleagues in the hope of utilising these skills on patients in my clinics in the coming months. This will help to streamline the patient experience and hopefully reduce the number of times they need to come to hospital for tests as I hope to be able to carry them out in their appointment on the same day.

I want to extend my special thanks to Hilary Tarr at Barts Guild for her kindness and support in liaising with myself, the Guild and the Allergy Academy. I am so thankful to the Guild for their financial generosity; it has been a huge blessing to attend the course at this point in my role and has really helped make a difference to skillset and knowledge.