A life-threatening allergy is a huge and frightening concept for a child and the rest of the family. Educating young patients and their parents, so they know how to live a full, safe life, is just one facet of the working life of Rosemary King, allergy sister and children's research sister at Southampton University Hospitals NHS Trust and the local Wellcome Trust clinical research facility (CRF).
Her dual role embraces research and clinical work, and she believes the two disciplines enhance each other. Her experiences in the children's allergy clinic help to inspire research projects. And her patients benefit from the latest study findings.
A recent case sums up this potentially life-saving symbiosis. Ms King recalls how an eight year old boy with severe peanut allergy took part in one of the CRF-based studies. `Like many of the families I see, they are pleased to help with research because they share our goal of finding a cure.?
The child's allergy had been identified when he was a baby. Since then his parents had made sure he did not eat any peanut products, but they had fears for his safety as he grew older and more independent. He had no recollection of what a reaction felt like. He and his parents spent a day with Ms King, undergoing double-blind controlled food challenges, with appropriate medical facilities on hand, and they learnt how to recognise and manage a reaction.
Just a month later, this new knowledge was well and truly put to the test when the family was on holiday. The boy tasted a piece of cake, and immediately recognised the tingling, fizzing sensation in his mouth. He was having a reaction. He spat the cake out and his parents administered his antihistamine medication.
`His parents phoned me afterwards to say they had had a terrifying experience, but they were delighted to know their little boy could now control his allergy,' Ms King says. `He had done exactly what was necessary to avoid being rushed to hospital - or worse.'
She believes there is a lot of misunderstanding surrounding allergy, and cites her own past beliefs as an example of this. `I knew very little about allergy when I first came to the CRF in 1991. To be honest I thought some parents were making a lot of fuss about peanuts and other foodstuffs. Then it came home to me. I saw that a baby with an allergy to cows? milk could be covered head to foot in eczema. And I learnt that some could even die.'
Ms King, who trained initially as an adult nurse then as a children's nurse, spent a couple of years working with young people with learning disabilities before she joined the CRF. When she saw the ad for the post, which at that time was purely in children's research, she realised she couldn?t resist applying. `I missed nursing children, and I missed the hospital environment. And here was an ad for what looked like the most fantastic job.'
Her research role was, and is, wide-ranging, and involved `a near vertical learning curve?. She quickly developed a passion for allergy studies, and her consultant colleagues encouraged her to take postgraduate certificates in mechanisms and management of allergy and in research methodology.
In 2004, Ms King was invited to take part in the weekly children's allergy clinic at the hospital. She helped to ease the burden on medical staff by carrying out food challenges and providing education for children and families. And the consultant allergist encouraged her to develop a nurse-led service which would manage straightforward cases.
Intriguingly, this includes `undiagnosis? of allergy. Ms King explains. `Many people have the label of allergy, when really they have an intolerance of certain foods or drugs. They cannot be managed properly while wrongly diagnosed, and they risk missing out on valuable treatments such as penicillin-based drugs.?
Ms King now maintains her research role four days a week, and on the fifth day she contributes to the consultant-led service in the morning, and is central to the multidisciplinary nurse-led service in the afternoon. She sees patients independently with on-call medical cover when needed.
Sometimes just simple interventions can make an enormous difference to children?s lives. For example, Ms King saw a 14-year-old boy with an allergy to multiple aeroallergens who was under-performing at school, and realised he had been taking sedating antihistamine treatment for most of his life.
`I can?t prescribe - but I can give advice,? she says. `So I suggested a non-sedating treatment and provided information on allergen avoidance. His parents said he was a changed boy within a week.?
It is this ability to transform patients? quality of life that makes allergy care such a rewarding specialty for Ms King. Her achievements were recognised last year when she was named as a finalist in the Innovations in your Specialty category of the NT Awards 2005.
She believes far more people could live happier, healthier lives if only the Government would invest in training, not just for specialists, but also for GPs, practice nurses and community nurses. `What I do isn?t rocket science,? she says. `But people with training can make such a difference.?
To this end, Ms King is taking part in an initiative at the British Society for Allergy and Clinical Immunology to set up guidelines for educating nurses to recognise and deal with allergy when they come across it in their everyday work.
Ms King?s commitment to quality of life underpins her research as well as her clinical work. She was a co-investigator in a study comparing children with allergy with those who had insulin-dependent diabetes. Their findings, published in 2004, showed that allergy had a more severe impact on quality of life.
She is now completing a study looking at the effect of allergy on the child?s father and older siblings. `Research to date tends to concentrate on the patients and the mother. We have found that fathers often feel marginalised. And older siblings, who may remember family life before allergy became an issue, demonstrate a lot of anger because the mother has to concentrate so much on the affected child.?
The combination of research and clinical work adds up to an unbeatable job package, for Ms King. `I just love doing what I do. I am able to work as an independent practitioner, making my own decisions. I work with a wonderful team including frontline academics. I never stop learning.?
`And I know I make a difference - the whole point of this work is to keep children safe, living full lives unhampered by allergy.'
Nurse-led children allergy clinic: tips for best practice
*Undergo training in allergy, including history-taking, allergy testing, blood tests, differential diagnosis, treatment and management, anaphylaxis and psychological issues
*Establish guidelines and practice boundaries through clinical supervision
*Keep a holistic view of the family as well as the child with allergy
*If research is planned, develop study skills and make sure all investigations are completely ethical and closely governed by good research practice