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Since the publication of the BSACI guideline on the management of nut allergy (NA) in 2017 1, little is known regarding current practice across the United Kingdom (UK). Between 07 December 2022 and 03 February 2023, an online survey was disseminated through the BSACI and local allergy networks to BSACI members and non-members. Respondents completed a survey (available via link below) covering resources and case vignettes to assess approaches to diagnosis and management of NA. Aims of the survey included to audit compliance with the published diagnostic pathways, and to establish current dietary and medical management. Finally, we assessed regional differences in service provision and management of NA. A total of 249 healthcare professionals (HCPs) responded to the survey. Of respondents, 190 (76%) were BSACI members and 59 (24%) were non-members. The response rate amongst BSACI members was 19% (190/979). 219/249 (88%) of respondents exclusively managed paediatric patients; 105/190 (55%) of the BSACI members were paediatric allergists/paediatricians with allergy interest. Amongst respondents from the different UK regions, at least 92% had access to skin prick testing (SPT), 95% to specific IgE (sIgE) testing and 93% to written allergy plans. Overall, ≥99% respondents had access to a dietitian via a referral process except in the North (referring to Health Education England's North East and North West regions). There was a large observed disparity in access to a dietitian in clinic; 74% in London compared to 35% in the North. Only respondents from 3 NHS trusts (Ireland, Wales and London) reported psychologist access in clinic. Diagnostic accuracy to three case vignettes was determined by correct interpretation and application of the published diagnostic algorithm 1. Only BSACI member responses were audited (n = 190). Responses resulting in diagnostic accuracy for primary peanut allergy (PA) were 140/149 (94%) and 142/148 (96%) for pollen food syndrome (PFS). Despite typical histories of PA and PFS, 43/149 (29%) and 105/148 (71%), respectively, suggested component resolved diagnostics (CRD), which are not recommended. Only 89/146 (61%) suggested CRD for a case of PFS/primary hazelnut allergy (diagnostic uncertainty), although the algorithm supports its use. Medical and dietary management was evaluated in BSACI members (n = 190). Prescribing AAIs for cases of anaphylaxis to peanut (147/149 (99%) ) and PFS with no asthma (17/153 (11%) ) were consistent across respondents. In example cases 1, 3 however, this is consistent with previous BSACI surveys. It illustrates an important snapshot of the current state of NA diagnosis and management and better dissemination of guidance may improve adherence. However, further work is required if the allergy community wish to provide a consistent message to patients in relation to dietetic and AAI provision. G. S. , A. D. , A. T. C. and S. S. were involved in initial creation of audit questionnaire and execution of the project. F. N. collated and evaluated the data and all authors contributed to the writing and revision of the article. Dr. Gary Stiefel is principal investigator on the NATASHA study looking at Peanut and milk desensitisation and is a trustee for Allergy UK. Dr. Andrew Clark is Chief Medical Officer and stockholder in Camallergy Ltd. The data that supports the findings of this study are available in https: //osf. io/dvm3z/? viewₒnly=ed289c3a6c3d4aa9ab3a5190c8f282d2.
Norris et al. (Tue,) studied this question.