Paediatric Allergy
SPIN Training Guide and Portfolio
October 2013
Version 3
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Special Interest in Allergy (SPIN) Portfolio
In addition to their e-portfolio, trainees should keep a prospective special interest training portfolio (SPIN) of their developing allergy
competences. This will be reviewed by the CSAC at the completion of training.
This training record provides a format to demonstrate acquisition of allergy SPIN competences. The e-portfolio is complementary
to the training record and items contained within the e-portfolio can be referenced in the SPIN training record, and do not need to
be duplicated.
We recommend that the trainee use the following framework to display their training and competences.
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
Curriculum vitae
Allergy Training Experience
Clinical Competences
Teaching/Training Attended
Teaching and Appraisal
Clinical Governance
Research
Management
Additional evidence
Reflective Notes
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Overview
Evidence to demonstrate clinical competence
Trainees undertaking a SPIN module in allergy should provide evidence to demonstrate attainment of competency by referencing
completion of an e-portfolio work-based assessment [WBA] (eCBD, eDOPS etc.) or by including other evidence within the SPIN
portfolio. Examples of evidence could include notes from MDT case discussions, anonymised clinic letters, reflective notes or
evidence of further learning – i.e. notes during a postgraduate teaching/learning session or taught course. Trainees should also
keep a log of clinics held/attended and procedures performed.
Postgraduate taught courses
There are a range of formal training opportunities in allergy available to trainees. Trainees are expected to have attended not less
than 5 training days that are of a standard recognised for SPIN allergy during level 3 training. Appropriate training days would
include attendance at national and international conferences on allergy or national training days held by BSACI and BPAIIG. Local
training events may be acceptable providing they are of sufficient academic and educational quality and have been granted CPD
approval from RCPCH or its equivalent.
Trainees are strongly encouraged to undertake a formal postgraduate course, such as a Postgraduate Certificate in Paediatric
Allergy.
Imperial College, London
http://www1.imperial.ac.uk/medicine/teaching/postgraduate/allergyprogramme/
University of Southampton
http://www.southampton.ac.uk/postgraduate/pgstudy/programmes/medicine/msc_pg_dip_pg_cert_allergy.html
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In addition,
 It is expected that trainees participate actively in local and regional subspecialty interest groups

They are strongly encouraged to join their preferred national &/OR european professional organisation, i.e. British Society of
Allergy & Clinical Immunology (BSACI), European Academy of Allergy & Clinical Immunology (EAACI), British Paediatric
Allergy, Immunology & Infection Group (BPAIIG),.
In your e-portfolio list all relevant postgraduate taught courses, professional memberships, and conferences attended. Include
evidence of your attendance such a certificates, programmes, membership certificates etc.
Teaching and appraisal
Evidence of formal and informal teaching/assessment of students, trainees and other healthcare professionals. Include evidence of
the evaluation and feedback of your teaching. Evidence of courses attended on education, appraisal and assessment.
Clinical governance
Provide evidence of participation in clinical governance activity. SPIN trainees are expected to have participated in at least 1 audit
that relates to a quality improvement issue within allergy.
Include evidence of attendance at critical incident meetings, MDT meetings & clinical guideline development.
Research
Trainees are expected to develop a practical understanding of clinical research and be able to interpret critically the evidence base.
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Involvement in collaborative multi-centre research is encouraged, specifically to gain experience of research ethics, research
governance and patient recruitment processes.
Management
Evidence of participation in management meetings and projects. This could include participation in a trainees’ group, chairing of an
MDT meeting, service development, complex patient care review, planning for food or drug challenge, immunotherapy etc.
Additional evidence
Trainees may wish to submit evidence of clinical training not covered elsewhere.
Reflective Practice
One reflective account should be completed for every 3 months in SPIN training. A potential template for your reflection is shown
below.
 Date, trainee
 Describe the clinical event in non identifying terms
 What did I think and feel?
 What were the context / factors which had an influence on the event?
 What did I do / say that was effective in the situation?
 What happened that exacerbated the problem?
 What was the outcome for the patient / parent / myself / others?
 Looking back what could I have done differently?
 What were the key learning point(s) from this event?
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Assessment framework
An Educational Supervisor (ES) should be allocated by the training centre and be responsible for the overall training, career advice,
progression and assessment of the trainees, preferably throughout their training period. The ES should be identified to the CSAC
and be familiar with the allergy SPIN programme. They should have a clinical interest in Paediatric Allergy and work as part of a
regional or national allergy network.
Additionally, a clinical supervisor (CS) should be allocated to oversee and supervise clinical work and may change as trainee
rotates through different posts. Educational and clinical supervisor should both support review of competence attainment in line
with the SPIN curriculum. Local RITA or ARCP should be conducted yearly through the Deanery School of Paediatrics.
The plan for SPIN training should be submitted prospectively to CSAC by trainee after discussion with ES / Deanery School of
Paediatrics.
SPIN training led by a secondary care allergy unit will be required to demonstrate appropriate opportunities for the trainee to attend
a regional allergy centre to demonstrate curriculum outcomes. If the regional paediatric specialist does not have a formal
supervisory role (ie, out with trainee’s Deanery) he/she should contribute to portfolio building & assessed competences.
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Section 2: General Competences in Paediatric Allergy
Competence
Have the knowledge and skills to take an allergy-focused history
and initiate management of patients presenting with common
allergic disorders, both in in-patient and out-patient settings.
Be familiar with the genetic, immunological, clinical,
epidemiological and psychosocial aspects of allergic conditions.
Be familiar with the concept and process of transition – from
secondary to primary care services, and from paediatric to adult
allergy services.
Be able to describe and explain to children, young people and
their parents or carers the rationale and methods of treatment in
terms they will understand.
Understand the importance, and have experience of
participation in a multidisciplinary team (including specialist
nurses and dietitians) and other professionals involved in the
care of children with allergic disease.
Potential source of evidence for attainment
Case reflections; Case based discussions (ePaedsCbD); Clinical
examination exercises (Paeds-Mini-CEX); log of inpatient and
outpatient cases seen; critical appraisal of cases, comparing
management to local and national guidance (guideline; care
pathways)
Attendance at taught course/conference, including reflective
notes on learning gained; presentation given, including evidence
of further reading; reflection on specific case, including evidence
of further reading.
Attendance at transition clinics, including log of patients seen;
relevant Case based discussions (ePaedsCbD); Clinical
examination exercises (Paeds-Mini-CEX); reflection on specific
case, including evidence of further reading.
Clinical examination exercises (Paeds-Mini-CEX) focusing on
communication skills; attendance at nurse specialist clinic,
including reflective note on learning gained.
Case reflections; Case based discussions (ePaedsCbD) where
MDT input to care is highlighted; feedback from team members
(ePaedsMSF).
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Be aware of, and have experience of the development of local
allergy care guidelines & referral pathways within a clinical
network.
Attendance at regional clinical network meetings; development
&/or appraisal of care guidelines/referral pathways; presentation
given, including evidence of further reading
Understand the national drivers for allergy care and service
delivery.
Attendance at taught course/conference, including reflective
notes on learning gained; development &/or appraisal of care
guidelines/referral pathways; presentation given, including
evidence of further reading
Understand how audit/quality improvement projects can
enhance service delivery.
Complete at least 1 audit/quality improvement project that
addresses an allergy care issue.
Be able to lead an allergy service in a secondary care setting.
Attendance at regional clinical network meetings; development
&/or appraisal of care guidelines/referral pathways; complete at
least 1 audit/quality improvement project that addresses an
allergy care issue; other leadership & management experience.
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Section 3: Specific Clinical Competences in Paediatric Allergy
Suggested
Evidence types
How achieved (portfolio reference)?
Good clinical care
1
2
Be able to assess and advise on the future risk of anaphylaxis and allergic
reactions and facilitate an appropriate management plan by liaising with
community teams.
WBA; clinic letter;
guideline
development
Be able to identify factors which exacerbate acute atopic conditions, to advise
parents and families appropriately about allergen reduction and avoidance at
homes and in schools.
Taught course;
WBA; clinic letter;
guideline
development
WBA; clinic letter;
reflection; taught
course
3
Have the knowledge and skills to be able to assess and initiate acute and
long‐term management of children.
4
Be able to manage, investigate and follow up children presenting with allergic
conditions.
WBA; clinic letter;
reflection; taught
course
5
Recognise the role of allergy in poly-symptomatic illness and behavioural
problems, investigate and adjust management plans appropriately.
WBA; clinic letter;
reflection; taught
course
9
Suggested
Evidence types
6
Know and understand the use and limitations of skin‐prick testing and
measurement of total and specific IgE.
WBA; clinic letter;
reflection; taught
course
Know about alternative allergy testing and methods of treating allergies.
WBA; clinic letter;
reflection; taught
course
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How achieved (portfolio reference)?
Safe-prescribing
Know common allergen cross‐reactivities.
Taught course;
presentation; WBA;
clinic letter
Know and understand indications and contra‐indications for specific allergen
immunotherapy.
Taught course;
presentation;
guideline
development
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9
Maintaining Good Medical Practice
Know and understand basic allergy mechanisms.
Taught course;
presentation;
personal reading
Know and understand the immuno‐pathogenesis of the immediate and late
phase allergic response.
Taught course;
presentation;
personal reading
10
11
10
Suggested
Evidence types
12
Know and understand the pathophysiology and the principles of treatment of
allergic disorders.
Taught course;
presentation;
personal reading
13
Understand the epidemiology, clinical history and natural history of common
allergic conditions.
Taught course;
presentation;
personal reading
Know about primary and secondary prevention of atopic disease.
Taught course;
presentation;
personal reading
15
Work closely with the dietetic team to manage nutrition in children with allergic
conditions.
WBA; clinic letter;
reflection; MDT
minutes
16
Be able to recommend nutritionally adequate allergen avoidance diets in infants
and children.
WBA; clinic letter;
reflection; MDT
minutes
Understand how manifestations of allergic disease change during adolescence.
Taught course;
presentation;
personal reading;
WBA; clinic letter
14
17
How achieved (portfolio reference)?
Relationships with patients
Be able to advise on the appropriate use of adrenaline.
WBA; clinic letter
18
11
Suggested
Evidence types
19
Understand and be able to advise parents and young people on current
controversies on allergy prevention, such as allergen avoidance in pregnancy
and infancy and the hygiene hypothesis.
How achieved (portfolio reference)?
WBA; clinic letter;
taught course;
personal reading;
reflection
Working with colleagues
20
Be able to co‐ordinate local support for children at risk of anaphylaxis at home
and in schools and be able to advise about the safety and efficacy of
immunotherapy injections.
Be able to run an effective sublingual immunotherapy service.
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Be able to run a food challenge service effectively.
Guideline
development; clinic
log; WBA
Be able to compile management plans for children at risk of anaphylaxis and
ensure that mechanisms are in place to allow them to be followed in the
community.
Clinic letter; clinical
network meeting;
guideline
development;
Membership/Confer
ence attendance
certificate
22
23
24
Clinic letter; clinical
network meeting;
guideline
development;
personal reading;
taught course
Guideline
development; clinic
log
Know about and have participated in specialist meetings relevant for clinicians
with an interest in allergy (e.g. BSACI, EAACI).
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Allergy
General allergy
Suggested
evidence types
25
Know the specificity, sensitivities and predictive values of skin‐testing and in vitro IgE antibody
measurements for individual allergens.
Taught course;
WBA; clinic letter
26
Be aware that these values vary with the allergen involved, the manufacturer the purity of the
product and the relative content of the allergen.
Taught course;
WBA; clinic letter
27
Identify patients who present symptoms mimicking allergy and know how to refer them to other
specialists.
WBA; clinic letter;
MDT minutes;
referral letter
28
Know and be able to recognise the relationship between food allergy, eczema, failure to thrive,
asthma and rhinitis.
Taught course;
WBA; clinic letter;
MDT minutes
WBA; clinic letter
29
Know and understand pet allergy and be able to advise sympathetically about reducing
exposure to animals.
How achieved?
Anaphylaxis
Ensure that guidelines for the management of anaphylaxis are implemented.
30
Guideline
development;
audit; clinic letter;
clinical network
minutes
13
31
Be able to advise about and interpret investigations performed immediately following acute
allergic reactions.
Taught course;
WBA; guideline
development; audit
32
Be able to identify precipitating causes using ingestion history and serial tryptase levels, as
appropriate
Taught course;
WBA; guideline
development; audit
Food Allergy
Know the common and uncommon foods that trigger IgE mediated and non IgE mediated
hypersensitivity reactions
Taught course;
reflection; WBA;
clinic letter
34
Know the mechanisms of IgE and non‐IgE food hypersensitivity reactions, including
eosinophilic enteropathy and food intolerances due to pharmacological effects of food or
enzyme deficiencies, and be able to explain this to parents.
Taught course;
reflection; WBA;
clinic letter
35
Be able to recognise multiple presentations of food allergy, be able to interpret a dietary diary
and be able to advise about its management, including the risks and benefits of avoidance
diets, use of alternative and hypoallergenic milk formulas and a hypoallergenic weaning diet.
Taught course;
reflection; WBA;
clinic letter
Know the indications for food challenges, challenge protocol procedures and safety
precautions.
Taught course;
guideline
development;
network minutes;
audit
Taught course;
guideline
development;
WBA; clinic letter;
audit
33
36
Be able to use measurement of specific IgE and skin test results to optimise the timing of food
challenges.
37
14
Be able to advise about the safe re‐introduction of food following a negative food challenge.
38
Taught course;
guideline
development;
WBA; clinic letter;
audit
Taught course;
reflection; WBA;
clinic letter
39
Know the relationship and cross‐reactivity between food, pollen and food, and latex and be able
to advise children and their families appropriately.
40
Be able to recognise the distinction between food allergy and oral allergy syndrome and advise
patients appropriately.
Taught course;
reflection; WBA;
clinic letter
41
Know how to assess future risk of allergic reactions and which children require the prescription
of injectable adrenaline.
Taught course;
reflection; WBA;
clinic letter
Eczema
42
Understand the role of allergen triggers and avoidance in the pathogenesis and management of
eczema and be able to advise children and their families appropriately.
Taught course;
reflection; WBA;
clinic letter
43
Know the role of diet in the pathogenesis of eczema and be able to advise appropriately about
dietary modification.
Taught course;
reflection; WBA;
clinic letter
44
Know the role of exposure to airborne allergens in the pathogenesis of eczema and be able to
advise appropriately about reducing exposure.
Taught course;
reflection; WBA;
clinic letter
Be able to examine and assess the severity of eczema in an affected child.
WBA; clinic letter
45
15
46
Know the sensitivity and specificity of measuring total and specific IgE and skin testing in
children with eczema and be able to investigate them appropriately.
Taught course;
reflection; WBA;
clinic letter
47
Be able to manage patients with severe eczema including the use of emollients,
anti‐inflammatory preparations and wet wraps.
WBA; clinic letter;
MDT minutes; clinic
log
Urticaria and Angioedema
48
Be able to manage and investigate patients presenting with an acute exacerbation of
angioedema.
Taught course;
reflection; WBA;
clinic letter
Be able to identify precipitating causes and advise about future avoidance.
Taught course;
reflection; WBA;
clinic letter
Know the definition causes and exacerbating factors of acute and chronic urticaria and
angioedema.
Taught course;
reflection; WBA;
clinic letter
Be able to investigate and manage children with acute and chronic urticaria.
Taught course;
reflection; WBA;
clinic letter
49
50
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Asthma and recurrent wheeze
Be able to identify allergen exposure as a cause of acute exacerbations of asthma.
52
Taught course;
reflection; WBA;
clinic letter
16
53
Know the role of allergy testing and allergen avoidance in managing children with asthma and
be able to advise families about allergen reduction measures.
Taught course;
reflection; WBA;
clinic letter
54
Know the concept of the unified airway and the importance of the treatment of rhinitis in
patients with asthma.
Taught course;
reflection; WBA;
clinic letter
Be able to advise about the effective methods of reducing exposure to house dust mite.
Taught course;
reflection; WBA;
clinic letter
Be able to interpret spirometry, pulmonary function testing and exercise challenge testing.
WBA; reflection;
clinic letter
Understand the changes in asthma which occur during adolescence including remission and
deteriorating asthma control.
reflection; WBA;
clinic letter
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56
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Rhinoconjunctivitis
Know the definitions of seasonal and perennial disease and exacerbating factors.
Taught course;
reflection; WBA;
clinic letter
Know about the aerobiology of pollen.
Taught course;
reflection; WBA;
clinic letter
Be able to diagnose accurately allergic rhinitis and conjunctivitis, know the differential
diagnosis, management guidelines and principles of therapy.
Taught course;
reflection; WBA;
clinic letter
58
59
60
17
61
Be able to advise young people and their families about the effective application of eye drops
and nasal sprays and identify patients who would benefit from pollen immunotherapy.
WBA; clinic letter;
reflection
Be able to diagnose the common cross‐reacting allergens relevant to the oral allergy syndrome.
WBA; clinic letter;
reflection; taught
course
62
Venom Allergy
Know the clinical features and grading of local and systemic reactions to insect stings.
WBA; clinic letter;
reflection; taught
course
Know when to refer patients for venom immunotherapy
WBA; personal
reading; clinic
letter; taught
course
63
64
Latex allergy
65
66
Be able to diagnose latex allergy, including skin prick testing, measurement of specific IgE and
provocation tests.
WBA; clinic letter;
reflection; taught
course
Be able to advise about the practical management of patients with latex allergy, including
avoidance and use of latex free alternatives; at home, in schools and nurseries, in dental clinics
and hospitals.
WBA; clinic letter;
reflection; taught
course; guideline
development
Reflection;
guideline
development
Know about hospital latex policies and be able to advise about their implementation.
67
18
68
Be able to identify cross‐reacting latex allergens in common foods and advise patients
accordingly.
WBA; clinic letter;
reflection; taught
course
Idiopathic anaphylaxis
Be able to investigate idiopathic anaphylaxis appropriately and exclude common causes.
WBA; clinic letter;
reflection; taught
course
70
Know the differential diagnosis including exposure to unusual allergens, exercise induced
anaphylaxis and systemic mastocytosis.
WBA; clinic letter;
reflection; taught
course
71
Be able to advise a family with a child at risk of anaphylaxis about prevention, rescue
medications and prognosis.
69
WBA; clinic letter;
reflection
Immunology & Infectious Diseases
Know the immunological basis of allergic disorders.
Taught course
Know how to manage acute anaphylaxis.
WBA; clinic letter;
reflection; guideline
development
72
73
19
74
Know in depth the UK national vaccination schedule, its continued development and its
differences from other nations.
Taught course; WBA;
clinic letter
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Section 4: Practical Procedures in Paediatric Allergy
1
Safe obtaining and handling of clinical specimens
WBA
2
Skin prick testing
WBA
3
Demonstration of asthma Inhaler technique
WBA
4
Simple spirometry
WBA
5
Eczema cream and dressing application
WBA
6
Demonstration of intranasal steroid technique
WBA
7
Adrenaline autoinjector training
WBA
8
Emergency management of anaphylaxis
WBA
21
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