Respiratory

Our respiratory medicine service diagnoses and treats a wide range of respiratory diseases and problems. We see patients from across east London and Essex, and sometimes further afield. Our dedicated team includes respiratory specialists, specialist nurses and physiotherapists, dieticians and physiologists.

We care passionately about helping people with respiratory conditions. We put your needs at the centre of your care. We aim to motivate and empower you to co-manage your condition and to provide the resources you need to lead a good quality of life.

Conditions we treat include allergies, asthma, chronic obstructive pulmonary disease, chronic cough, bronchiectasis, cystic fibrosis, lung cancer, interstitial lung disease, complex breathlessness, sleep disordered breathing, home mechanical ventilation, and tuberculosis, including drug-resistant strains.

In addition, our team are involved in national and international respiratory research studies which aim to improve care for all respiratory patients. During your appointment, you may receive information about our research studies. Please speak to them if you are interested in joining.

Inpatient respiratory services

  • Newham Hospital
  • St Bartholomew’s Hospital
  • The Royal London Hospital
  • Whipps Cross Hospital

Outpatient respiratory clinics

  • Shrewsbury Road – Newham Hospital
  • Clinic 1 and 3 – ground floor, KGV building, St Bartholomew’s Hospital
  • Clinic 3 – The Royal London Hospital
  • Max Caplin Unit – 2nd floor, Mile End Hospital
  • Outpatient block, Whipps Cross Hospital

Allergy

The Barts Health adult allergy service is one of the country’s leading specialist centres, providing the very latest facilities and treatments for patients at St Bartholomew’s Hospital.

We provide specialist care for a range of conditions in adults (age 16+):

  • Allergy to wasp or bee venom
  • Anaphylaxis 
  • Chronic urticaria
  • Drug allergy
  • Food allergy
  • Moderate to Severe rhinitis
  • Latex allergy

Why choose us?

We are commissioned by NHS England and we provide specialised treatments such as immunotherapy (desensitisation) and biologic injections, as well as day case challenge testing with foods and drugs.

We accept referrals from GPs and other consultants and provide a holistic and multidisciplinary approach with doctors, nurse specialists, dietitians and specialised pharmacists.

We offer a one-stop clinic in which you will be assessed by one of our specialists. You will receive an appropriate allergy test and be given a self-management plan, with input from our specialist dietitian and nurse specialist.

Our aim is to see and diagnose most patients in just one visit, with further follow-up readily available if necessary. We use a number of different techniques and clinics to test for allergies which are listed below.

Tests and treatments

Skin prick test
Challenge test
Intradermal skin test
Specific IgE blood test
Prick test using fresh foods

Skin prick test

A small needle (lancet) is used to gently prick the skin through a droplet of fluid containing a known allergen. If the skin around the needle prick becomes itchy, red and swollen, in combination with a suggestive history, we are likely to be able to confirm your allergy. You will need to stop taking antihistamines for at least 72 hours before the test.

Challenge test

Challenge tests are used in cases where it is not possible to test for an allergy using a simple skin prick test or blood test in clinic e.g. in drug allergy or in cases of food allergy where the initial tests are inconclusive. Challenge testing is undertaken as a day case admission. It involves administering the substance that you are suspected to be allergic to. In the cases of drugs, this will be either by mouth or by injection depending on the drug. Therefore this kind of testing is under close medical supervision.

For some drugs, skin tests are also carried out at the same session.  If skin tests are positive, the challenge test may not be required. Full information about these tests, including written information, is given to you before we go ahead.

Intradermal skin test

A very small amount of the drug is injected just below the skin using a  small needle in your forearm to create a small bleb (swelling). A positive reaction will cause an  increase in the size of the bleb with redness and itching.

Specific IgE blood test

This is another way to test for allergies by taking a sample of blood and measuring the allergic antibodies (chemicals) in the bloodstream. It is suitable for patients unable to have skin prick tests, for example, those who cannot stop taking antihistamines or who have severe skin conditions, or where further information is needed after skin prick testing.

Prick test using fresh foods

You will need to bring in foods that you suspect you are allergic to which we will use for testing. A lancet is used to prick the food and then, the same lancet is used to prick your skin. After 15 minutes, the site is inspected to check for any reaction such as swelling.

Adrenaline auto-injector pen training
Allergen immunotherapy
Biologics

Adrenaline auto-injector pen training

Anaphylaxis is a severe allergic reaction with airway obstruction (difficulty in swallowing or breathing) or a drop in blood pressure (feeling faint or collapsing). The immediate treatment for this is adrenaline. After an extreme allergic reaction, you should always be seen in an emergency department and referred on to an allergy clinic.

If you are at risk of anaphylaxis, you will be prescribed an adrenaline auto-injector pen. There are three widely-used types of auto-injector pen: the Epipen, Emerade and Jext. They contain a single dose of adrenaline that can be injected into the body. The adrenaline helps open to the airways so that you can breathe and reverse any fall in blood pressure. Our nurse specialist will give you advice and practical training, using a ‘dummy’ pen for demonstrations.

Allergen immunotherapy

This treatment may be helpful for patients with severe allergic rhinitis due to pollens, animal dander or dust mite, when they have not responded to conventional treatment. It is also beneficial in those with significant with bee or wasp venom allergy.  The aim is to help the body tolerate the allergen so that in the long-term any reaction is not so severe and medication can be reduced.

A consultant will assess your suitability, and then if appropriate, you will start a three-year course of treatment. This involves having either subcutaneous injections (under the skin; used for both airborne and venom allergens) or sublingual tablets (dissolved under the tongue; used for airborne allergens but not venoms). You will be closely monitored after each injection, in case there are any side effects.

Biologics

This treatment is suitable for patients with severe chronic spontaneous urticaria who have not responded to conventional treatment. It involves up to six injections of anti-IgE monoclonal antibodies, at four weekly intervals. Suitable candidates are offered the chance to self-inject at home, after training, once they are established on the injections.

For clinicians

We accept referrals from GPs and other hospitals for allergy conditions as above. Treatments include allergen immunotherapy, biologic therapy and challenge testing.

We will not accept a referral for patients with:

  • Urticaria/angioedema of less than three months duration. In these patients, symptoms may resolve spontaneously
  • Gastrointestinal symptoms who have not identified a specific allergen - referral to a Gastroenterology clinic may be a preferable first step.

We do not offer patch testing. This is offered by dermatology at The Royal London Hospital. 

For patients aged under 16, please refer to the paediatric allergy service at The Royal London Hospital.

Allergy Service referral information for clinicians [pdf] 146KB

Asthma

We run general asthma clinics across Barts Health NHS Trust which focus on improving asthma care for the local populations.

We also run the regional Difficult and Severe Asthma Clinic at St Bartholomew’s Hospital.

General asthma

  • We provide general respiratory clinics and general asthma clinics across Barts Health NHS Trust, run by specialist doctors and nurses and tailored to each local site
  • Standard on-the-day tests are available to help with diagnosis and symptom management
  • We follow the local asthma care guidelines

Difficult and severe asthma

  • The North Central and East London Severe Asthma Service is based at St Bartholomew’s Hospital
  • We see patients with uncontrolled asthma symptoms or frequent asthma attacks who have already been seen by local asthma services and where a specialist opinion is needed
  • Patients undergo a severe asthma assessment. During the assessment you may see a physiotherapist; ear, nose and throat (ENT) surgeon; psychologist; pharmacist; dietician; speech and language therapist as well as respiratory doctors and nurses
  • We have over 350 patients on injectable biologic therapies and our specilalist team meet weekly to review new patients for potential advanced therapies not available at general hospitals
  • We accept referrals from across north east and north central London

Your care

Patients with well-controlled asthma have no regular asthma symptoms and no asthma attacks. We want all patients to reach that level of asthma control.  

We provide local care where possible and for more complex patients already on the strongest inhalers, we have a specialist team clinic at St Bartholomew’s Hospital.This may mean travelling a longer distance but some specialist services for severe treatment-resistant asthma are only available at this site.

Please be reassured that for patients needing to transfer between local care and the specialist clinic, we will guide you through the process.

Please bring any inhalers, including spacers, other medications and peak flow charts to your clinic appointments. If you are having lung function tests that morning please try to avoid your inhalers until after your tests. 

For clinicians

Please send referrals to the correct service where possible (referrals will otherwise be transferred internally as needed).

For advice on diagnosis and management of mild-to-moderate asthma, please refer to a General Respiratory or General Asthma Clinic at the closest local site.

For advice on patients with frequent exacerbations or uncontrolled asthma symptoms despite maximum-dose inhaled corticosteroids (severe and difficult asthma), please refer to the Difficult Asthma Clinic for Severe Asthma Service review.

Patients referred to the Difficult Asthma Clinic will undergo a multidisciplinary review – this can take some time and patients need to be aware that in the initial period they may need to attend appointments with several members of the team before any decision is made on prescribing advanced therapies.

Research

We have an active portfolio of clinical trial and laboratory science research in asthma and COPD, in collaboration with Queen Mary University of London and the William Harvey Clinical Research Centre, led by our academic asthma consultant, Dr Paul Pfeffer.  

These trials help improve the global understanding of airways disease and also allow some patients earlier access to advanced therapies in a safe, controlled environment.

With patient consent we contribute to the UK Severe Asthma Registry and International Severe Asthma Registry, with team members in the steering group for both.

We would like to thank our patients who have participated in this research.

Resources