Respiratory

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

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

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

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

• Asthma + Lung UK
• RightBreathe

Patients do not always present with a known diagnosis, they often present with symptoms such as breathlessness or cough. With this in mind, Barts Thorax Centre runs specialist breathlessness and cough clinics both for patients in our local area and more widely.

Breathlessness 

• Breathlessness is a common symptom, sometimes the diagnosis may be clear and you can be referred to the appropriate clinic such as Asthma or COPD.  
• Sometimes the diagnosis is less obvious or the symptom of breathlessness may be felt to be worse than might be expected.  
• This clinic is especially designed for patients with either an unclear diagnosis or disproportionate symptoms with a ‘one stop shop’ approach with same day breathing tests and Specialist Respiratory Physiotherapist review.

Cough 

• We run a pair of specialist cough clinics, one linked to the Breathlessness Clinic at Mile End Hospital and the other at Whipps Cross University Hospital.
• If you have had a cough for more than 3 weeks or have other associated symptoms like fever, chest pain or weight loss it is important that you see your GP who should arrange a chest x-ray.
• If no cause is found on your chest x-ray and your cough carries on for more than 2-3 months then we call this ‘chronic cough’ and this is the clinic for you.

Meet the team 

We run a dedicated symptoms based service led by a Consultant Chest Physician (Dr Will Ricketts) with a special interest in this field.  The clinic also has specialist Respiratory Physiotherapists and Physiologists to facilitate a streamlined ‘one stop shop’ approach, as well as working closely with colleagues in Barts Heart Centre.

Cough is not always a lung problem and we work closely with other specialities such as Ear, Nose and Throat (ENT) Surgeons, Speech and Language Therapists (SLT) and Gastroenterologists to ensure the right approach for you.

This multidisciplinary approach ensures all patients are assessed in personalised and holistic manner.

Our tests and diagnosis 

We have access to the majority or Respiratory Physiology testing as part of a one stop shop approach in the clinic at Mile End Hospital.  Patients requiring more complex tests or a larger number of tests may be asked to attend St Bartholomew’s Hospital in advance of their appointment to ensure that these tests are done and reviewed in time. 

Most chronic cough requires no further tests and we take a personalised patient centred approach to optimise management for you, however where further investigation is required we have access to all the latest scanning, endoscopy and physiology testing at our hospitals.

We are able to offer a wide range of state of the art testing to investigate breathlessness and cough including:

• Spirometry
• Gas transfer
• Impulse oscillometry (IOS)
• Cardiopulmonary exercise testing (CPET/CPEX)
• FENO
• Respiratory muscle assessment 
• High resolution and spectral CT scanning
• Lung perfusion scanning including SPECT
• Thoracic ultrasound
• Echo including specialist echo’s such as stress and bubble testing
• Upper GI Physiology/pH manometry

Patient preparation

You may be asked to complete various questionnaires in advance of your appointment and bring the results with you.

We also may ask you to complete assessments at home between appointments in order to expedite your diagnosis and treatment via a process called PIFU (patient initiated follow-up) putting you in more control of your care.

Research

We work closely with academic colleagues at Queen Mary University of London (QMUL) to ensure that patients are able to access the latest clinical trials and technology relevant to this evolving field of medicine.

The Barts Health chronic obstructive pulmonary disease (COPD) service falls within our general respiratory services. Patients are seen if they remain symptomatic despite optimising treatment following the community guidelines, or if there is diagnostic doubt. The outpatient services operate at all four hospital sites.

There is high value in having COPD interventions as part of routine COPD care. Therefore, we work closely with the community respiratory teams and the wider health care system to support local GP practices with the management of COPD patients.

The Barts Health severe COPD service specialises in the management of patients with severe obstructive lung function for consideration of lung volume reduction strategies if they have predominant emphysema (a type of COPD).

This dedicated Severe COPD only clinic operates at Mile End Hospital, in the heart of our local community.

We have an active portfolio of clinical research in COPD in collaboration with Queen Mary University of London and the William Harvey Clinical Research Centre, led by our academic consultants, Dr Paul Pfeffer and Dr Heinke Kunst, and encourage participation in research studies from primary care.

Our tests and diagnostics

Where possible you will have local access to your appointment. However more complex tests and procedures will take place at our specialist clinics at the Royal London or St Bartholomew’s hospitals.

In particular our specialist clinic at Mile End Hospital sees patients with confirmed spirometric evidence of COPD (that is a predicted FEV1 <50%, with a need for ongoing secondary care input).

To further assess the pattern of your COPD symptoms, we may recommend you undergo further tests including the following: 

• Detailed pulmonary function testing including gas transfer and lung volumes
• High resolution CT scans
• Echocardiograms
• Nuclear medicine quantitative perfusion scan
• COPD assessment test (assessment of how COPD affects patients symptoms)
• MRC dyspnoea (score to  assess breathlessness)

Why choose us?

Our specialist and multidisciplinary service

We run a monthly severe COPD MDT to assess patients for surgical intervention for emphysema, such as lung volume reduction surgery or endobronchial valve insertion.

As well as local patients, our service extends across north east London to include referrals from neighbouring trusts including Southend, Basildon, Colchester and Princess Alexandra. 

Our team consists of specialist respiratory physicians, thoracic surgeons and radiologists who are dedicated to providing specialist and detailed investigations to better understand your ‘COPD phenotype’ and identify distinct features or patterns of your condition. This will facilitate the provision of a personalised and effective management of your condition. 

To further facilitate this, we also work closely with the sleep and ventilation and breathlessness service, and with St Joseph’s Hospice for the management of complex COPD patients

Useful links

• British Lung Foundation support

We care for patients with a wide range of chest or lung conditions as inpatients and outpatients.

We provide inpatient care at The Royal London Hospital. We also offer general respiratory outpatient clinics at The Royal London, Mile End and St Bartholomew's hospitals.   

We care for patients with a variety of conditions such as asthma, bronchiectasis, COPD and chronic cough working collaboratively with sub-specialty clinics should the need arise. 

We see patients with symptoms of chronic breathlessness and chronic cough.  

Our service includes:

• Diagnostics
• Inpatient wards at The Royal London Hospital 
• Outpatient reviews at Mile End Hospital, Royal London Hospital and St Bartholomew’s Hospital.
• Admission avoidance and supported discharge via the ArCARE team (Tower Hamlets only)

You will have been referred by your GP or by another specialty to our service. We may organise some tests before your first appointment.

You may require tests such as a chest x-ray, lung function tests, blood tests or a CT scan of your chest as part of your assessment.  

Our team includes:

• Doctors
• Nurses
• Physiotherapists (inpatient and outpatient)
• Inpatient (ward) Occupational Therapists
• Inpatient (ward) Speech and Language Therapists
• Inpatient (ward) Dieticians 
• Physiologists (lung function dept.)
• Tobacco cessation support (inpatient and outpatient)
• Administration staff

We work closely with other services and teams like the ArCARE team, home oxygen team and other hospital specialists.

Contact us

• For appointment changes call 020 7767 3200
• Ward 13E Royal London Hospital on 0203 7642878 
• Ward 13F Royal London Hospital on 0203 7642907
• Respiratory admin email address for other queries: bhnt.respiratory-admin-sbh@nhs.net

Why choose us?

We offer thorough respiratory assessment and management of all general respiratory conditions and work alongside the sub-specialty services listed below as needed.  

• Severe asthma
• Allergy
• Breathlessness
• Bronchiectasis
• Chronic obstructive pulmonary disease (COPD)
• Interstitial lung disease (ILD)
• Lung cancer
• Pulmonary nodule clinic
• Sleep apnoea
• Tuberculosis

We are continuously reviewing and improving the service we provide and welcome feedback from our patients to help us do so.

For clinicians

GP referrals can be made via ERS – Advice and Referral system

Referrals from other hospital doctors can be made to Professor Neil Barnes,  Dr Kunst, Dr David Simcock or Dr Nanak Singh, Dr Stephanie Uys and Dr Veronica White.

Clinics

• St Bartholomew’s Hospital: Dr Kunst, Dr White, Dr Uys
• Mile End Hospital: Professor Neil Barnes
• Royal London Hospital: Dr Simcock, Dr Singh

Research

We have studies running at various times. Please contact the team if you are interested 

Useful links

• NHS England information on living with COPD
• British Lung Foundation support
• Help to stop smoking
• Breathe Easy support groups

We care for people with patient experiencing sleep disorders and with long term respiratory failure who need support from a ventilator (breathing machine). We are one of the largest services in the UK.

We work closely with our lung function department to perform specific tests to diagnose sleep disordered breathing.

After diagnosis, we will suggest the treatment that best suits the individual patient – this may be non-invasive ventilation (NIV) or Continuous Positive Pressure (CPAP). Once treatment has been agreed, you will be seen as an outpatient or inpatient depending on what machine you need. You will be seen by a specialist member of the sleep ventilation team who have a range of devices and interfaces to ensure your comfort.

Our specialist team cares for patients with problems related to:

• Sleep apnoea – obstructive sleep apnoea and central sleep apnoea
• Obesity related breathing disorderss
• Chest wall disorders, Chronic lung disease or neuromuscular conditions with respiratory failure

Our service includes:

• Diagnostics 
• Inpatient ward 
• Daycase unit
• Outpatient review 
• Outreach service
• Supported discharge with remote monitoring as appropriate

You will have been referred by your GP or another hospital to our service. We may organise some tests before your first appointment.

CPAP

This is mainly an outpatient service. After all your tests, if you need to start CPAP, you will be offered appointment with our specialist technicians or practitioners to start your treatment.

Follow up is provided through physiotherapy or medical led clinics and we offer telephone follow up to minimise the need for hospital visits.

If you have any problems with your machine or mask, contact the team on 0203 765 8390 or email sleepvent.bartshealth@nhs.net.

For CPAP machine breakdowns: Monday to Friday 08.00-16.00: contact 0203 765 8390 or sleepvent.bartshealth@nhs.net.

NIV

Based on your referral and depending on your initial diagnosis and needs, you will be offered either an inpatient, outpatient or day case review.

Our specialist ward is based at St Bartholomew’s hospital where people with more complex sleep and ventilation disorders may be admitted to investigate and treat their condition.  The day case unit is based on the ward. 

If you are planning to fly, please contact us via the respiratory administration email address so that we can advise whether any precautions or investigations are required before you travel.  We recommend that you contact us before making any arrangements. 

For NIV machine breakdowns: Monday to Friday 08.00-16.00: contact physio 0203 765 8390. Out of hours e.g. overnight and weekends, contact 4D ward on 0203 7658368 or 0203 7658374.

Our team

Our team includes

• Doctors
• Nurses
• Physiotherapists
• Sleep ventilation practitioners and technicians
• Physiologists (in lung function)
• Administration staff
• Clinical Engineers
• Inpatient (ward) Occupational Therapists
• Inpatient (ward) Speech and Language Therapists
• Inpatient (ward) Dieticians 

We work closely with other services and teams like lung function, the neuromuscular and metabolic services, Ear, Nose and Throat specialist and Orthodontics across our area.

Contact us

Appointment queries

020 7767 3200 or bhnt.respiratory-admin-sbh@nhs.net

Physiotherapy

For problems with your machine or if you require new consumables e.g. mask, tubing or filters: 0203 765 8390 or email sleepvent.bartshealth@nhs.net. Non urgent requests will be replied to within 48 working hours.

Contact Ward 4D on 0203 7658368 or 0203 7658374.

If you wish to contact us regarding DVLA or TFL forms, please contact the admin team on bhnt.respiratory-admin-sbh@nhs.net  

Why choose us?

We have a highly specialised multi-disciplinary team who continuously aim to provide prompt investigation and treatment for patients with sleep and ventilation issues.  To do this we have recently introduced the following features to our service:

• Highly specialised multidisciplinary team
• Outreach physiotherapy service to ensure you receive support at home
• Introduction of remote monitoring system for sleep and ventilation devices 
• Virtual clinics to reduce travel time for our patients
• Day case unit

We are continuously reviewing and improving the service we provide and welcome feedback from our patients to help us do so.

For clinicians

GP referrals can be made via ERS. Referrals from other hospital doctors can be made to Dr  Andrea Benjamin, Dr Prina Ruparelia, Dr David Simcock or Dr Nanak Singh.

For internal hospital transfers please contact the consultants above via NHS mail.

Research

We have studies running at various times. Please contact the team if you are interested.

Useful links

• NHS England: living with COPD
• British Lung Foundation information

The following guidance has been produced for patients by our respiratory service:

Bronchoscopy patient information leaflet [pdf] 915KB

Endobronchial ultrasound (EBUS) patient information leaflet [pdf] 688KB