Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • acute anaphylaxis:
    • difficult/noisy breathing
    • swelling of tongue
    • swelling/tightness in throat
    • difficulty talking and/or hoarse voice, wheeze, or persistent cough
    • persistent dizziness or collapse
    • persistent abdominal pain, vomiting after insect sting
  • adrenaline has been administered

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • patients under 17 years old
  • patients being treated for same condition at other hospital

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • anaphylaxis of unknown cause
  • anaphylaxis requiring adrenaline injector authorisation
  • anaphylaxis to insect sting, see Insect Venom Allergy CPC

Category 2 (appointment clinically indicated within 90 days)

  • anaphylaxis in patient who has an adrenaline injector
  • anaphylaxis of known cause to avoidable allergen

Category 3 (appointment clinically indicated within 365 days)

  • review of previous anaphylaxis for update of management plan

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Additional information to assist triage categorisation

  • recurrence
  • ability to avoid suspected trigger
  • for insect stings – specific IgE for culprit insect for instance, honeybee, common wasp, paper wasp, jumper ant
  • serum tryptase taken between 30 minutes and six hours after onset of anaphylaxis, baseline mast cell tryptase 24 hours after recovery
  • for medication allergy, please refer to Medication Allergy CPC

Clinical management advice

If acute anaphylaxis is present or suspected, see ‘referral to emergency.’ Otherwise:

  • phone relevant Local Health Network/on-call Allergy/Clinical Immunology Registrar/Consultant to consider eligibility for subsidised Pharmaceutical Benefits Scheme (PBS) authority for initial adrenaline injector (see ‘contacts for clinical advice’). Note adrenaline injector usually not indicated for drug allergy
  • complete Australasian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Anaphylaxis
  • ensure asthma is well controlled
  • educate on strict avoidance of suspected allergen
  • provide psychological support – alleviate alarm, assist in communication as required
  • consider medical alert bracelet
  • ensure allergy alert is in place within relevant patient records

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.