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.

  • angioedema affecting oropharyngeal or laryngeal mucosa (e.g. presence of stridor)
  • anaphylaxis*. Symptoms include:
    • difficult/noisy breathing
    • swelling of tongue
    • swelling/tightness in throat
    • difficulty talking and/or hoarse voice, wheeze, or persistent cough
    • persistent dizziness or collapse
    • pale and floppy in young children
    • persistent abdominal pain, vomiting are signs of severe allergic reaction to drugs/insects
  • symptoms have required the administration of adrenaline

*Refer to the Australasian Society of Clinical Immunology and Allergy (ASCIA) Guidelines – Acute Management of Anaphylaxis for the definition of and recommended treatment for anaphylaxis.

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

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

  • Flinders Medical Centre (08) 8204 5511, after hours on-call service for patients of all ages until 11:00 pm

Women’s and Children’s Hospital Network


Exclusions

  • idiopathic urticaria less than 6 weeks duration
  • acute self-limiting episodes of urticaria and/or angioedema in a child less than five years old without suspicion of allergic cause, viral infection is the most likely cause
  • urticarial vasculitis. Urticaria lasting greater than 24 hours, with associated bruising - refer to Dermatology

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • angioedema with:
    • low complement component 4 (C4)
    • suspected hereditary angioedema (HAE) - family history, recurrent episodes of angioedema without urticaria, associated abdominal pain and vomiting, associated upper airway obstruction (stridor) 

Category 2 (appointment clinically indicated within 90 days)

  • recurrent angioedema of unknown aetiology
  • idiopathic urticaria greater than six weeks duration
  • physical urticaria, e.g. cold urticaria

Category 3 (appointment clinically indicated within 365 days)

  • nil

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.

  • duration and site of urticaria and/or angioedema
  • history of autoimmune disease, lymphoproliferative disorders
  • family history
  • complement component 4 (C4) level for patients with recurrent angioedema without urticaria
  • suspected possible etiologic factors including allergic precipitants (e.g. drugs, food, venom)

Additional information to assist triage categorisation

Investigations are usually normal in chronic urticaria. Where relevant, consider:

  • full blood count (FBC)
  • erythrocyte sedimentation rate (ESR)
  • anti-thyroid peroxidase (anti-TPO) antibody, thyroid function
  • H. Pylori serology
  • antinuclear antibody (ANA), antineutrophil autoantibodies (ANCA) 
  • complement component 3 (C3),  C4
  • C-reactive protein (CRP)
  • electrolytes, urea and creatinine (EUC)
  • liver function tests (LFTs)
  • stool ova, cysts, parasites (OCP), stool nucleic acid amplification testing (NAT)

Allergy & Anaphylaxis Australia have trained health professionals (doctors, registered nurses and dietitians) responding to clinician and consumer enquiries through the:

Clinical management advice

  • although angiotensin-converting enzyme (ACE)-inhibitors are not commonly prescribed in children, please note that they can cause angioedema and alternatives should be considered
  • idiopathic urticaria less than sx weeks duration is likely self-limiting and can be managed with high dose non-sedating antihistamines (Zyrtec 0.25mg/kg/dose BD, Singulair 4mg or 5mg)
  • chronic urticaria with or without angioedema is very rarely associated with food allergy - allergy testing (including skin testing) and/or dietary restriction is rarely indicated
  • some exacerbating factors may need avoidance (e.g. NSAIDs, spicy food, heat, tight clothing)

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.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.