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.

  • Food Protein Induced Enterocolitis Syndrome (FPIES) with symptoms including:
    • unwell child
    • pale and floppy
    • lethargic
  • 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.

For more information on symptoms of FPIES, see ASCIA FPIES. 

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


Inclusions

  • suspected IgE- or non-IgE mediated food allergy i.e. the following in response to a food trigger
  • symptoms of 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
    • pale and floppy in young children
    • persistent abdominal pain, vomiting are signs of severe allergic reaction to drugs/ insects
    • swelling of lips, face or eyes
    • hives or welts
    • abdominal pain or vomiting, excluding carbohydrate malabsorption, refer to exclusions
    • severe eczema in young children which is unresponsive to treatment, refer to Eczema CPC
  • specific IgE blood test is positive and patient has associated symptoms on exposure to the test food (note positive specific IgE levels where the food is tolerated without symptoms is unlikely to be clinically relevant. See Clinical Management Advice for further information.

Exclusions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • anaphylaxis related to food, also see Anaphylaxis CPC
  • infants less than 12 months of age with food allergy where there is likely to be delayed introduction of a likely tolerated food, see clinical management advice
  • allergy to multiple foods, including at least two staple foods – i.e. wheat, egg, dairy, soy
  • associated feeding disorder, unable to ingest solids in any form after eight months of age
  • associated severe faltering growth or at risk of nutritional compromise
  • suspected Food Protein Induced Enterocolitis Syndrome (FPIES), see clinical resources
  • severe recalcitrant eczema in a child less than 5 years old where there is a pattern of consistent eczema exacerbations following consumption of specific food/s, see Eczema CPC. Please note concurrent referral to dermatology is recommended for these patients.

Category 2 (appointment clinically indicated within 90 days)

  • allergy to non-staple food/s (peanut/nuts/seeds/seafood) which may significantly impact on diet and cannot be easily avoided
  • allergy to one staple food in child greater than 12 months of age
  • infants less than 12 months of age with food allergy where does not otherwise meet category 1 criteria

Category 3 (appointment clinically indicated within 365 days)

  • allergy to non-staple food/s with a low impact on diet that can be easily avoided

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.

  • past medical history including any previous anaphylaxis
  • identification of trigger foods; symptoms, including timing of reaction
  • excluded foods
  • concerns about feeding disorders or faltering growth
  • if patient uses formula, please specify which formula used
  • current medications

Additional information to assist triage categorisation

  • results of any previous allergy testing
  • weight, height
  • faltering growth investigations if relevant
    • complete blood picture (CBP)
    • electrolytes, urea & creatinine (EUC)
    • liver function tests (LFTs)
    • albumin
    • calcium, phosphate and magnesium
    • immunoglobulin G, A and M levels
    • vitamin D
    • C-reactive protein (CRP)
    • iron studies
    • vitamin B12
    • folate
    • zinc
    • thyroid function

Allergy & Anaphylaxis Australia have trained health professionals (doctors, registered nurses and dietitians) responding to clinician and consumer enquiries through the national allergy support phone line and website.

Clinical management advice

Advise on strict avoidance of suspected allergen/s, provide an:

See ASCIA Action, First Aid, Management, Transfer, Travel and Treatment Plans. Contact immunologist or paediatrician for adrenaline device prescription.

Inappropriately delayed introduction of foods may lead to failure to develop tolerance, refer to ASCIA Guidelines – Infant Feeding and Allergy Prevention. Do not advise removal of foods child is already tolerating. Encourage continued introduction of foods to infants as per the ASCIA Guidelines – Infant Feeding and Allergy Prevention.

In children with peanut and/or tree nut allergy, previously tolerated nuts should remain in the diet – exclusion may be associated with a break in tolerance. Children with cow’s milk/soy allergy may require elemental formula. Please see clinical resources for guides by ASCIA and The GP Infant Feeding Network (UK) on selecting an appropriate formula. In complex cases or if further guidance is required, please contact relevant Local Health Network.

Isolated raised IgE is most often associated with atopy and is not clinically significant, however differentials would include intestinal parasites and disorders of inborn errors of immunity if associated with recurrent severe infections and/or immunodysregulation.

Provide relevant ASCIA Action Plan for Allergic Reactions, and provide education on how it should be used to identify symptoms and manage allergic reaction

  • trigger does not need to be confirmed prior to completion of action plan
  • general practitioners can complete action plans

Vaccinations and food allergies

Be aware that risk of vaccination reactions is not increased by having food allergy, routine vaccinations should proceed.

Yellow fever vaccinations are contraindicated in some egg allergic children, please see Specialist Immunisation Service CPC.

Serum specific IgE testing

Serum specific IgE testing for food allergens:

  • may be helpful if there is a history
  • is indicated if there is a history of symptoms of an IgE-mediated allergic reaction to a specific food.
  • is NOT a useful as a screening test, for currently tolerated foods or non-IgE mediated symptoms, and is not required prior to referral
  • specific IgE for food mixes (staple food, nut mixes etc) hve poor specificity and are therefore NOT recommended.

See SA Pathology Allergy Testing Guidelines (PDF 111KB) for further information

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.