Allergic conditions
Red flags
Consider urgent referral for patients with the following
- Anaphylaxis for investigation.
Information That May Lead to More Urgent Categorisation
- Most cases where an anaphylactic reaction has recently occurred will be category 1
Referral for allergic conditions is usually for diagnosis and management. The GP will often be required to take an active part in the management if desensitisation therapy is used.
In scope conditions:
- Allergic rhinitis/rhinosinusitis
- Please see Respiratory Allergy – Allergic Rhinitis (Hay Fever), Asthma and Sinusitis – Australasian Society of Clinical Immunology and Allergy (ASCIA) for information regarding initial medical management of allergic rhinitis
- Anaphylaxis
- Please see ASCIA Guidelines Acute management of anaphylaxis – Australasian Society of Clinical Immunology and Allergy (ASCIA) for definition of anaphylaxis and management guidelines
- ASCIA adrenaline autoinjection guidelines ASCIA Guidelines for adrenaline injector prescription – Australasian Society of Clinical Immunology and Allergy (ASCIA)
- Angiooedema
-
- Consider ACE inhibitor induced angioedema in patients treated with ACE inhibitors, even if these agents have been tolerated long term
-
- Antibiotic allergy
- Drug Allergy
- Food intolerance (Limited cases)
- Food intolerance is a diverse term that encompasses non-IgE mediated food allergy. Allergy testing (skin prick or specific IgE) is of limited utility.
- Referrals will not be accepted without clinical details suggestive of allergy.
- Food intolerance – Australasian Society of Clinical Immunology and Allergy (ASCIA)
- IgE mediated food allergy
- IgE-mediated reactions to food are associated with the onset of allergic features such as urticaria, angioedema or respiratory compromise within 60 minutes of food ingestion.
- Mast cell activation syndrome (MCAS) (Limited cases)
- Urticaria/hives
Other Conditions:
- Anaesthetic allergy
- Multiple services exist across Queensland. Clinical Immunology recommends that referrers liaise with local providers. Find your nearest testing centre: Testing Centres – ANZAAG.
- Food intolerance
- Food intolerance is a diverse term that encompasses non-IgE mediated food allergy. Allergy testing (skin prick or specific IgE) is of limited utility.
- Food intolerance – Australasian Society of Clinical Immunology and Allergy (ASCIA)
- Respiratory allergy (generally refer to Thoracic Medicine)
- Mast cell activation syndrome (MCAS)
- Further information is required to accept these referrals – please essential referral information below
Out of scope conditions:
- Anaesthetic allergy
Multiple services exist across Queensland. Clinical Immunology recommends that referrers liaise with local providers. Find your nearest testing centre: Testing Centres – ANZAAG. - Asthma
Please refer to Respiratory or asthma clinic, however referrals will be accepted from respiratory physicians for collaborative management. - Atopic dermatitis/eczema
Referrals will only be accepted from a Dermatologist for collaborative management - Eosinophilic oesophagitis
Please refer to gastroenterology, however referrals will be accepted from gastroenterologists for collaborative management - Itch without rash
- Non-allergic rhinonsinusitis
Best evaluated by ENT. Referrals will only be accepted from an ENT Surgeon for collaborative management. - Non-urticarial rashes
Non-urticarial rashes should be referred to Dermatology - Respiratory allergy
Generally refer to Thoracic Medicine
Other important information for referring practitioners
Lifestyle changes
- Allergen avoidance
- Dust reduction
- Air filters in air conditioning units and vacuum cleaners
- Reduced carpets and soft furnishings that may trap dust
- Advise on Medic Alert (bracelet, pendant)
Medical management
- Ensure the availability of an epipen if anaphylaxis has occurred
- Provide information on anaphylaxis action plan (see link below)
- Careful history taking will often narrow down the possible allergens
- Advise patients with intermittent rash to take photos which may help in diagnosis
- Use diet and symptom diary to help identify food allergies
- RAST testing is expensive and if performed should be targeted specifically at the most likely allergens. Do not perform blanket testing.
Referral requirements
A referral may be rejected without the following information.
Essential referral information
Allergic rhinitis/rhinosinusitis
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
- Please provide details of trialled medical management (i.e antihistamines, intranasal corticosteroid sprays) with the referral. Referrals will not be accepted without this detail.
- Referrals for continuation of desensitisation commenced by another practitioner will not be accepted.
- Referrals for desensitisation for animal danders or moulds will not be accepted unless there is an occupational requirement associated with dander exposure.
Anaphylaxis
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
Angiooedema
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
Antibiotic allergy
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
- Please provide details of implicated agents, alternatives tolerated (e.g if the patient is penicillin allergic have cephalosporins been tolerated) and clinical need.
Drug Allergy
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
- Please provide details of implicated agent, details of reaction and clinical need.
- Referrals for recognised medication adverse effects or non-immunologic reactions are not accepted.
Food intolerance (Limited cases)
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
IgE mediated food allergy
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
Mast cell activation syndrome (MCAS) (Limited cases)
- Clinical features of severe, recurrent (episodic) systemic symptoms consistent with mast cell mediator release (urticaria, angioedema, anaphylaxis)
- Documented increase in mast cell mediator levels – serum tryptase is the only clinically validated test available currently.
- Clinical improvement with mediator blockers i.e. antihistamines.
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
Urticaria/hives
- Reason for referral
- List of symptoms and timeline
- Include frequency and severity of symptoms as these are important for accurate triage
- Suspected or proven allergens
- List significant medical conditions
- Medication trialled and reasons for failure
- Current medications and known allergies – please note that an up-to-date medication list is essential
- Please provide details of treatment to date
Additional referral information (useful for processing the referral)
- Eosinophil count
- Total IgE
- FBC, CRP, Chem20, thyroid function tests
- Skin prick testing if available
- Skin biopsy results if performed
- Imaging if previously performed including CXR
- For suspected food related reactions: specific IgE/RAST to suspected food(s). Food mix testing is of limited utility and should not be routinely performed in assessment of food allergy.
- Serum tryptase (random)
- C3/C4 and C1-esterase inhibitor level/function for angioedema
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
Clinical Modifiers (where relevant)
- 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
Reason for Referral (essential)
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical Information (essential)
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
Patient’s Demographic Details (essential)
- 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
Referring Practitioner Details (essential)
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Other Information (where relevant)
- 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.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Fax number:
Metro North Central Patient Intake
1300 364 952
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org
Locations
Resources
Clinical resources
- Australian Society of Clinical Immunology and Allergy anaphylaxis action plans
- Acute management of anaphylaxis guidelines
- Guidelines for the influenza immmunisation of egg allergic patient