Allergic conditions

Red flags

Consider urgent referral for patients with the following

Anaphylaxis

Information That May Lead to More Urgent Categorisation

Most cases where an anaphylactic reaction has occurred previously 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.

Main conditions in this category are:

Allergic rhinitis/rhinosinusitis
Angio-oedema
Conjunctivitis
Drug Allergy
Food allergy
Respiratory allergy (generally refer to Thoracic Medicine)
Urticaria

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

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

Additional referral information (useful for processing the referral)

Eosinophil count
Total IgE
Specific RAST testing (include results of all such testing even if negative)
- (do not perform extensive RAST panels for screening as these are expensive and often unhelpful)
Skin prick testing if available
Skin biopsy results if performed
Imaging if previously performed including CXR

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