Information for health professionals
Information for GPs: We accept referrals for adult and paediatric patients from the age of 16, with the following conditions:
Drug allergy
We investigate patients with suspected drug allergy, including allergic reactions during general anaesthesia, to antibiotics, NSAIDs and any other drugs, particularly when alternative drugs choices are limited or complex (such as for cystic fibrosis patients).
Drug desensitisation is offered where appropriate (for example to aspirin).
Penicillin allergy will be investigated if the patient is strongly believed to be allergic to more than one class or family of antibiotics, or where a penicillin is considered highly important for the treatment of specific infections (and another class of antibiotic is not sufficient to safely manage this). If a patient needs frequent courses of antibiotics or long term use, they may be referred to our drug allergy multi-disciplinary team.
Peri-operative allergy
It is strongly recommended peri-operative allergy is referred using the Anaesthetics Association of Great Britain and Northern Ireland’s referral form available online in order that sufficient information is provided to assess individual cases.
It is helpful to be given appropriate detail with all referrals for drug allergy investigation. For example we require wherever possible precise clinical descriptions of symptoms experienced, but also of all possible variables regarding drug brand/formulation/route/dose/timing and number of doses taken before a reaction and related medications tolerated since this took place.
Patients with urgent need for a drug to which they may be allergic can be referred directly to the drug allergy MDT avoiding the need for an initial outpatient clinic assessment. This is only possible if sufficient clinical information is provided, however all reasonable efforts will be made to see such patients in a timely manner.
We do not routinely perform drug allergy testing in a predictive manner - we will not test a patient for a drug that they have not formerly taken without strong reasoning to support this route of action. It may be performed only in exceptional circumstances.
Rhinitis, conjunctivitis and rhino-sinusitis
We will diagnose allergies and consider desensitisation immunotherapy for patients with rhinitis, conjunctivitis and rhinosinusitis symptoms that aren't controlled by medical treatment. Unilateral nasal symptoms, prominent nasal bleeding, anosmia or sinusitis symptoms should be referred to ENT for initial assessment
We also have a nurse-led skin testing service for referrals direct from ENT or respiratory consultants within UHS. This service can confirm or exclude aeroallergen allergy, in circumstances where these doctors are happy to receive the results of testing without the need for consultant allergist review and result interpretation. This clinic will test reaction to aeroallergens only, unless specifically requested by one of our allergy consultants.
Urticaria and angioedema
We investigate and manage severe or persistent urticaria and angioedema, which does not respond to conventional first line treatment. Please note that we do not provide allergy reviews for patients with a single acute episode of urticaria without systemic symptoms.
Latex allergy
Patients with reactions that include significiant physiological disturbance of their airway, breathing or circulation should be referred for investigation and management. Please refer patients with delayed onset symptoms after exposure to latex to dermatology for patch testing.
Multi-system allergic disease
Our allergy team will review patients with asthma, rhinitis, eczema, acute reactions due to food or inhalant allergies, which are moderate or severe and necessitate complex management strategies.
Asthma
We have a specific asthma and allergy clinic, aimed at patients with a suspected allergic trigger that needs to be confirmed and managed. We also focus on inhaler technique, and have close links with the severe asthma clinic. Please do not refer to the allergy service as an alternative route to the asthma service.
Please refer to the respiratory department for lung function testing, confirmed or suspected severe asthma, or where monoclonal antibody treatments are being considered.
Eczema
Our team will review the diagnosis and management of patients with eczema where
- a specific aeroallergen or food allergic trigger is strongly suspected and requires confirmation and management, and/or;
- it co-exists with significant asthma, rhinitis or food allergy, complicating management.
Please do not refer to the allergy service as an alternative route to dermatology.
Please do not refer to the allergy service for patch testing as we do not perform it. Examples where patch testing is used include reactions to soaps, fragrances, laundry products, topical medications, hair dye, cosmetics and contact reactions to metals such as jewellery or dental amalgam.
Multiple non-specific symptoms
We can offer advice and risk assessment to assist with diagnosis when an allergic cause needs to be excluded. We don't offer ‘blanket’ testing for patients indiscriminately requesting food allergy tests where symptoms are in keeping with chronic spontaneous urticaria, or for symptoms suggestive of IBS, wheat, lactose or other food intolerance.
Our team does not accept referrals for 'multiple chemical hypersensitivity'. We do not offer a specialist service for patients requesting investigation for mast cell activation or histamine intolerance.
We strongly advise against inappropriate referral to allergy services for patients with symptoms of chronic fatigue, chronic pelvic pain or other medically unexplained symptom cases. We will be happy to discuss any specific individual patient before referral where testing is felt to be needed on strong clinical grounds.
External test results
Our team would be happy to suggest appropriate testing which should be performed before referral to our service.
Please consider limited appropriate investigation and avoid “screening” panels of sIgE tests.
Please remember that raised total IgE and or raised eosinophil count may have a wide variety of causes, including but not exclusive to allergy. Please consider discussion with the laboratory or request consultant advice where such indices are raised, rather than directly requesting allergist outpatient review on the basis of a blood result with limited clinical information.
Armed Forces patients
Our service is on the Official Forces Register of units. This means we accept appropriate referrals for investigation and management advice for patients who in the Armed Forces, who have suspected or confirmed allergies. Our team will take all reasonable steps to ensure such patients are seen, diagnosed and advised in a timely manner.