Referral Form

Service description

This is a full-time consultant-led children’s specialist allergy service supported by multidisciplinary team comprising of specialty doctor, allergy specialist nurses, allergy dietitians and clinical psychologist. The service aims to deliver high quality, specialist care for children with severe and complex allergies in Leeds and wider region.
 *Please note that Leeds Paediatric Allergy service is completely separate to Paediatric  Immunology and two should not be confused.

The service primarily delivers secondary and tertiary care for Leeds CCG patients and offers tertiary care for patients from the wider Yorkshire region. Referrals from  GPs outside the Leeds CCG area that are deemed to be for secondary level care will be rejected and redirected to their local secondary level allergy clinic. We will accept direct Leeds CCG GP referrals and referrals from paediatric or other specialists from Leeds and the wider region.

Referrals will be accepted provided that they are on the list of conditions we treat and they do not meet the remit of Community Paediatric Clinics. Children /young people will be accepted up to their 16th birthday.

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Testing prior to referral

 There is no need to request blood tests for specific IgE measurement prior to a child’s referral. Skin prick tests and are often more reliable, less painful, provide immediate results and are more cost effective. The need for blood testing will be assessed by a specialist in clinic. There is an exception for this under heading of “Respiratory and ENT allergy”.

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REMIT OF COMMUNITY PAEDIATRIC CLINICS

The management of simple, non-IgE mediated milk allergy (< 2 years of age) is currently commissioned to the Community Paediatrics team at Leeds Community Trust.
https://www.leedscommunityhealthcare.nhs.uk/seecmsfile/?id=4475

Types of new referrals to be redirected to the community paediatrics team:

  • Infant with suspected delayed type, non-IgE mediated cow’s milk allergy  (CMPA) , sometimes also referred to as cow’s milk protein intolerance with range of gastrointestinal and skin symptoms:
  • Diarrhoea: loose or frequent stools,
  • Constipation, can include straining on defecation but soft stools
  • Vomiting in irritable child with back arching and screaming
  • Poor feeding but hungry infant; food refusal and aversion
  • Gastro-oesophageal reflux
  • Blood and/ or mucus in stool
  • Skin pruritus, erythema, atopic eczema, delayed urticaria (hives)

Note: where there is a suspicion of additional food reactions in an infant already under community paediatrics team for non-IgE mediated cow’s milk   +/- soya allergy, the referral will be accepted by the responsible Paediatric Allergy consultant for an opinion. If allergy to other allergens is excluded, the child will be referred back to the community paediatrics team for further management.

  • Feeding difficulties and food aversion
  • Poor weight gain

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OTHER REFERRALS NOT SUITABLE FOR INITIAL PAEDIATRIC ALLERGY ASSESSMENT

  • Older child (> 2 years old) with unexplained gut symptoms that have started beyond infancy such as diarrhoea, abdominal pain or constipation where multiple foods are suspected to be a trigger but the relationship between symptoms and food are vague.  
  • Older child (>2 years) with troublesome eczema where parents suspect allergy but there is no clear history of immediate reactions. These children should be, referred to paediatric dermatology initially.

REFERRALS TO PAEDIATRIC ALLERGY SERVICE AT LEEDS TEACHING HOSPITALS

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Anaphylaxis and immediate allergic reactions

  • Immediate ( <1 hour) reactions to foods
  • Insect sting allergy
  • Immediate reactions without clear cause
  • Latex allergy

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Skin allergy

  • Eczema with suspected immediate or delayed-onset (2 to 24 hours) due to following triggers:
  • Chronic urticaria persisting >6 weeks +/- angioedema
  • Isolated angioedema - if facial angioedema only, consider possible contact allergy and to question possible exposures.  Consider checking C4 and C1 inhibitor levels to rule out hereditary angioedema (HAE), particularly if there is a family history. HAE is managed under Leeds Paediatric Immunology clinic.

Note: Contact allergic reactions such as to plasters and cosmetic or body care products are within remit of dermatology clinics.

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Respiratory and ENT allergy

  • Allergic asthma
  • Moderate /severe allergic rhinoconjunctivitis not responding to standard treatment with non-sedating antihistamines  +/- intranasal corticosteroids
  • Chronic rhinosinusitis

www.lhp.leedsth.nhs.uk/detail.aspx?id=6

Note: where there is already a clinical history of suspected inhalant allergy, GPs can request blood test to measure specific IgE levels to individual inhalant allergens (e.g. Separate measurements for house dust mite, grass pollen, tree pollen, any pets or mould that are relevant to patient’s history) as these are helpful in determining relevant allergen trigger and in providing initial avoidance advice.

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Drug Allergy

Immunotherapy

  • Poorly controlled persistent rhinitis or rhinoconjunctivitis due to confirmed common inhalant allergy (tree or grass pollen and house dust mite)
  • Anaphylaxis to bee and wasp sting

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Referrals considered URGENT

  • Severe eczema in child < 1 year of age where multiple food allergies are suspected by the parent or referring clinician 
  • Infants with moderate /severe eczema and egg allergy (for consideration of early introduction of allergenic foods)  
  • Clinical suspicion of multiple food allergies in child < 1 year old 
  • Systemic allergic reaction (anaphylaxis) or severe delayed allergic reaction 
  • Confirmed / suspected IgE-mediated food allergy with concurrent asthma  
  • Faltering growth in combination with food allergy / severe eczema / gastrointestinal symptoms 

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Referral of siblings or children of food allergic parent

We do not accept referrals for infants and toddlers who have no personal history of atopic disease such as eczema or food allergy as they are considered to have a low risk of developing allergy to foods
Current British Society of Allergy and Clinical Immunology (BSACI) and British Dietetic Association (BDA) joint recommendation is that these children are to be weaned as normal between the ages 4-6 months when developmentally ready, without any special precautions or further delays in introduction of these foods (typically nuts in age appropriate form) into their diet. Please see detailed advice below.
https://www.bsaci.org/wp-content/uploads/2020/02/pdf_Infant-feeding-and-allergy-prevention-PARENTS-FINAL-booklet.pdf

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SPECIALIST ALLERGY TESTS AVAILABLE

  • Skin prick testing
  • Intradermal testing
  • Specific IgE levels  ( ImmunCAP, ISAC)
  • Diagnostic food and drug challenges
  • Specialist imaging

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SPECIALIST ALLERGY TREATMENTS

  • Anaphylaxis management
  • Management of multiple allergic comorbidities, including advice on allergen avoidance and  management with medications
  • Specialist nurse advice/ support
  • Specialist dietetic advice/ support
  • Specialist clinical psychologist assessment and support
  • Allergen specific immunotherapy for rhinitis/ rhinoconjunctivitis
  • Bee and wasp venom immunotherapy

 

 

 

 

 

Leeds Health Pathways