The following pre-referral guideline covers allergen desensitisation for children of all ages.

When to refer

Refer to allergy specialist for assessment regarding suitability of specific immunotherapy for:

• Patient with severe seasonal rhinitis or chronic allergic rhinitis where symptoms are not controlled with optimal medical management over the season or for at least six months.
• Severe allergy (anaphylaxis) to honey bee, wasp or Jack jumper ant

This management includes:

• Preventative topical steroid.
• Allergen avoidance.
• Saline nasal spray.
• Antihistamines.

Specific immunotherapy is not recommended for childhood asthma

Please include all prereferral management already tried, doses, length of time used, side effects etc 

• Make a referral: Specialist Clinics (download templates etc)

Urgent referral/clinical query call ED or Registrar on-call 9345 7062

Suggestions about managing immunotherapy in the community

• Do not perform induction or unscheduled updosing of immunotherapy in doctor's rooms. This should be performed in a specialist centre.
• Maintenance therapy may be provided at doctor's rooms, provided resuscitation equipment is available.
• Asthma management must be optimised in patient receiving immunotherapy.
  • See the National Asthma Council  Managing Asthma resources

Resources

• Department of Allergy and Immunology
• Kids Health Info Parent fact sheet- Tree nut and Peanut Allergy
• Kids Health Info-Allergic and Anaphylactic reactions
• Private paediatric allergists
• Clinical Services Directory Allergy and Immunology

• Paediatric Handbook (2009) Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

Guideline developed by RCH Department of Allergy and Immunology. First published Jan 2008. Reviewed October 2013. Please read  Copyright and Disclaimer