Introduction

This guideline relates to allergic reactions or anaphylaxis in paediatric patients. 

For more information on assessment and management please visit The Royal Children's Hospital (RCH) clinical practice guidelines:

• Anaphylaxis
• Food allergy IgE mediated food allergy

Other pre-referral guidelines for specific details of certain allergic triggers:

• Food allergy
• Drug allergy
• Insect allergy
• Latex allergy

This does not cover acute management. Please call an ambulance (000) if concerned.

When to refer

Always refer confirmed or suspected anaphylaxis to the RCH Department of Allergy and Immunology. This is an urgent referral

• Food allergy
• Drug allergy
• Insect allergy
• Latex allergy

Wait time for appointments 

Specialist Clinics wait times

Services available closer to home

Alternative paediatric services available in Victoria

• Public paediatric allergy services:
  • The Northern Hospital paediatric allergy clinic
  • Sunshine Hospital paediatric allergy clinic
  • Monash Children’s Hospital paediatric allergy clinic
  • Consider referral to a private allergist as an alternative to RCH. Options available on ASCIA website: Locate a specialist

Pre-referral work up/management

Pre-referral management includes:

• Avoidance of the suspected allergen, while continuing other foods that have previously been tolerated. For example, if a child had a reaction to cashew nut, but has previously tolerated peanut, hazelnut and almonds, parents and carers can be reassured that the child can continue eating peanut, hazelnut and almonds in the diet.  
  
• In children presenting with milk or egg allergy, baked milk or baked egg can be continued if they are already being tolerated in foods such as cakes or muffins. Many children with milk or egg allergies can tolerate extensively heated milk or egg in baked goods.  Heating denatures the milk and egg proteins, making them less allergenic.  Families should not introduce baked milk or baked egg for the first time without appropriate clinical advice, but there is no need to remove these foods from the diet if they are already being eaten without symptoms.
  
• Parents and carers can be encouraged to continue trying other common food allergens in the diet.  For example, if an child reacted to egg, they are encouraged to try peanut, tree nuts, wheat, cow's milk, fish and shell fish in their diet. 
  
• Provide an ASCIA Anaphylaxis Plan where there is a history suggestive of anaphylaxis, even if the trigger has not yet been confirmed.
  
• Prescribe an adrenaline device (Eg: EpiPen or EpiPen Jnr)
  • This can be discussed with an allergist, paediatrician or the ED on - call team via the number below to access authority funding.
  • Provide education on correct use of the adrenaline device.
• Ensure asthma is well controlled, as poorly controlled asthma is associated with more severe allergic reactions.
  
• Support the family with school or childcare communication, including provision of an ASCIA Action Plan 
  
• Do not attempt an oral food challenge or deliberate re-exposure to the suspected allergen in the community.

Helpful referral information

Clearly indicate if the child has confirmed or suspected ANAPHYLAXIS. This is an URGENT referral

• Date reaction(s) occurred
• Allergic reaction symptoms experienced
  • Severe systemic reaction (anaphylaxis)
    • Difficulty breathing
    • Swelling of the tongue or throat
    • Difficulty talking\
    • Hoarse voice, wheezing or persistent coughing
    • Loss of consciousness and/or collapse
    • Young children appearing pale and floppy
  • Mild-Moderate local reaction
    • Swelling of lips, face or eyes
    • Hives/urticaria or welts
    • Abdominal pain and /or vomiting
      
      
• Potential causes of reaction(s):
  
  • Details of the suspected trigger: eg which insect, type of food, exact medication etc
  • Time to onset of reaction
    
    
• When, where or how did the reaction(s) happen?
• Treatment given and patient response
• Previous or subsequent exposure to allergen
• Please send blood ssIgE or other results together with your referral if these were done. If performing ssIgE for foods, please ONLY request for food of concern and NOT foods that have not caused a reaction. Please do not request ‘food panels’ as these are not useful.
• If tryptase was done, please add results or indicate which pathology lab this request was sent

How to refer

Specialist Clinics referral

  Please complete the above and submit via:

• Facsimile (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED or Registrar on-call (03) 9345 7062

Information for families

Consider providing education to families regarding pre-referral management, as above

For infants with suspected food allergy, nip allergies in the BUB

• RCH Kids Health Info: Allergic and anaphylactic reactions
• RCH Kids Health Info: Peanut and tree nut allergy
• RCH Kids Health Info: Insect bites and stings
• Allergy & Anaphylaxis Australia

Resources and links

• RCH Clinical Practice Guideline: Anaphylaxis
• RCH Clinical Practice Guidelines: Food allergy IgE mediated food allergy

• National Asthma Council Australia 
  

Acknowledgements

The development of this guideline was coordinated by the Department of Allergy and Immunology (Dr Jo Smart and Dr Paulina Alhucema). Guideline reviewed in March 2026.