Introduction

This guideline relates to allergic reactions or anaphylaxis in paediatric patients. For more information please visit: Allergy and Immunology : Allergy and Immunology

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

For more information on acute management and details on history taking, please see:

• Allergy and Immunology : Allergy
• Clinical Practice Guidelines : Anaphylaxis

When to refer

• ALWAYS refer confirmed or suspected anaphylaxis to the RCH Department of Allergy and Immunology. This is an URGENT REFERRAL
• Clinical history or specific IgE blood testing indicates that a child may be growing out of moderate to severe allergy and challenge testing is required
• Food allergy:
  • Specific IgE blood test is positive
  • Suspected IgE or non IgE mediated food allergy  is causing one of the following:
    • Severe eczema (or asthma in rare cases)
    • Failure to thrive
    • Dysphagia
    • Reflux/GI symptoms
• Drug allergy:
  • Allergy skin test is required
  • Challenge testing is required to identify a safe drug for future use (e.g., anaesthetic or a patient with a history of severe penicillin allergy)
  • There is no other drug alternative  (e.g., insulin, chemotherapy or penicillin) and desensitisation is required to get the child onto the drug without causing a severe allergic reaction (transient tolerance)
• Latex allergy:
  • All patients with suspected latex allergy
• Insect sting:
  • Desensitisation is indicated (e.g., anaphylaxis to stinging insect)
  • History and RAST/SPT do not correspond and further specialised testing (i.e. challenge) is required
  • When a patient is identified as having a systemic reaction to insect venom
  • When a diagnosis of Jack jumper ant allergy is suspected (Note: RAST to JJA is currently only available as a research test (2011)

Do not refer                                               

• For allergy screening if there is no clear history of allergic reaction
• When family history is positive, in a healthy patient who does not have an allergic condition
• Food allergy:
  • Suspected food intolerance (contact General Medicine or Gastroenterology department)
• Drug allergy:
  • If the drug reaction is mild, there are alternative drugs available and avoidance is an option for management (e.g., Ceclor reactions)
• Insect sting:
  • Large local reactions and mild-moderate systemic reactions are NOT indications for desensitisation

Services available closer to home

Alternative paediatric allergy services available in Victoria include:

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

Referral criteria/required information

• History of allergic reaction:
  • Type of latex
  • Specific details of nature of reaction, previous or subsequent exposure?
  • History of atopy e.g., eczema or asthma
  • Family history of allergies

How to refer

RCH Specialist Clinics Referral.pdf

Please complete the above and submit via:

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

Suggested pre-referral work-up/management 

Pre-referral management includes:

• Diagnostic:
  • Detection of latex-specific IgE by RAST test
  • Note: SPT (Skin Prick Test) is not recommended for latex
• Interpretation of RAST test:
  • Test results should be interpreted together with history
  • Positive allergen-specific IgE (RAST or SPT) in the presence of a clear history of allergic reaction confirms clinical allergy
• Allergen avoidance
• Prescribe Epi-Pen/Epi-Pen junior

Information for families

• Kids Health Info : Allergic and anaphylactic reactions

Resources and links

• Clinical Practice Guidelines : Anaphylaxis

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 February 2025.