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Primary Care Liaison

Food allergies

  • Introduction

    This guideline relates to food allergies in paediatric patients. For more information please see:  Allergy and Immunology : Allergy and Immunology

    When to refer

    • ALWAYS refer confirmed or suspected anaphylaxis to the RCH Department of Allergy and Immunology. This is an URGENT REFERRAL
    • Patients <16 years old
    • Failure to thrive (FTT) in a child with suspected food allergies
    • Multiple food allergies (particularly staple food e.g., milk, eggs, wheat)
    • Suspected IgE-mediated food allergy, unclear trigger
    • Suspected IgE-mediated food allergy if assistance is required for diagnosis and management
    • Suspected FPIES (food protein induced enterocolitis- non-IgE food allergy)
    • Other suspected non-IgE food allergies e.g., proctocolitis will only be accepted if there is FTT, not improving after cow’s milk/soy elimination or referral is from a paediatrician or gastroenterologist
    • Suspected eosinophilic esophagitis e.g., dysphagia (in a child with atopy history). These referrals can also be sent to gastroenterology department
    • Presence of IgE-mediated food allergy and significant other allergic co-morbidity e.g., unstable asthma
    • History and blood test IgE levels/Skin Prick Test do not correspond (e.g., convincing history but negative test) as further specialised testing (i.e. challenge) may be needed
    • Note: allergy testing ONLY useful if there is a suspected IgE-mediated food allergy

    Do not refer

    • For allergy screening if there is no clear history of allergic reaction
    • Family history of allergy, if the child has not presented a clear allergic reaction to foods
    • Concerns with food allergy due to eczema alone. Food does not cause eczema.
    • Concerns with food intolerances
    • Concerns with contact skin reactions with foods, where there are no other symptoms
    • Proctocolitis, which is usually secondary to cow’s milk and/or soy milk (non-IgE food allergy) that is well controlled, with no FTT 

    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

    The GP at first consultation is in the best position to get the most comprehensive information from parents on the details of an allergic reaction. Please collect and include in your referral as much detail as possible. Referrals may be rejected if information is insufficient to triage appropriately

    Please include:                                                                                     

    • CLEARLY INDICATE if the child has confirmed or suspected ANAPHYLAXIS. The referral will be triaged as urgent
    • 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/urticarial or welts
        • Abdominal pain and/or vomiting
    • Potential causes of reaction(s):
      • What food/s
      • Form e.g., raw or cooked
      • Amount ingested
      • 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 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

    How to refer

    RCH Specialist Clinics Referral.pdf

    Please complete the above and submit via:

    Suggested pre-referral work-up/management 

    • Provide an ASCIA allergy management plan if child has presented a mild-moderate reaction or an ASCIA anaphylaxis action plan if child has presented anaphylaxis (even if trigger not yet confirmed)
    • Prescribe Epi-Pen/Epi-Pen Junior if child has presented with anaphylaxis
      • Can be discussed with an allergist, paediatrician or ED on-call (via number below) to access authority funding
      • Provide education on correct use of Epi-Pen
    • Ensure asthma is well controlled (poor asthma control is associated with more severe reactions)
    • Educate on strict avoidance of allergen to which child reacted. Continue foods regularly tolerated
    • Support parent with school/child care communication
    • Do not attempt to perform a challenge to the allergen. This should only be done in a specialist allergy unit

    Information for families

    Resources and links

    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.