Food allergies in children

Specialty: Children's food allergies
Age group: Children

Criteria for referral to public hospital service

• Suspected or confirmed anaphylaxis related to a food allergy
• For IgE mediated allergies
  • Infants with allergies to staple food such as milk, eggs, wheat, peanuts, tree nuts, sesame and seafood
  • Children older than 1 year with multiple food allergies, particularly to staple foods such as milk, eggs, wheat, peanuts, tree nuts, sesame and seafood
  • Children older than 1 year with suspected or confirmed concurrent asthma or faltering growth
• For non-IgE mediated allergies
  • Children with associated faltering growth, or who have not improved with initial dietary elimination measures, including the exclusion of milk and soy e.g. infants with food protein-induced allergic proctocolitis (FPIAP).

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient, or their carer, and the referring clinician from referral to the health service
• Age
• Findings on physical examination
• Suspected or confirmed food causing the allergy including form of the food (e.g. raw, cooked, baked)
• Relevant allergy test results, such as serum-specific IgE (sIgE) and past skin prick test reports, include the date of the test
• Description of onset, nature, progression, recurrence and duration of symptoms
• If suspect or confirmed anaphylaxis
  • details of respiratory and cardiovascular symptoms
  • if the child has been prescribed an adrenaline device, such as an adrenaline autoinjector (e.g. EpiPen) or adrenaline nasal spray (e.g. Neffy)
  • presence and details of an action plan
• Details of current and previous management including the course of treatments and outcome of treatments
• Relevant medical history and comorbidities including any other known or suspected allergies, asthma, eczema, allergic rhinitis or other triggers or allergic diseases
• Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs).

Provide if available

• Details of any relevant previous assessments or opinions
• Any prior allergy tests, include the date of these tests
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child is neurodiverse
• If the child is gender diverse
• If the child has a disability
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If the child is a refugee, seeking asylum or has a bridging visa while waiting for an immigration outcome
• If the child is aged 14-18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

This statewide referral criteria does not cover referrals for non-food allergies (e.g. medicines, insect venom, allergic rhinitis). Note there are statewide referral criteria for children for Assessment of dermatitis (eczema) management in children and Blistering eruptions, rash of unknown cause and adverse drug reactions in children.

Note there is statewide referral criteria for Assessment of asthma management in children.

Referral to an adult service may be appropriate for children older than 16 years. Referring clinicians should contact the health service to discuss the available options.

The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.

Skin prick, sIgE and radioallergosorbent test (RAST) tests are not recommended for foods that a child has already eaten and tolerated, or that the child has not yet been exposed to.

Testing for multiple foods or ‘food mixes’ do not inform the assessment of referrals and unnecessary testing adds to parental concern.

A mild perioral rash which appears during or immediately after food consumption, with no other symptoms of allergy, may not be a sign of an allergic reaction.

Note: Patients will be discharged back to the care of their GP with a detailed management plan, unless they require ongoing treatment.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Concerns about a family history of allergies without a clear history of an allergic reaction
• Food allergies that are well managed
• Food allergy screening
• Food intolerances
• Mild perioral rash or contact skin reactions to foods with no other symptoms
• Positive sIgE, RAST or skin prick test results in the absence of the child having eaten the food or a clear history of an allergic reaction
• Proctocolitis that is adequately managed in the absence of faltering growth.