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The Alfred Hospital Referral & Management Guidelines Issue Date: December 2006 Page 2 Latest Update: 20 February, 2008 THE ALFRED SPECIALIST CONSULTING CLINICS APPOINTMENT PRIORITY GUIDE Asthma, Allergy and Clinical Immunology New Appointment Priority Definitions: Immediate -phone Allergy/Respiratory registrar on call on 9076 2000 and/or send to The Alfred Emergency & Trauma Centre 1. Urgent -likely to receive an appointment within 1-2 weeks 2. Soon -likely to receive an appointment within 2-6 weeks 3. Intermediate & non-urgent -likely to receive an appointment within 6-12 weeks Referrals are best faxed to 9076 2245. All referrals are reviewed on the day of receipt by a specialist nurse and triage arranged. The Allergy & Asthma service can be phoned on 9076 2934. Please note: Urgent cases can be discussed with the Allergy/Respiratory registrar or consultant on call to obtain appropriate prioritisation and then a referral letter faxed to 9276 2245. Priority Criteria Examples (not an exhaustive list) IMMEDIATE Contact Allergy/Respiratory registrar by phone (9276 2000) and/or send to The Alfred Emergency & Trauma Centre . É Current symptoms of anaphylaxis should be directed to an ambulance immediately É Unstable asthma where the peak flow is less than 50% predicted É Acute anaphylaxis É Acute severe asthma 1. URGENT É Recurrent anaphylaxis to an unidentified agent É Initial episode of severe anaphylaxis É Unstable asthma where the peak flow is less than 60% of predicted or previous best. É Recent anaphylaxis É Anaphylaxis where no management plan exists É History of life-threatening asthma or hospital admission for asthma in the past year 2. SOON É Unstable asthma where the peak flow is greater than 70% predicted É Anaphylaxis to an avoidable identified agent É Formulation of an anaphylaxis management plan and Epi-Pen education É Asthma Education 3. INTERMEDIATE É Referral for insect venom desensitisation É Recent onset urticaria É Difficult to treat asthma with peak flows greater than 70% predicted É Assessment for non-HIV immunodeficiency where there is end-organ disease É Possible immunodeficiency with bronchiectasis or recurrent sinusitis. 4. NON-URGENT É Assessment for Allergic rhinitis É Asthma where an allergic component is considered a relevant trigger É Assessment for immunotherapy to aeroallergens É Latex or drug allergy where no immediate requirement for exposure exists É Assessment of chronic urticaria É Non-anaphylactic food allergy É Drug allergy where the drug is readily avoidable É Assessment for immunodeficiency where there is no evidence of underlying disease É Anaesthetic allergy Note: The current waiting list for a routine appointment is 8 weeks. More urgent appointments are seen sooner. Not Seen: Children under 16 years of age are not seen at The Alfred unless by special arrangement - phone 9076 2934. REFERRAL & MANAGEMENT GUIDELINES : ASTHMA, ALLERGY AND CLINICAL IMMUNOLOGY DIAGNOSIS EVALUATION MANAGEMENT REFERRAL GUIDELINES ALLERGY Stinging insect Food allergy Latex allergy Drug allergy Skin testing Respiratory allergy Careful history Document anaphylaxis, severity of symptoms and interval between exposure and reaction. History of rhinitis and/or asthma Skin or blood-specific IgE testing is performed at The Alfred. Avoid skin testing where the reaction to the suspected culprit is anaphylaxis A careful history of ingestion of foods and/or drugs prior to an episode of anaphylaxis is critical. This is particularly important in drug or anaesthetic allergy as patients are not always aware exactly what drugs they’ve had. ANAPHYLAXIS Identify causative agent from history if possible Make safe if possible: Anaphylaxis Action plan and Epi-Pen Will expedite appointment if the triggering allergen is uncertain or difficult to avoid.

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<h2>ASTHMA, ALLERGY AND CLINICAL IMMUNOLOGY HOSPITAL REFERRAL & MANAGEMENT GUIDELINES</h2> <p style="text-align: justify;">The Alfred Hospital Referral & Management Guidelines Issue Date: December 2006 Page 2 Latest Update: 20 February, 2008 THE ALFRED SPECIALIST CONSULTING CLINICS APPOINTMENT PRIORITY GUIDE <a title="Asthma" href="http://911medicalcare.com/healthcare/asthma/">Asthma</a>, Allergy and Clinical Immunology New Appointment Priority Definitions: Immediate -phone Allergy/Respiratory registrar on call on 9076 2000 and/or send to The Alfred Emergency & Trauma Centre 1. Urgent -likely to receive an appointment within 1-2 weeks 2. Soon -likely to receive an appointment within 2-6 weeks 3. Intermediate & non-urgent -likely to receive an appointment within 6-12 weeks Referrals are best faxed to 9076 2245. All referrals are reviewed on the day of receipt by a specialist <a title="nurse" href="http://911medicalcare.com/healthcare/nurse/">nurse</a> and triage arranged. The Allergy & Asthma service can be phoned on 9076 2934. Please note: Urgent cases can be discussed with the Allergy/Respiratory registrar or consultant on call to obtain appropriate prioritisation and then a referral letter faxed to 9276 2245. Priority Criteria Examples (not an exhaustive list) IMMEDIATE Contact Allergy/Respiratory registrar by phone (9276 2000) and/or send to The Alfred Emergency & Trauma Centre . É Current symptoms of anaphylaxis should be directed to an ambulance immediately É Unstable asthma where the peak flow is less than 50% predicted É Acute anaphylaxis É Acute severe asthma 1. URGENT É Recurrent anaphylaxis to an unidentified agent É Initial episode of severe anaphylaxis É Unstable asthma where the peak flow is less than 60% of predicted or previous best. É Recent anaphylaxis É Anaphylaxis where no management plan exists É History of life-threatening asthma or hospital admission for asthma in the past year 2. SOON É Unstable asthma where the peak flow is greater than 70% predicted É Anaphylaxis to an avoidable identified agent É Formulation of an anaphylaxis management plan and Epi-Pen education É Asthma Education 3. INTERMEDIATE É Referral for insect venom desensitisation É Recent onset urticaria É Difficult to treat asthma with peak flows greater than 70% predicted É Assessment for non-HIV immunodeficiency where there is end-organ disease É Possible immunodeficiency with bronchiectasis or recurrent sinusitis. 4. NON-URGENT É Assessment for Allergic rhinitis É Asthma where an allergic component is considered a relevant trigger É Assessment for immunotherapy to <a title="aeroallergens" href="http://911medicalcare.com/medicalcare/aeroallergens/">aeroallergens</a> É Latex or drug allergy where no immediate requirement for exposure exists É Assessment of chronic urticaria É Non-anaphylactic food allergy É Drug allergy where the drug is readily avoidable É Assessment for immunodeficiency where there is no evidence of underlying disease É Anaesthetic allergy Note: The current waiting list for a routine appointment is 8 weeks. More urgent appointments are seen sooner. Not Seen: Children under 16 years of age are not seen at The Alfred unless by special arrangement - phone 9076 2934. REFERRAL & MANAGEMENT GUIDELINES : ASTHMA, ALLERGY AND CLINICAL IMMUNOLOGY DIAGNOSIS EVALUATION MANAGEMENT REFERRAL GUIDELINES ALLERGY Stinging insect Food allergy Latex allergy Drug allergy Skin testing Respiratory allergy Careful history Document anaphylaxis, severity of symptoms and interval between exposure and reaction. History of rhinitis and/or asthma Skin or blood-specific IgE testing is performed at The Alfred. Avoid skin testing where the reaction to the suspected culprit is anaphylaxis A careful history of ingestion of foods and/or drugs prior to an episode of anaphylaxis is critical. This is particularly important in drug or anaesthetic allergy as patients are not always aware exactly what drugs they’ve had. ANAPHYLAXIS Identify causative agent from history if possible Make safe if possible: Anaphylaxis Action plan and Epi-Pen Will expedite appointment if the triggering allergen is uncertain or difficult to avoid.</p> <p style="text-align: justify;">(Read More on Free Ebook at PDF Format)</p> <p style="text-align: justify;"><a href="http://911medicalcare.com/pdf/asthma-allergy-and-clinical-immunology-hospital-referral-management-guidelines" target="_blank">Download</a> ASTHMA, ALLERGY AND CLINICAL IMMUNOLOGY HOSPITAL REFERRAL & MANAGEMENT GUIDELINES.pdf</p><br/><a href="http://www.socialmarker.com/?link=http://911medicalcare.com/asthma/asthma-allergy-and-clinical-immunology-hospital-referral-management-guidelines/&title=ASTHMA%2C+ALLERGY+AND+CLINICAL+IMMUNOLOGY+HOSPITAL+REFERRAL+%26%23038%3B+MANAGEMENT+GUIDELINES&text=...&tags=" target="_blank"><img src= "http://www.socialmarker.com/bookmark.gif" border="0" /></a><noscript><a href="http://www.socialmarker.com" >Social Bookmarking</a></noscript> <p>The article <a href="http://911medicalcare.com/asthma/asthma-allergy-and-clinical-immunology-hospital-referral-management-guidelines/">ASTHMA, ALLERGY AND CLINICAL IMMUNOLOGY HOSPITAL REFERRAL & MANAGEMENT GUIDELINES</a> is provided by <a href="http://911medicalcare.com" title="Manual Nurse and health Guidelines"> Manual Nurse and Health Guidelines</a>. 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