Clinical Immunology

Who to refer

• Recurrent major infection. Please refer all of the following
  • Two major infections in 12 months (major = requires hospital admission)
  • One major + 2 minor (minor = microbiologically proven and needs oral antibiotic) in 12 months
  • Second episode of bacterial meningitis ever
  • Infections (major or minor) in relative of patient with known primary immunodeficiency
  • Patients with unexplained bronchiectasis and/or sinusitis
  • Recurrent deep abscesses of the skin or internal organs
  • Unexplained chronic mucocutaneous candidiasis.
• Recurrent severe boils (failed initial therapy; deep seated abscesses)
  • Most are due to staphylococcal carriage or local disease (hidradenitis suppurativa).
  • Rarely may be due to neutrophil or antibody deficiency. Refer all patients with deep-seated abscesses (liver, brain).
• Anaphylaxis
  • Refer all patients with anaphylaxis (= allergic reaction with systemic features, hypotension, laryngospasm, bronchospasm). See NICE Guideline.
• Angioedema in people NOT on ACE Inhibitors including hereditary angioedema
  • Angioedema may be caused by ACE inhibitors (up to 10% of patients): stop drug and wait 3 months. Refer if persists.
  • All cases of hereditary angioedema should be referred.
  • Acquired angioedema in the older population may be associated with lymphoma.
• Food allergy — known or suspected
  • The following conditions currently have no contingency, as they require the skills of a trained clinical immunologist; however, referral to Immunology can continue. The patients will be listed in order of date of referral. When the service resumes the patients will be contacted in date order of receipt of referral.
• Condition
  • Food allergy
  • Drug allergy