An allergy is the response of the body’s immune system to normally harmless substances, such as pollens, foods, and house dust mite.  But for some people allergies can be very serious.   

The most common causes of allergic reactions are: 

• Pollen from trees and grasses 

• Proteins secreted from house dust mites 

• Moulds 

• Foods such as peanuts, tree nuts, milk and eggs 

• Pets such as cats and dogs, and other furry or hairy animals such as horses, rabbits and guinea pigs 

• Insects such as wasps and bees 

• Medicines (these may cause reactions by binding to proteins in the blood, which then trigger the reaction). 

Symptoms of an allergic reaction can appear within minutes or after a few hours. 

Symptoms may include: 

• a runny nose or sneezing 

• red or watering eyes 

• pain or tenderness around your cheeks, eyes or forehead 

• coughing, wheezing or breathlessness 

• a raised rash (hives), or itchy or red skin – redness can be harder to see on brown or black skin 

• diarrhoea, stomach cramps or bloating 

• feeling or being sick 

• rapid swelling of the skin (face, lips, eyelids) or gut, typically lasting 1–3 days (angioedema) 

• swollen eyes, lips, mouth or throat 

The symptoms can be mild and treated with age appropriate over the counter antihistamine, these can be in a variety of forms such as tablets, eye drops, creams or nasal sprays.  

The Immunology Department at Castle Hill Hospital provide: -  

• General allergy clinics investigating hay fever, asthma, food allergy, urticaria (rash) and angioedema (swelling) 

• Allergen immunotherapy using subcutaneous or sublingual desensitisation for inhalant and insect venom sensitivities 

• An anaphylaxis clinic for patients with systemic allergic reactions, providing expert training in the use of self-injectable adrenaline devices 

• Biologic clinics assessing patients for anti-IgE therapy for resistant urticaria 

• A drug allergy clinic investigating reactions to prescribed and over-the-counter medications, including suspected in-hospital or peri-operative anaphylaxis 

Call 999 if: 

• your lips, mouth, throat or tongue suddenly become swollen 

• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air) 

• your throat feels tight or you're struggling to swallow 

• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet) 

• you suddenly become very confused, drowsy or dizzy 

• someone faints and cannot be woken up 

• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face) 

• You or the person who's unwell may also have a rash that's swollen, raised or itchy. 

These can be signs of a serious allergic reaction (anaphylaxis). Anaphylaxis needs immediate treatment in hospital. 

Management of Anaphylaxis

Referral form for suspected in hospital or peri operative anaphylaxis

The first step in managing an allergy is identifying the cause(s) of the problem. Diagnosing allergy can be difficult since the symptoms may be similar to other conditions.  

To assess an allergic reaction the following need to be considered and a record of symptoms and occurrences kept, to assist in a diagnosis: 

• Do your symptoms occur at any specific time of the day? 

• Do you only get symptoms at certain times of the year? 

Do you suffer more at nighttime or during the day? 

• Do your symptoms occur when you are in the house as well as outside? 

• Does exposure to animals bring on your symptoms? 

• Do you think that any food or drink brings on your symptoms? 

• Do the symptoms occur every time you come into contact with the allergen? 

• Do your symptoms improve when you are on holiday? 

Allergy testing 

Anyone who believes they have an allergy, should tell their GP about the symptoms, when they happen, how often they occur and if anything seems to trigger them. 

Your GP or local pharmacist can offer advice and treatment for mild allergies with a clear cause. If your allergy is more severe or it’s not obvious what you’re allergic to, you may be referred for allergy testing at a specialist allergy clinic. 

Support is also available for Allergy UK Helpline on 01322 619898  

Blood tests 

The Royal College of Pathologists has also published ‘Best Practice Recommendations’ on the use of laboratory allergy testing in primary care. ((Please link to attached PDF: 

There are two general types of allergy blood tests: 

1. A total IgE test is used to measure the total amount of IgE antibodies in your blood. 

2. A specific IgE test measures how much IgE your body makes in response to a single allergen. A separate test is done for each allergen that may be causing your allergies. 

Allergy testing kits 

The use of commercial allergy-testing kits is not recommended.  These tests are often of a lower standard than those provided by the NHS or accredited private clinics and are generally considered to be unreliable. Allergy tests should be interpreted by a qualified professional who has detailed knowledge of your symptoms and medical history. 

Lactose intolerance  

Lactose intolerance and much more commonly cow’s milk intolerance both require an exclusion diet as a first line investigation.  

For GPs  

Management and when to refer to secondary care guidance is attached for ((GH - Please link to attached PDFs in Any other Information.): -  

• Angioedema (Flow chart, Management and Referrals) 

• Urticaria Flow chart and Referrals) 

• Drug Allergy 

• Food Allergy  

• Insect Sting Allergy 

• Seasonal or Perennial Allergic Rhino conjunctivitis 

Referral to Allergy should only be considered in severe cases or where standard treatment does not resolve or reduce symptoms.  

For Latex allergy, please use the information below to guide to the most appropriate department.  

1. Does the patient have a history of spina-bifida or repeated catheterization? 

2. Does the patient have a history of immediate itching, swelling or rash after contact with latex or rubber products? (E.g., rubber gloves, condoms, pencil erasers, balloons, or after internal examinations such as pelvic or rectal examinations? 

3. Does the patient have a history of swelling of tongue or lips after dental examinations or after blowing up balloons? 

If all above answers are NO, assessment complete – patient not at risk of latex allergy. History of delayed reactions to latex (contact dermatitis) should be referred to Dermatology for Patch Testing.  

If there is still uncertainty, please refer to allergy, with full details.      

Any with suspected in hospital or peri-operative anaphylaxis will be managed through hospital-to-hospital assessment.  If confirmed the patients GP will be notified with details. 

DO NOT REFER

Do not refer mild or self-managing allergies. 

Do not refer patients who have experienced only large local reactions to insect bites and not affecting or causing other symptoms such as breathing, swelling and signs of systemic symptoms, angioedema in patients on ACE inhibitors, acute urticaria without a trigger, eczema.

We do not investigate cases of food intolerance.    

Lactose intolerance can be normally diagnosed based on clinical symptoms only, however if further investigations including hydrogen breath test are required, please consider contacting the Programmed Investigation Unit at Hull Royal Infirmary or the Gastrointestinal Physiology Department at the Castle Hill Hospital, for further investigation.  Gastroenterology A&G may also be able to offer further guidance. 

For contact dermatitis please refer to community dermatology.

Referral Criteria 

The Department will see 

• Severe allergic rhino-conjunctivitis 

• Anaphylaxis has occurred recently 

• Suspected local anaesthetic allergy where a procedure involving local anaesthetic is needed  

• SAID reactions involving urticaria, angioedema, or asthma  

• Beta-lactam allergy

• Patients with a label of ‘multiple antibiotic allergy’  

• Patients with a history of immediate or non-immediate reaction to penicillin/s and/or cephalosporin/s with a requirement for frequent antibiotics, for example patients with bronchiectasis, CF, diabetes, primary and secondary immunodeficiencies or with asplenia/hypersplenism.  

• Patients with a history of immediate or nonimmediate reaction to penicillin/s and/or cephalosporin/s requiring specific treatment with a beta-lactam.  

• Syphilis in pregnancy with penicillin allergy (for consideration of desensitization)  

• There is diagnostic uncertainty or multiple drugs were involved (especially where the reaction is systemic)  

• Systemic reaction to insect venoms (anaphylaxis) for investigations and consideration of venom immunotherapy. 

• Severe reaction to latex – plasters or gloves  

Advance testing (alongside bloods where possible) include: - 

• Skin prick testing 

Referrals should be completed by a Health Care Professional via the NHS e-Referrals Service.  Advice and Guidance (A&G) is also available as a first contact if required. 

Guidance on using the advice and guidance element of ERS is available below 

• Enhanced advice and guidance overview 

• Managing advice and guidance requests 

The service is listed as Immunology and Allergy under Hull University Teaching Hospitals NHS Trust (RWA) and chose either A&G or referrals.  An A&G can also be revised to a referral following discussion with the Allergy Specialist through the system.  

For a routine referral, please send a referral letter, including patient details (name, address, DoB, NHS number, history and reason for referral, including background and any medications) and the practice details through NHS eRS to Immunology and Allergy.  Patients will be contacted to arrange appointments by the Trust and information on and following the appointment will be confirmed with the patient and their GP.

Support is available for Allergy UK Helpline on 01322 619898 or website https://www.allergyuk.org/  

Flow chart - Management of angioedema

Flow chart - Management of urticaria

Referral - Advice for Agioedema due to ACE inhibitors

Referral - Anaphylaxis

Referral - Chronic Urticaria and Angioedema

Referral - Drug Allergy

Referral - Food Allergy

Referral - Insect sting allergy

Referral - Seasonal or Perennial rhinoconjuctivitis

Referral form for suspected in hospital or peri operative anaphylaxis

Management of Anaphylaxis

G194 BPR Use of laboratory testing in primary care

Suspected Latex Allergy referral form

Suspected Latex allergy testing protocol

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