Immunology and Allergy
Starship Paediatric Immunology and Allergy provides both inpatient and outpatient services for two main groups of patients:
- children with primary immune deficiency disorders where the immune system does not function properly. Many of these children will have multiple hospital admissions and they will also be seen in outpatients. Some will require ongoing immunoglobulin replacement therapy. The service is involved in the care of immune deficient children from around New Zealand, in liaison with the child's local paediatrician.
- children with allergic disorders. Allergy is extremely common, and most children with allergy will be looked after by their general practitioner, sometimes with the assistance of a general paediatrician. Only a minority of children with allergy will need to be seen by the Starship Immunology and Allergy service. Examples of allergy problems that may need to be seen by the Starship Immunology and Allergy service include very severe allergic reactions / anaphylaxis, complicated food allergy, or severe insect sting reactions. Most allergy patients will be seen only in outpatients.
- Dr Shannon Brothers Paediatrician
- Dr Jan Sinclair Paediatrician
- Dr Kuang-Chih Hsiao Paediatrician
The Starship Paediatric Immunology and Allergy service receives more referrals than it is possible to see. Many of these referrals will be forwarded to general paediatric services. Referrals from paediatricians or other specialists will always be accepted. Some referrals will be returned to the GP with advice if, from the details in the referral, an appointment is not needed.
The waiting time for an appointment depends on the nature of the referral. Referrals for possible immune deficiency will be seen urgently. Referrals for severe allergic reaction will generally be seen within 6 weeks, while referrals for less urgent allergy problems may wait longer to be seen.
At the clinic your child will be seen by a Consultant Immunologist or an Immunology Registrar (who will discuss each case with the consultant). The doctor will take a detailed history of symptoms and ask about previous illnesses and medications. The history is the crucial part of the consultation. There will be other questions about general health designed to add helpful information to diagnose what is causing your child's symptoms. The doctor will then examine your child. They will explain to you as they go the reasons for the examination and then what tests or treatments are coming. It is helpful to bring your child’s well child book to the appointment, particularly if there are concerns about growth or food allergy.
If relevant, the doctor may ask for skin tests to be performed, either on the first clinic appointment or at a subsequent appointment. Certain skin tests may take some time to perform (e.g. up to 2 hours for some antibiotic allergy tests).
Your child may be started on medications or asked to undergo further testing (e.g. blood tests) before being seen again in the clinic or may be discharged back to your GP for ongoing management. A letter will be sent to your GP (with a copy to the family) with treatment recommendations as well as the results of any tests that are undertaken.
Some patients will need other procedures arranged such as food or drug challenge, or venom immunotherapy. Wait times for these procedures vary considerably depending on clinical urgency.
Common Conditions / Procedures / Treatments
Allergy Skin Prick Tests
Many children referred for possible allergies will have skin prick tests done at the time of their appointment. It is important that no antihistamine (e.g. Phenergan, Lorapaed, Dimetapp etc) has been taken for 5 days prior to skin tests, as these can interfere with the results. Skin testing involves placing small drops of the allergen (the allergen is the thing being tested, such as dust mite or peanut) on the skin and then pricking through the drop with a small lancet. The prick is very superficial, and most children are not upset by having skin tests done. The results will be read after 15 minutes and your child will be seen with the result.
Some allergy skin tests are more complicated. If the first stage skin prick tests show no reaction for antibiotics and venom then a second stage of intradermal (injections just under the skin) tests are done. This type of testing is often difficult in very young children, so may not always be pursued depending on the history of reaction.
Specific IgE Blood Tests (sometimes called RAST)
Specific IgE (sIgE) tests are a way of doing allergy tests by a blood test rather than a skin test. A variety of foods and environmental allergens can be tested for. These tests involve taking a teaspoon of blood and the results are generally available after about 7 days. For these reasons skin tests are the preferred option in the allergy clinic, as results are immediately available.
sIgE tests may be preferred in situations where skin tests cannot be done, such as with continuous antihistamine treatment or severe eczema. sIgE tests are sometimes used to predict the likely time course of growing out of a food allergy. Importantly neither sIgE tests nor skin tests can predict the severity of an allergic reaction.
Deciding whether a child is truly allergic to a food, or deciding whether a food allergy has resolved with time, can be difficult. At times having the child eat the food may be necessary to decide this. If there is a chance of a significant food allergic reaction then a supervised food challenge may be recommended.
Waiting times for food challenge vary. The Starship service generally runs a "summer catch up" food challenge programme, doing many food challenges over summer months when the hospital is generally quieter. If your child is waiting for a food challenge make sure we have your correct phone numbers / mobile - there are often last minute cancellations for children booked for food challenge, so you may be able to be offered a cancellation slot at short notice.
If a child has a severe allergic reaction/anaphylaxis to a bee or wasp sting, immunotherapy or desensitisation will generally be recommended. This involves giving injections of venom, initially in tiny and then in increasing doses, to make the child tolerant of the venom, which will minimise the risk of a further severe sting reaction.