Much of the activity of immunology services is specialised and commissioned by NHS England’s CRG for Immunology and Allergy.
Paediatric, adolescent and transition services
Often rare and or complex immunological disorders (some familial) present in childhood and should be seen by paediatric specialists. However, where this is not possible, consultant immunologists may deliver joint clinics with a paediatrician (eg infectious diseases or respiratory).
Transition and handover clinics
Arrangements for combined / transition / handover clinics are important to smooth the transfer process for adolescents, diagnosed in childhood, but now aged 16–18 years.
NICE guideline-triggered referrals
Much important regional allergy work is generated by NICE guideline-triggered referral, eg:
- anaphylaxis cases – referred by A&E or GP (see NICE anaphylaxis guidance)
- drug allergy cases – anaesthetics, GIM, GP (see NICE drug allergy guidance).
Laboratory diagnostics generated
Irrespective of sample origin (GP, other), the diagnostic immunopathology lab may provide a new diagnosis, sometimes entirely unexpected by the referring doctor. Direct clinical liaison with the referrer is important, often with speedy referral to the immunology clinic helping to confirm the diagnosis and treat the patient. Examples include:
- history of infection, low immunoglobulins and absent B lymphocytes suggesting thymoma
- complement abnormality with rash suggesting cryoglobulinaemic vasculitis.
Rare disease referral from other specialties
- infectious diseases – unusual type or recurrent nature of infection
- respiratory medicine – bronchiectasis due to ‘occult’ immunodeficiency
- anaesthetics – drug anaphylaxis during anaesthesia (sometimes joint clinics with anaesthetics are held)
- dermatology – purpuric rash that could be related to cryoglobulinaemia, vasculitis or autoimmune conditions.