Immunology & Allergy

We aim to provide excellence in the care of patients with:

• allergic diseases (rhinitis and asthma, food allergy, stinging insect allergy, anaphylaxis, urticaria and angioedema and drug allergies)
• immunodeficiency diseases (both inherited and acquired)
• autoimmune diseases (vasculitis and other connective tissue diseases)

Through evidence based clinical practice benchmarked by published research and active participation in teaching and clinical governance facilitated by links with our precinct partners including The University of Melbourne, The Walter and Eliza Hall Institute and the Royal Children’s Hospital.

We are accredited by the Joint Specialist Advisory Committee (JSAC) of the Royal Australasian College of Physicians and The Royal College of Pathologists of Australasia to train specialist doctors in Clinical Immunology & Allergy and in Immunopathology.

Allergic diseases

Allergic diseases are common and are increasing in prevalence. Services available include diagnosis and management of the following.

Allergy skin testing

This is offered where indicated for investigation of allergic disease.

Respiratory allergy

Allergy testing and lung function testing are available on-site:

• Rhinitis, chronic sinusitis and hay-fever for investigation
• Asthma
• Severe Asthma: the Department runs a joint clinic with Thoracic Medicine to assess and treat people suffering from severe asthma and identify those who may benefit from some of the newer medications such as omalizumab (Xolair).
• Clinical trials in severe asthma and rhinitis are currently being conducted within the department and some of these involve the newer medications for severe asthma.
• Prescription of sub-cutaneous or sublingual immunotherapy where indicated

Food allergy

• diagnosis including skin testing, blood testing or challenge testing where appropriate
• Developing a treatment plan including specialist nurse education.
• Prescription where necessary of adrenaline auto-injectors

Allergen desensitisation (immunotherapy)

Desensitisation (immunotherapy) is offered to patients with:

• Stinging insect venom allergy
• Respiratory allergies: especially hay fever

Desensitisation can be by the injected or sublingual route and both are available and offered to the patient if appropriate.

Anaphylaxis

Often due to drugs, stinging insects, foods or with a cause not yet identified. We aim to offer:

• diagnosis including skin testing, blood testing or other testing where appropriate
• A comprehensive treatment plan including specialist nurse education
• Prescription where necessary of adrenaline auto injectors
• Immunotherapy or desensitisation treatment where appropriate

Drug allergies, such as penicillin allergy

We have very many patients referred for drug allergy testing and cannot meet demand. Therefore we have prioritized the service so that patients referred for drug and antibiotic allergy testing should have a clear requirement for the drug such as:

• A chronic condition with multiple drug allergies and a limited range of antibiotics available
• planned armed services entry and a history suspicious for penicillin allergy
• A serious condition and an absolute requirement for an antibiotic where the patient describes a sensitivity

In such cases the patient will be assessed in our clinic and where appropriate follow-up antibiotic testing can be offered in our day-ward. For some patients desensitisation to a particular antibiotic is required and we will arrange this in collaboration with the treating unit.

If the request is urgent, please phone the consultant on call and we will endeavour to assist.

General anaesthetic allergy

We undertake anaesthetic allergy testing in conjunction with the Department of Anaesthetics and Pain Management. Patients should be referred using the referral form on the ANZAAG website. In many instances we will assess the patient initially in our clinic to determine any underlying significant medical problems, organise relevant blood tests and to identify clearly which drugs ought to be tested.

If patients are being referred, please be aware that the Alfred Hospital and Monash Medical Centre also offer this service.

Allergy challenge and drug allergy challenge testing

All patients referred for possible challenges are seen in the clinics for assessment prior to conducting a challenge.

Stinging insect allergy

Patients who have suffered a systemic reaction to a stinging insect sting should be reviewed in our clinic for diagnosis and prescription of an action plan and adrenaline auto injector.

Patients with diagnosed anaphylaxis due to venom sensitivity will generally be offered desensitisation therapy. This is available for patients who suffer from allergies to bee and wasp venoms. We currently have a wait-list for Jumper Ant allergy.

Urticaria and angioedema

We see and assess patients with urticaria and angioedema. In many instances chronic urticaria is not an allergic condition so that patients are initially treated with antihistamines and many will resolve spontaneously.

We also investigate and treat patients with angioedema including hereditary angioedema.

We are currently conducting research studies into developing new treatments in urticaria and angioedema.

Systemic mastocytosis

Patients with cutaneous or suspected systemic mastocytosis are invited to be referred to our service. Services for patients with mastocytosis are run in close collaboration with the Department of Dermatology. We are undertaking an active clinical trial in this rare condition and are therefore currently seeking symptomatic patients.

Primary immunodeficiency

The Royal Melbourne Hospital provides a comprehensive adult immunodeficiency service with close links to the Department of Clinical Genetics, Royal Melbourne Hospital, the Immunopathology laboratory and The Royal Children’s Hospital, together with research links to the Walter and Eliza Hall Institute.

We see referred patients aged 16 years of age or above in a regular clinic staffed by specialists in Immunology and Allergy. Patients will receive infusion treatments, if necessary, in the day-wards of the Royal Melbourne Hospital.

A transition program is in place with The Children’s Hospital to assist the transition of primary immunodeficiency patients from paediatric to adult care.

Patients with immune deficiencies may have problems affecting many organ systems so that the expertise of colleagues in other medical and surgical specialities is particularly important and this expertise is available within the Royal Melbourne.

• Investigation of suspected immunodeficiency
• Management of humoral Immunodeficiencies including assessment for and administration of immunoglobulin therapy
• Management of cellular Immunodeficiencies such as Chronic Granulomatous Disease
• Management of Hereditary Angioedema (HAE)
• Genetic counselling for families affected by inherited immunodeficiency in a multidisciplinary Immunogenetics clinic run in conjunction with the Department of Clinical Genetics
• Participation in research for patients with immunodeficiency in collaboration with the Walter and Eliza Hall Institute and Clinical Genetics

Autoimmune disease

The service provides diagnosis and management of patients with a broad range of systemic connective tissue and autoimmune conditions including: - vasculitis, sarcoidosis and Behçet’s disease.

Clinical immunology laboratory

The Clinical Immunology Laboratory provides a comprehensive autoimmune serology service and also performs testing for allergen specific IgE and functional testing of the complement pathway. Testing for immune deficiencies is performed with specific testing being undertaken at the Royal Children's Hospital.

Research activities and projects

Mastocytosis

A randomized, placebo controlled trial of omalizumab in symptomatic mastocytosis.

Clinical asthma

• NH & MRC funded studies on the mechanisms of corticosteroid resistance in severe asthma in collaboration with the Lung Health Research Centre
• Commercially funded trials of biological agents in severe asthma

Primary immunodeficiency

A study of the genetics of common variable immune deficiency in collaboration with the Department of Clinical Genetics and the Walter and Eliza Hall Institute.

Allergic rhinitis (hayfever)

A study of grass pollen allergy and allergic rhinitis

Urticaria

Studies of the immunological mechanisms of idiopathic urticaria and angioedema

Education and training

In 2015 our department in conjunction with the University of Melbourne is pleased to offer a “Practicum in Clinical Allergy” a 1.5 day course designed for doctors, both general practitioners and specialists to educate to provide an up-to-date refresher in clinical allergy practice.

Clinical education

The Immunology & Allergy Department hold an 8am Breakfast Meeting each week (except school holidays and public holidays). If you are interested in attending please contact us.

Medical students

The Immunology & Allergy Department hold an 8am breakfast meeting each week, except school holidays and public holidays. If you are interested in attending, please contact us.