Immunology and Allergy provides services in the specialty of clinical and laboratory immunology and 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 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.
Allergy testing and lung function testing are available on-site:
- Rhinitis, chronic sinusitis and hay-fever for investigation
- 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
- 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.
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.
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.
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
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
A randomized, placebo controlled trial of omalizumab in symptomatic mastocytosis.
- 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
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
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.
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.
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.
As there are limited services in Clinical Immunology and Allergy in Victoria, we welcome referrals from throughout the state and beyond, if geographically appropriate.
Referring doctors should also be aware that comprehensive clinical allergy services are also offered at the Alfred Hospital with smaller services also at the Austin Hospital, Western Hospital, Box Hill and Monash Medical Centre, which may be geographically more convenient for some patients.
When should a patient be referred
- In cases of severe, life threatening allergy (anaphylaxis)
- If immunotherapy (desensitization) for treatment of allergic diseases is contemplated
- When food allergy is suspected or diagnosis and management of food allergy is required
- Suspected stinging insect allergy causing a systemic reaction
- Asthma where an allergic trigger is suspected
- For investigation of possible autoimmune conditions (vasculitis, unexplained fevers, weight loss)
- Investigation of frequent or unusual (opportunistic) infections where immune deficiency is suspected
Immune deficiency diagnosis and management
We have close links with Clinical Genetics and bone marrow transplant and active research projects in this exciting area.
Diagnosis and management of immune system disorders for further investigation
We are currently conducting clinical trials in the area of severe asthma which will inform future treatments. Some patients may be eligible for trials of some of the new biological agents in asthma.
We have a large number of mastocytosis patients in our clinic, active trials of new treatment. We work with dermatology and haematology to provide best diagnosis and clinical care for this condition.
Urticaria and angioedema
We have active research projects studying new therapies in this condition.
This service is offered to country patients after their initial appointment in The Allergy Clinic. Telehealth consultations are currently run by Skype for review patients (Medicare Bulk Billed). To book a review Telehealth appointment please call 9342 7191 or fax 9349 3199 (attention to: Immunology Tele-med).
Allergy and drug challenge testing
We do not make direct appointments for food allergy challenge or drug testing. Access to these sessions is only following a consultation in one of our clinics and referral by one of our consultants. Once referred, we carefully triage challenge testing or desensitisation by need and there is no undue delay in appointments being offered for these patients.
We accept GP and specialist referrals for this service.
Referrals are triaged depending on priority. Emergency cases can present to the Emergency & Trauma Service at any time.
To refer a patient, complete and send your referral to Outpatients by fax to (03) 9342 4234.
You can use the following form or a template from your own system:
Referrals should include:
- relevant clinical history for the patient
- the reason for referral
- patient details including address, date of birth and contact phone numbers
- your details and provider number
- the name of the consultant (for Medicare clinics)
- if your patient requires ongoing management, please identify the referral as being "indefinite"
Special referral instructions
Allergy skin testing is offered on site and a clinical nurse specialist in allergy and asthma is present. A dietitian is available for suitable patients. Lung function testing can be performed.
Patients are bulk-billed.