When should I refer a patient with severe eczema to an allergy specialist?

Refer a patient with severe eczema to an allergy specialist if:

• They have moderate or severe atopic eczema with suspected food allergy, requiring specialist investigation and management.
• There is significant atopic eczema where multiple or cross-reactive food allergies are suspected by the parent or carer.
• There is persisting parental suspicion of food allergy despite a lack of supporting history.
• There is strong clinical suspicion of IgE-mediated food allergy but allergy test results are negative.
• There is clinical suspicion of multiple food allergies.

These criteria apply particularly to children and young people, and referral should be considered based on an allergy-focused clinical history and the presence of severe eczema with suspected food allergy.

Additionally, referral to a dietitian with appropriate competencies is advised for support in managing suspected food allergies.

For severe eczema not responding to optimal topical therapy or complicated by infections, referral to dermatology is recommended, but allergy specialist referral is specifically indicated when food allergy is suspected or confirmed.

References: ¹, ²