What are the recommended referral criteria for a patient with suspected food allergies to a specialist?

Arrange referral to a specialist for allergy testing if a person has had one or more acute systemic reactions, or severe delayed reactions, or if there is a history of moderate to severe reactions, or if they are at increased risk of anaphylaxis such as with a history of food allergy and poorly controlled asthma ¹.

Referral is also recommended if the diagnosis is uncertain, if there is clinical suspicion of multiple food allergies, or if the person has not responded to a single allergen elimination diet ¹.

In children and young people, consider referral to secondary or specialist care based on allergy-focused clinical history, including if they have faltering growth with gastrointestinal symptoms, or if there is a strong suspicion of IgE-mediated food allergy despite negative allergy test results ².

For suspected IgE-mediated cow's milk allergy, arrange referral to a specialist allergy clinic for allergy testing if there are systemic symptoms, suspected anaphylaxis, or if the history suggests severe reactions or multiple food allergies ³.