Urgent referrals If you feel your patient needs to be seen urgently, denote “urgent” on the allergy/immunology referral form. All referrals marked “urgent” are reviewed and clinically triaged to help make sure the patients with highest medical need are seen in a timely fashion. If you wish to speak to the on-call allergist/immunologist, call 404-785-DOCS (3627).

Examples of conditions that may warrant an urgent referral include:

• An infant with atopic dermatitis and suspected food allergy.
• A severe immune deficient patient or an abnormal newborn screen for SCID.
• Severe allergic reaction/anaphylaxis (usually resulting in an emergency department visit and/or hospitalization) without an obvious avoidable trigger.

We do not treat the following conditions within Children's Allergy and Immunology:

• Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)
• Postural Orthostatic Tachycardia Syndrome (POTS) / undifferentiated “mast cell” symptoms (sometimes called Mast Cell Activation Syndrome)
• Long COVID
• Chronic fatigue syndrome/myalgic encephalomyelitis
• Autoimmune concerns: Refer these patients to a rheumatologist
• Suspected contact dermatitis: Refer these patients to a dermatologist as we do not perform patch testing in our clinic
• Isolated episode of acute urticaria without a clear trigger: This is usually caused by an infection and is not allergic. Evaluation and testing are usually not indicated in this scenario.

For patients with suspected allergic rhinitis/environmental allergies, you can initiate a diagnosis and treatment. For many patients with uncomplicated allergies (e.g. no sleep disturbance, difficult-to-control asthma, chronic sinus disease) the steps listed below are often sufficient to provide significant and rapid relief, and an allergy referral may not be necessary.

• If your patient has already had allergy testing for environmental allergies, view tips on allergen avoidance measures.
• If your patient has not been tested, we recommend regional environmental allergy panels to measure serum IgE to common inhalant allergens. These panels are available through Children’s lab (test code INHALP), Quest Lab (test code 10285) and LabCorp (test code 602629).
• If you add food testing to an environmental panel, choose only the individual food(s) the patient has already clinically reacted. IgE panel testing is usually not appropriate for food allergy.
  • After avoidance measures, the first line evidence-based treatment for allergies is intranasal steroids given daily during the allergy season. These are often administered with PRN oral antihistamines and allergy eye drops. Intranasal antihistamines can be used as an alternative. Many of these are available over the counter, and some payers cover prescriptions for OTC meds written by a provider. Visit choa.org/parent-resources to view various options and dosing recommendations.
  • Most patients respond well to allergen avoidance and medical therapy. If the above measures are not helping and/or your patient is specifically interested in allergen immunotherapy (e.g. allergy shots), we can discuss alternative treatment.