Allergy Clinic Consultation Letter

Paediatrician Letter to GP, copy to parents. Diagnosis 1. Severe peanut allergy (IgE mediated) 2. Allergic rhinitis Examination Height 120 cm Weight 25 kg Current Medication 1. Cetirizine 5mg, once daily as needed for allergic rhinitis. 2. Salbutamol inhaler 100mcg, two puffs as needed for asthma symptoms. Investigations Skin prick tests were performed during the consultation. Results showed a 10mm wheal to peanut extract, indicating a significant peanut allergy. Tests for house dust mite and grass pollen also yielded positive results with 5mm and 4mm wheals respectively, confirming allergic rhinitis to these environmental allergens. No reactions were observed for other tested allergens including tree nuts (almond, cashew, hazelnut, walnut), cow's milk, and egg. PLAN 1. Prescribed EpiPen Junior (0.15mg) with clear instructions on administration in case of accidental peanut exposure. 2. Referred to allergy dietitian for detailed dietary advice and label reading education. 3. Advised to continue Cetirizine as needed for allergic rhinitis symptoms and review effectiveness. 4. Recommended environmental control measures for house dust mite and pollen. 5. Follow-up appointment scheduled in 6 months to review management and discuss progress. Outcome Patient discharged with clear action plan for allergy management and follow-up appointment scheduled. Dear Colleagues Thank you for referring Master Alex Johnson, whom I was pleased to review in my allergy clinic on 1 November 2024, accompanied by his mother, Mrs. Sarah Johnson, regarding recurrent anaphylactic reactions to peanuts. Master Johnson, a 7-year-old boy, presented with a history of recurrent severe allergic reactions following accidental peanut ingestion. The first reaction occurred at age 2, involving widespread urticaria, angioedema, and respiratory distress, requiring emergency medical attention and adrenaline administration. Subsequent accidental exposures have led to similar, increasingly severe reactions. His mother reports strict avoidance measures are in place, but concerns remain regarding accidental exposure at school and social events. He also suffers from seasonal allergic rhinitis, primarily in spring and autumn, with symptoms of sneezing, rhinorrhoea, and itchy eyes, which are managed intermittently with over-the-counter antihistamines. Background Master Johnson has a past medical history of mild asthma, well-controlled with a Salbutamol inhaler as needed. There is a strong family history of atopy, with his father suffering from hay fever and his maternal aunt having a shellfish allergy. He attends St. Mary's Primary School and his mother is keen to ensure all necessary precautions are in place to manage his allergies safely in the school environment. Conclusion and Plan Based on the clinical history, examination findings, and positive skin prick test results, the diagnosis of severe IgE-mediated peanut allergy and allergic rhinitis to house dust mite and grass pollen is confirmed. A comprehensive management plan has been put in place, including the provision of an adrenaline auto-injector (EpiPen Junior) with detailed instructions for emergency use, and a referral to an allergy dietitian for nutritional guidance and support. We have discussed environmental control measures for his allergic rhinitis and reviewed his current medication regimen. Safety netting advice regarding recognition of allergic reactions and appropriate emergency response has been thoroughly reviewed with his mother. A follow-up appointment has been arranged in six months to assess adherence to the action plan, address any ongoing concerns, and consider further management options if required. This letter summarises today's clinic appointment. It was created using voice recognition software. If you notice any inaccuracies or have questions, please contact me at 0207 123 4567.