Table 1 Example of clinical symptoms and related laboratory or instrumental findings indicating the need for an allergy or immunology specialist’s need for an urgent consultation
Presenting symptoms and/or laboratory findings | More probable allergic and/or immune-mediated disease | Possible alternative diagnosis |
|---|---|---|
Uncontrolled asthma-like symptoms | Severe asthma or asthma with comorbidities (asthma plus) | Dysfunctional breathing disorders, aspiration disease, foreign bodies (< 6 yr), ANCA-associated pulmonary vasculitis, interstitial lung disease |
Recent severe asthma attack | Uncontrolled asthma | Dysfunctional breathing disorders, aspiration disease, foreign bodies (< 6 yr) |
Chronic diarrhea with failure to thrive and/or malabsorption | FPIES or eosinophilic gastroenteritis | Combined immunodeficiency, cystic fibrosis, autoimmune enteritis, gastrointestinal infections |
Acute hypersensitivity symptoms occurring after the first introduction/s of a fooda | Anaphylaxis | FPIES, spontaneous urticaria |
Acute hypersensitivity symptoms occurring after drug administrationb | Anaphylaxis | Mastocytosis or idiopathic mast cell activation syndrome, spontaneous urticaria |
Severe cutaneous adverse reaction (SCAR) w/wt systemic symptoms occurring after drug administrationb | DRESS, TEN, Stevens-Johnson syndrome | viral infection (EBV, CMV, HHSV6, others), staphylococcal and streptococcal shock syndrome, autoimmune diseases |
Acute hypersensitivity symptoms occurring after vaccine administration c | Anaphylaxis (rare) | Spontaneous urticaria |
Chronic unexplained cough | Wet: protracted bacterial bronchitis, bronchiectasis Dry or mixed: foreign body, pertussis or parapertussis, or Mycoplasma infection | Pulmonary tuberculosis, tracheobronchomalacia, vascular rings/slings, aspiration syndrome, cystic fibrosis, primary ciliary dyskinesia |
Prolonged respiratory symptoms and/or interstitial pneumonia, especially if combined with poor weight gain | Combined immunodeficiency | interstitial lung disease, cystic fibrosis, Shwachman disease |
Hypereosinophilia (not allergy-related) | Hypereosinophilic syndromes, parasitic disease | Malignancies, primary atopic disorder |
Severe neutropenia (< 0.5 × 109/L) in the context of a pyogenic infection | Severe congenital neutropenia (SCN) | Drug-related agranulocytosis, aplastic anemia, autoimmune neutropenia (rare) |
Severe lymphopenia in the context of severe or atypical infections and/or failure to thrive | Severe combined immunodeficiency (SCID) | Other primary immunodeficiencies |
Recurrent fever in a “sick” appearing child | Autoinflammatory disease | Malignancies, chronic inflammatory bowel disease, recurrent organ infections in an immunocompromised child |
Multiple autoimmune diseases | Primary immunodeficiencies, systemic rheumatological disease |