‘Our GP was really good’

For Victorian Phoebe Lynch, the local general practice gave a crucial early warning for the profound challenges that lay ahead.
 
Speaking to newsGP during World Allergy Week, Ms Lynch recounted how their doctor first picked up on the allergies suffered by her then infant son Owen.
 
‘It started with our GP noticing Owen not putting on a lot of weight and having a lot of vomits,’ she said. ‘Our GP was really good at being proactive and referring us.’
 
Since then, Keilor-based Owen has travelled in an ambulance four times and been to the Royal Children’s Hospital around a dozen times.
 
The four-year-old, who has milk, peanut and egg allergies, first suffered an anaphylactic shock after eating a home-made wonton at the age of three.
 
Having the right training was important preparation.
 
‘We’ve got management plans everywhere, [my partner] and I are first-aid trained and we have done anaphylactic training,’ Ms Lynch said.
 
‘The good thing about having EpiPen training is that when Owen did go into anaphylaxis, he knew what process we were doing. But it was still pretty scary on the way to the hospital.’
 
However, Ms Lynch says a shortage of EpiPens has been a particular concern since the onset of COVID-19.

‘It was quite stressful – there wasn’t a great supply,’ she said. ‘I would call three or four different chemists, then try and get our GP to get funding for it and get the PBS prescription, and then go back to him in a few months’ time and change it all over.
 
‘Every time we change the EpiPens we have to change the management plans with childcare and kinder. It’s just a lot of paperwork, really.’
 
Beyond the emergency response, Ms Lynch highlighted the parenting challenges involved.
 
‘Really early on it changed our lives. When I was breastfeeding, I had to take all the dairy out of my diet,’ she said.
 
‘The impact has ripple effects to our extended family and friends. Eating out as a family is pretty limited, just because in so many places their knowledge of anaphylaxis and allergies is not great.
 
‘It’s just really limiting in terms of what we do and where we go. You’re hyper-vigilant all the time.’
 
Dr Joanne Simpson, Chair of RACGP Specific Interests Allergy, said that in the past allergies may not have been considered an important part of medical training.
 
‘I think that’s changing,’ she told newsGP. ‘With better education, it’s well within a GP’s capacity to appropriately manage allergies and refer if needed.’
 
According to Dr Simpson, patients self-diagnosing is a particular challenge, but it can be addressed by taking a careful history and paying attention to the time that symptoms present
 
‘Patients have often made their own assumptions on the diagnosis and what’s causing it. They often blame allergies for symptoms that are not necessarily allergies [and] they will often blame food,’ she said.
 
‘Someone presenting with wheeze or cardiovascular collapse could be a bit more difficult to diagnose and the assumption could be made that it is asthma when in fact it could be allergy.
 
‘I think most GPs are very well aware of the symptoms of allergy.’
 
Dr Preeti Joshi, who is the National Allergy Strategy co-Chair and a paediatric clinical immunology/allergy specialist, told newsGP that around one sixth of anaphylactic patients do not present with external symptoms such as rashes on their skin. 
 
‘If someone presents with a sudden onset of a wheeze and they have been exposed to something they were allergic to, and they were otherwise perfectly well before, that almost certainly should be treated as anaphylaxis,’ she said.
 
The speed of treatment, the use of adrenaline rather than steroids, and having access to equipment such as an auto-injector are all key elements in the response, she said, as is ensuring careful monitoring and preventive measures against hypotension.
 
‘GPs, as usual, are at the forefront at these sort of events,’ Dr Joshi said.
 
She underlined the usefulness of information offered by the Australasian Society of Clinical Immunology and Allergy (ASCIA).
 
With anaphylaxis accounting for around 2400 hospital admissions and 20 deaths in Australia – and around four million Australians thought to be living with an allergy – there is a strain on resources, an issue also referenced by Dr Joshi.
 
‘It’s a difficulty that GPs face, getting their patient to see a qualified immunologist/allergist,’ she said. ‘There’s a long wait time for a lot of people, certainly for public hospitals.
 
‘What we’re trying to do as part of the National Allergy Strategy is develop a model whereby we just ease the access of care and advice so there’s a streamlined passage.
 
‘We don’t have the ongoing funding for that yet – but one of our big aims is a model that looks at that.’
 
Ms Lynch, who ultimately decided to take Owen to a private clinic, said the past few years have reinforced the value of regularly engaging with the family GP. 
 
‘It’s really important for a parent that you have a good relationship with your GP and that you do see them quite regularly and it’s not just for those colds and flus, particularly around the time we were introducing food to Owen,’ she said.
 
‘That definitely made us more at ease knowing that he was always our first port of call.’
 
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