Clinical Immunology

We offer a dedicated immunology service comprising of outpatient assessment, day ward evaluation and treatment and consultation for inpatients.  

We provide specialist services in the following areas:

• Primary immunodeficiency
• Complex secondary immunodeficiency
• Vasculitis – particularly small vessel vasculitis
• Chronic spontaneous urticaria and angioedema
• Anaphylaxis and other serious allergic reactions
• Drug allergy – (please review information for referring doctors)
• Complex autoimmune disease
• Desensitisation treatment (allergic rhinitis – grass and house dust mite only)
• Venom desensitisation

We also provide an in-patient consult service and, as a pathology specialty, have roles in the INAB accredited Diagnostic Immunology Laboratory Service including; result validation, communication and quality control.

Primary immunodeficiency and vasculitis are the priority clinical areas of this department. Recent years have seen huge increases in referrals for allergic disease. We continue to advocate for resources to meet this area of overwhelming demand.

The Immunology Department is actively involved in research and education and regularly collaborates in research published in international peer-reviewed journals. We have a programme of weekly seminars which deal with clinical case studies, translational research and laboratory techniques.

Appointments for the Immunology Clinical Service are made on receipt of a referral letter from the patient’s GP or other referring doctor. Referral letters are evaluated by the consultant and appointments are offered to patients, if clinically appropriate. All referral letters should be sent to:

• Immunology Clinical Secretary
  Hospital 5
  St James's Hospital
  Dublin 8
  Phone: (01) 416 2928

The wait for a routine clinical immunology appointment may be up to 24 months. Urgent referrals are seen sooner. There is no private immunology clinic available in St James’s Hospital.

If you receive an appointment but feel you should be seen sooner, you should discuss this with your referring doctor who may then contact the Immunology medical team to provide further details.

The single most important factor in our long waiting list is the lack of specialist clinical immunology doctors and nurses available to provide the increasing breadth of service required for an increasing number of patients. Increased recognition and referral of allergic disease is also a major factor in our long waiting times. We believe that this is a major unmet need across the health service.

We are continuing to engage with St James’s Hospital management, Dublin Midlands Hospital Group and the HSE to secure the resources required to improve all aspects of our service including waiting times.

Immunology departments also exist in Beaumont and Galway Hospitals. Please note clinical immunology services are not available in St Vincent’s Hospital, Mater Hospital, Cork University Hospital, Limerick University Hospital or other regional hospitals.

Contact allergy – please refer patients to our Dermatology Service. Our Immunology Service does not have access to patch testing.

Eczema – in general, patients with eczema should be seen by a dermatologist, unless there is specific evidence of associated serious food allergy. Please note that whilst food allergy is associated with eczema, eczema in adults is not caused by food allergy.

Food intolerance / irritable bowel syndrome – there are no evidence-based diagnostic laboratory tests for food intolerance. Patients with non-allergic gut symptoms (bloating, excessive flatulence, diarrhoea) may benefit from assessment for coeliac disease, or in certain cases testing for lactose intolerance (provided by the Gastroenterology Service). Assessment by a specialist gut doctor (gastroenterologist) may be helpful rule to out other stomach conditions. Food intolerance is best managed by dietary manipulation under the supervision of an experienced dietician. We do not recommend the use of non-evidence based tests or management strategies such as food specific IgG, Vega testing, kinesiology, enzyme potentiated desensitisation or naturopathy. The use of such tests in allergic disorders may be dangerous.

Non-allergic rhinosinusitis – whilst we do offer desensitisation for patients with allergic nasal disease, if there is no evidence of allergic sensitisation on testing then there is no role for immunology services. Most cases of allergic rhinitis should be managed in primary care.

Lyme disease / chronic lyme disease – referrals should be directed to an appropriate infectious disease specialist.

Chronic fatigue syndrome / ME and related disorders – the Immunology Department is currently unable to offer services to manage chronic fatigue syndrome. We do not offer experimental immune system treatments. We advise, in line with NICE (UK) guidelines, that patients with CFS/ME, should engage in a supervised graded exercise programme with supporting cognitive behavioural therapy. Unfortunately, this approach is not available in the Immunology Department or locally in St James’s Hospital at this time.

Immunology

Ten ways to help your immune system

Patient Information Leaflet - Hereditary Angioedema

Immunodeficiency diseases support groups

Ataxia Telangiectasia Society

Chronic Granulomatous Disease Society

Gene People – The genetic conditions support group

HAE UK

IPOPI – International patient organisation for primary immunodeficiency

Max appeal

Allergy

Frequently asked questions about allergy

Irish Food Allergy Network

Epipen – step by step video

Penicillin Allergy Patient Information

Information for patients with confirmed penicillin allergy

Vasculitis

Vasculitis Ireland Awareness

Behҫet’s UK

We understand that many people are waiting for long periods on their immunology appointment and that this is frustrating.

Between 10 and 25% of patients (2015-2017) did not attend their scheduled appointment and these appointment slots are wasted. This is unfortunate for people waiting on a much needed appointment.

In most cases, patients that do not attend their appointment will not be offered a further appointment with us. The referring doctor or GP will be informed.

We do recognise that circumstances change – if you no longer want or need an appointment, please cancel it by contacting the immunology secretary on (01) 416 2928.

The department provides a number of advice services to GPs. These include management of chronic spontaneous urticaria in general practice.  

Information regarding the immunology laboratory service, including test repertoire, turnaround times and results, can be found here.

 

Additional test requests

• Please contact the Immunology Department if additional testing is required 01416 2034, Monday to Friday, 9 am to 5 pm. Samples are stored for different lengths of time, so direct communication with Immunology is required. Please note that samples are retained in the laboratory for three days post reporting. Extra tests may be requested during this time.

Turnaround times

• Turnaround times for immunology tests the interval between the date the sample is logged into the laboratory and the date the test result is authorised for release.  Hard copy results to GPs via Healthlink are normally posted five hours after authorisation. Further testing (follow-on tests) will delay the printed report, which is normally available for dispatch the day after the result is authorised.
• Further information regarding the Immunology Laboratory Service, including test repertoire, turnaround times and results can be found here.

Critical Results Policy

• The Immunology Department provides an urgent out of hours service for anti-neutrophil cytoplasmic antibodies (ANCA) and glomerular basement membrane (GBM) antibody testing.
• Physicians who require an urgent ANCA and GBM test must contact the laboratory directly (or the hospital switchboard) to organise this service. The turnaround time will be approximately three hours from receipt of the sample into the laboratory. A policy document outlining the procedure for ordering urgent ANCA and/or GBM antibody testing can be found here Urgent ANCA GBM Request Procedure.
• Results that are abnormal and may require immediate clinical management are communicated by the Immunology Department to the appropriate healthcare professionals. A policy document outlining the list of tests and their respective critical phone limits is available here Critical Phone Limits in Immunology 2022.

Contact Details

Monday to Friday, 9am to 5pm

(01) 416 2924

A hospital wide patient representative meeting takes place once a month.

Clinical advice

• The medical and scientific staff of the Immunology Department are very happy to discuss any issues regarding the appropriate tests to perform, how to interpret test results or possible patient management strategies with GPs or other doctors.

Allergy Advice:

• For allergy advice please email: allergyadvice@stjames.ie. (This email service is for GPs and other Health Professionals only. For legal reasons, direct advice cannot be given to patients. Referrals cannot be accepted via this email address.)

Professor J David M Edgar, Consultant Immunologist

Professor Niall P Conlon, Consultant Immunologist

Dr Salma Alamin, Locum Consultant Immunologist