General Practitioners – information on referrals to immunology centres

All referrals into an immunology service must come via the NHS e-Referral system. 

Information on specialist immunology centres in the UK can be found at Find a clinical immunologist | British Society for Immunology 

Any referrals for suspected immunodeficiency should include details about the infections, including frequency, treatment response and microbiology results. An infection diary can be used to record the details; this can help with referral triage.  

Centres will offer guidance on their referral criteria on their website. Examples include: 

• Manchester University NHS Foundation Trust – Clinical Immunology and Allergy – Referral guidance 

• Great Ormond Street Hospital – Immunology admission criteria 

The warning signs of primary immunodeficiency in adults are listed below:

• Clinical features suggestive of immunodeficiency 

• Four or more new ear infections within 1 year 

• Two or more serious sinus infections within 1 year 

• Two or more months on antibiotics with little effect 

• Two or more pneumonias within 1 year 

• Failure of an infant to gain weight or grow normally 

• Recurrent, deep skin or organ abscesses 

• Persistent thrush in mouth or elsewhere on skin 

• Need for intravenous antibiotics to clear infections 

• Two or more deep-seated infections 

• A family history of primary immune deficiency 

Read more at Essentials-of-PID-diagnosis.pdf 

Warning signs of secondary immunodeficiency include:

• A history of recurrent infection for more than 6 months following chemotherapy or immunotherapy for cancer.  

• The occurrence of Severe, Persistent, Unusual, or Recurrent (SPUR) infections is relevant. 

• Use of medications that can cause low IgG: 

Read more about the cause and treatment of secondary immunodeficiency at ImmunodeficiencyUKSecondaryImmuno.pdf.  

March 2026