When should I consider referring a patient with suspected EGPA to a specialist, and what information should I include in the referral?

When to refer a patient with suspected eosinophilic granulomatosis with polyangiitis (EGPA) to a specialist:

• Consider referral to a specialist (rheumatologist, immunologist, or respiratory physician with expertise in vasculitis) if EGPA is suspected based on clinical features such as adult-onset asthma, eosinophilia, systemic vasculitis symptoms (e.g., neuropathy, skin lesions, constitutional symptoms), or if there is diagnostic uncertainty.
• Urgent referral is warranted if there are signs of organ involvement or rapidly progressive disease.
• Referral is also appropriate if initial investigations in primary care suggest EGPA but confirmation and management require specialist input.

Information to include in the referral:

• Detailed clinical history including onset and nature of asthma and any systemic symptoms.
• Results of relevant blood tests, especially eosinophil count, inflammatory markers (CRP, ESR), and any autoantibody tests if done.
• Findings from any imaging or biopsy if performed.
• Current medications and response to treatment.
• Any evidence of organ involvement (e.g., neuropathy, renal impairment, skin manifestations).
• Reason for referral and specific questions or concerns for the specialist.

Early specialist involvement is important for diagnosis confirmation, assessment of disease extent, and initiation of appropriate immunosuppressive therapy to prevent organ damage.