In this episode of The Good GP, host Dr Tim Koh is joined by Dr Bhavesh Patel, a Queensland-based paediatric surgeon, to discuss the assessment and management of scrotal problems in boys, a common area of concern for general practitioners.

Dr Patel outlines the common scrotal issues encountered in newborns and children, including hydroceles, inguinal hernias, undescended testes, and varicoceles. He explains the typical presentations of these conditions and highlights key distinctions, such as the differences between retractile and undescended testes, as well as the nuances of diagnosing these conditions in a clinical setting.

Providing guidance on the natural history and management of hydroceles, saying that most hydroceles resolve without intervention within the first 1–2 years of life.

On the subject of undescended and retractile testes, Dr Patel advises on clinical assessment, the importance of careful examination, and when follow-up is necessary. They also address counselling parents regarding potential long-term risks, monitoring strategies, and indications for referral.

Additionally, they also covered the evaluation of inguinal hernias presenting as scrotal swellings and the differential diagnosis of other less common scrotal conditions, such as lymphatic malformations and testicular tumours.

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Maria Li welcomes Dr Arthur Price, an immunologist based in Wellington, New Zealand, to discuss penicillin allergy—one of the most frequently reported and commonly misunderstood drug allergies in general practice.

Dr Price clarifies the true prevalence of penicillin allergy, explaining that while approximately 10% of patients admitted to hospital carry a penicillin allergy label, only about 10% of those actually have a genuine allergy. Emphasising that most patients with a penicillin allergy label can be safely de-labelled after proper assessment.

They address the typical presentations of penicillin allergy. Outlining three main patient groups: those who clearly are not allergic based on history (such as patients with only gastrointestinal side effects or late-onset rashes), those with uncertain or vague histories (including childhood reactions where details are unclear), and those with definitive immediate or severe delayed reactions (such as anaphylaxis or severe cutaneous adverse reactions like Stevens-Johnson syndrome). Dr Price provides practical advice on history-taking to help GPs risk stratify and identify true penicillin allergy, including key questions to ask about timing, symptoms, and the nature of the reaction.

Discussing the investigation and referral pathways for suspected penicillin allergy. Dr Price recommends that patients with unclear or potentially significant histories should generally be referred to an immunologist for assessment, rather than managed solely in primary care. He highlights the limitations of current tests and the importance of specialist input.

For general practitioners, Dr Price advocates a proactive approach to reviewing penicillin allergy labels and encourages considering referral for possible de-labelling where appropriate. They highlight the value of accurate documentation and patient education in ensuring safe and effective future care.

Links & Resources:

The ASCIA guidelines Arthur referred to in the podcast:

https://www.allergy.org.au/images/stories/hp/info/ASCIA_HP_Consensus_Penicillin_Allergy_2020.pdf

Aimed at immunologists, so while GPs may find it useful for context and interest, it’s not something intended for day-to-day practice in primary care

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.

In this episode of The Good GP, host Dr Maria Li speaks with Dr Arthur Price, a clinical immunologist with expertise spanning food allergy and immunodeficiency, on the frequently overlooked condition known as oral allergy syndrome (OAS).

Dr Price begins by defining oral allergy syndrome as a mild form of food allergy where symptoms—typically oral itching—are limited to the mouth, lips, and throat following the consumption of raw fruits, vegetables, or certain nuts. He highlights the prevalence of OAS, noting that it affects up to 10% of the general population and is even more common among patients with hay fever and eczema.

Covering typical clinical presentations seen in general practice, commonly triggered foods (such as apples, stone fruits, and hazelnuts), and the distinct lack of systemic symptoms in classic OAS cases.

They provide practical advice on recognising OAS, taking a thorough history, and distinguishing it from more severe or systemic food allergies. Dr Price emphasises the importance of a clinical diagnosis and discusses why routine allergy testing is seldom indicated unless the case is atypical. They also talked about the management of OAS, the role of dietary avoidance, the use of antihistamines if symptoms do not resolve quickly, and reassurance regarding the very low risk of severe or life-threatening reactions.

Discussing the impact of food preparation (e.g. tolerance of well-cooked fruits vs. raw forms), when to consider referral to allergy specialists, and how to support patients in making sensible, evidence-based decisions about food avoidance while maintaining good quality of life.

Links & Resources:

• https://www.allergyuk.org/wp-content/uploads/2022/03/Oral-Allergy-Syndrome-v5.pdf
• https://www.allergy.org.au/patients/food-other-adverse-reactions/oral-allergy-syndrome
• https://www.bsaci.org/wp-content/uploads/2024/03/Pollen-Food-Syndrome-PIL.pdf

The Good GP Podcast is a proud member of the Talking HealthTech Podcast Network - the premier audio destination for cutting-edge insights and thought leadership in healthcare delivery, innovation, digital health, healthcare ICT, and commercialisation. Learn more at www.talkinghealthtech.com/podcast/network

If you have any questions or would like to contact The Good GP, send an email to thegoodgp@gmail.com. Visit www.thegoodgp.com.au for previous episodes and more information.