history control tooltip
divider handle tooltip
Anaphylaxis
Short Text
Introduction
This pathway covers assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode.
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. It is characterised by rapidly developing, life threatening problems involving: the airway (pharyngeal or laryngeal oedema) and/or breathing (bronchospasm with tachypnoea) and/or circulation (hypotension and/or tachycardia). In most cases, there are associated skin and mucosal changesResuscitation Council (UK) 2008. Emergency treatment of anaphylactic reactions. Guidelines for healthcare providers..
In emergency departments a person who presents with the signs and symptoms listed above may be classified as having a 'severe allergic' reaction rather than an 'anaphylactic' reaction. Throughout the guideline, anyone who presents with such signs and symptoms is classed as experiencing a 'suspected anaphylactic reaction', and should be diagnosed as having 'suspected anaphylaxis'.
After an acute anaphylactic reaction, it is believed that many people do not receive optimal management of their condition. One reason for this is healthcare professionals' lack of understanding when making a diagnosis, for example failing to differentiate anaphylaxis from less severe histamine-releasing reactions or from other conditions that mimic some or all of its clinical features. Another reason is a lack of understanding of when or where to refer patients. This can affect the likelihood of the person receiving a definitive diagnosis, which can lead to anxiety, inappropriate management and recurrent reactions. It can also lead to avoidable costs for the NHS and increase the need for acute care.
Source guidance
The NICE guidance that was used to create the pathway.
Anaphylaxis. NICE clinical guideline 134 (2011)
Pharmalgen for the treatment of systemic reactions to bee and wasp venom allergy. NICE technology appraisal guidance 246 (2012)
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
8 February 2013 Minor maintenance updates.
9 March 2012 Minor maintenance updates.
22 February 2012 Pharmalgen for the treatment of bee and wasp venom allergy (NICE technology appraisal guidance 246) added to Specialist allergy service.
4 January 2012 Minor maintenance updates.
Supporting information
Glossary
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. It is characterised by rapidly developing, life threatening problems involving: the airway (pharyngeal or laryngeal oedema) and/or breathing (bronchospasm with tachypnoea) and/or circulation (hypotension and/or tachycardia). In most cases, there are associated skin and mucosal changes.
After complete recovery of anaphylaxis, a recurrence of symptoms within 72 hours with no further exposure to the allergen. It is managed in the same way as anaphylaxis.
Denotes a form of anaphylaxis where no identifiable stimulus can be found. All known causes of anaphylaxis must be excluded before this diagnosis can be reached.
The diagnosis, prior to assessment by a specialist allergist, for people who present with symptoms of anaphylaxis.
In emergency departments a person who presents with the signs and symptoms of anaphylaxis may be classified as having a 'severe allergic' reaction rather than an 'anaphylactic' reaction. Throughout this guideline, anyone who presents with such signs and symptoms is classed as experiencing a 'suspected anaphylactic reaction', and should be diagnosed as having 'suspected anaphylaxis'.
The diagnosis, prior to assessment by a specialist allergist, for people who present with symptoms of anaphylaxis.
In emergency departments a person who presents with the signs and symptoms of anaphylaxis may be classified as having a 'severe allergic' reaction rather than an 'anaphylactic' reaction. Throughout this guideline, anyone who presents with such signs and symptoms is classed as experiencing a 'suspected anaphylactic reaction', and should be diagnosed as having 'suspected anaphylaxis'.
After emergency treatment for a suspected anaphylactic reaction
After emergency treatment for a suspected anaphylactic reaction
Investigation in adults and young people (16 years or older)
Investigation in adults and young people (16 years or older)
Investigation in adults and young people (16 years or older)
After a suspected anaphylactic reaction in adults or young people aged 16 years or older, take timed blood samples for mast cell tryptase testing as follows:
- a sample as soon as possible after emergency treatment has started
- a second sample ideally within 1–2 hours (but no later than 4 hours) from the onset of symptoms.
Inform the person (or, as appropriate, their parent and/or carer) that a blood sample may be required at follow-up with the specialist allergy service to measure baseline mast cell tryptase.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeInvestigation in children (younger than 16 years)
Investigation in children (younger than 16 years)
Investigation in children (younger than 16 years)
After a suspected anaphylactic reaction in children younger than 16 years, consider taking blood samples for mast cell tryptase testing as follows if the cause is likely to be venom-related, drug-related or idiopathic:
- a sample as soon as possible after emergency treatment has started
- a second sample ideally within 1–2 hours (but no later than 4 hours) from the onset of symptoms.
Inform the person (or, as appropriate, their parent and/or carer) that a blood sample may be required at follow-up with the specialist allergy service to measure baseline mast cell tryptase.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeAssessment after the suspected anaphylactic reaction
Assessment after the suspected anaphylactic reaction
Assessment after the suspected anaphylactic reaction
Document the acute clinical features of the suspected anaphylactic reaction (rapidly developing, life-threatening problems involving the airway [pharyngeal or laryngeal oedema] and/or breathing [bronchospasm with tachypnoea] and/or circulation [hypotension and/or tachycardia] and, in most cases, associated skin and mucosal changes).
Record the time of onset of the reaction.
Record the circumstances immediately before the onset of symptoms to help to identify the possible trigger.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeObservation for adults and young people (16 years or older)
Observation for adults and young people (16 years or older)
Observation for adults and young people (16 years or older)
Adults and young people aged 16 years or older who have emergency treatment for suspected anaphylaxis should be observed for 6–12 hours from the onset of symptoms, depending on their response to emergency treatment. In people with reactions that are controlled promptly and easily, a shorter observation period may be considered provided that they receive appropriate post-reaction care prior to discharge.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeAdmission for children (younger than 16 years)
Admission for children (younger than 16 years)
Admission for children (younger than 16 years)
Children younger than 16 years who have emergency treatment for suspected anaphylaxis should be admitted to hospital under the care of a paediatric medical team.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeReferral
Referral
Referral
After emergency treatment for suspected anaphylaxis, offer people a referral to a specialist allergy service (age-appropriate where possible) consisting of healthcare professionals with the skills and competencies necessary to accurately investigate, diagnose, monitor and provide on-going management of, and patient education about, suspected anaphylaxis.
Each hospital trust providing emergency treatment for suspected anaphylaxis should have separate referral pathways for suspected anaphylaxis in adults (and young people) and children.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeAdrenaline injector
Adrenaline injector
Adrenaline injector
After emergency treatment for suspected anaphylaxis, offer people (or, as appropriate, their parent and/or carer) an appropriate adrenaline injector as an interim measure before the specialist allergy service appointment.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePatient information and support before discharge
Patient information and support before discharge
Patient information and support before discharge
Before discharge a healthcare professional with the appropriate skills and competencies should offer people (or, as appropriate, their parent and/or carer) the following:
- information about anaphylaxis, including the signs and symptoms of an anaphylactic reaction
- information about the risk of a biphasic reaction
- information on what to do if an anaphylactic reaction occurs (use the adrenaline injector and call emergency services)
- a demonstration of the correct use of the adrenaline injector and when to use it
- advice about how to avoid the suspected trigger (if known)
- information about the need for referral to a specialist allergy service and the referral process
- information about patient support groups.
NICE has written information for the public explaining its guidance on anaphylaxis.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeSpecialist allergy service
Specialist allergy service
Specialist allergy service
Pharmalgen for the treatment of bee and wasp venom allergy
Pharmalgen is recommended as an option for the treatment of IgE-mediated bee and wasp venom allergy in people who have had:
- a severe systemic reaction to bee or wasp venom, or
- a moderate systemic reaction to bee or wasp venom and who have one or more of the following: a raised baseline serum tryptase, a high risk of future stings or anxiety about future stings.
Treatment with Pharmalgen should be initiated and monitored in a specialist centre experienced in venom immunotherapy.
These recommendations are from Pharmalgen for the treatment of bee and wasp venom allergy (NICE technology appraisal guidance 246).
NICE has written information for the public explaining the guidance on Pharmalgen.
Implementation tools
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-singleSource guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeFor children and young people (younger than 19 years) with a food allergy
Children and young people (younger than 19 years) with a food allergy
Food allergy in children and young people pathway
View the 'Food allergy in children and young people overview' pathPaths in this pathway
Pathway created: December 2011 Last updated: February 2013
Copyright © 2013 National Institute for Health and Care Excellence. All Rights Reserved.