Signs and Symptoms

Anaphylaxis is characterised by one or more of:

• Airway – tightness or lump in the throat, Swollen tongue, hoarse voice, hacking cough
• Breathing – shortness of breath, wheeze, persistent cough, unable to speak in full sentences, noisy breathing
• Circulation – feeling faint, weakness, floppiness, glazed expression, collapse
• Neurological – sense of impending doom, visual changes
• Other - Skin and/or mucosal changes (flushing, urticaria, angioedema)
• GI symptoms- Vomiting, abdominal pain, and incontinence

History

• Identify any potential triggers (e.g., foods, drugs, stings, exercise) in the 4 hours before the reaction if at all possible
• Food is the most common trigger for anaphylaxis in children. Foods most associated are: peanuts, tree nuts, fish, shellfish, cow's milk, soya and egg
• Insect venoms, drugs and latex are other causes
• Drugs – Ensure potential drug allergies are explained to the patient and documented in the medical records with appropriate details

• Multiple admissions for anaphylaxis – there may be an underlying cause for recurrent anaphylaxis outside the main 4 areas, suggesting an immune mediated condition that requires investigation.
• Patients who have a known allergy and multiple episodes of anaphylaxis also need exploration of why avoidance is not working successfully for them.

• Acute measurement of mast cell tryptase (immediately and 2 hours after the onset of symptoms) should be performed during their acute admission.
• Further investigations will usually be undertaken in the specialist allergy service.

• Acute management of anaphylaxis should be treated according to Resuscitation Council guidelines
• Children younger than 16 years who have had emergency treatment for suspected anaphylaxis should be reviewed in hospital under the care of a paediatric medical team.
  • After emergency treatment for suspected anaphylaxis in Devon, the paediatric medical team should offer people a referral to a specialist allergy service (age-appropriate where possible).
  • Referrals may need to be completed by primary care if a child or young person has received emergency treatment away from their local hospital.

• Advise patients to avoid potential triggers identified in the history pending further investigations.
• Prescribe up to 4 self-injectable adrenaline devices (2 accompanying the patient at all times, and 2 at school) with appropriate training to patients with:
  • Anaphylaxis (see definition above)
  • Less severe allergic reaction but have pre-existing moderate asthma
  • A provoking allergen that may be accidentally encountered again e.g. stings (or idiopathic)

All patients who have been prescribed an adrenaline autoinjector whether in primary or secondary care should have written guidance on how to use them.

Please follow the link here to BSACI allergy action plan.

Referral Criteria- Paediatric Allergy clinic

• Children (16 years and under) with suspected anaphylaxis.
• Children (16 years and under) with a less severe allergic reaction in combination with known moderate asthma.

Please include details of index reaction with copy of appropriate correspondence (e.g. ED discharge summary) and suspected triggers.

Referral Instructions

e-Referral Service Selection

• Specialty: Children & Adolescents
• Clinic Type: Allergy
• Service: DRSS-South Devon & Torbay-Children's & Adolescent Services- Devon ICB - 15N

Referral Forms

DRSS referral form

Torbay and South Devon seeking advice form

GP Information

NICE Anaphylaxis: assessment and referral after emergency treatment

NICE Angio-oedema and anaphylaxis

Resuscitation Council (UK) - Anaphylaxis

Patient Information

NHS Choices Anaphylaxis

Anaphylaxis UK

Allergy UK

Medic Alert

bsaci - Allergy Action plans for Children

How to use Epipen information

How to use Jext

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: 6 July 2016

Updated: January 2025