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Referral
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Anaphylaxis
Scope
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction which is likely when both of the following criteria are met:
- Sudden onset and rapid progression of symptoms
- Life-threatening airway and/or breathing and/or circulation problems
+/- Skin and/or mucosal changes (flushing, urticaria, angioedema) can also occur, but are absent in a significant proportion of cases.
NICE guidelines available here
For guidelines describing the management of urticaria and angioedema in the absence of systemic features see guidance for spontaneous urticaria and angioedema
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 and Examination
- Anaphylaxis should be treated according to Resuscitation Council guidelines
- Acute measurement of mast cell tryptase (immediately and 2 hours after the onset of symptoms) should be performed
- Identify any potential triggers (e.g. foods, drugs, stings, exercise) in the 4 hours before the reaction if at all possible
- Anaphylaxis may be immunologically mediated, non-immunologically mediated or idiopathic. Food is the commonest trigger for anaphylaxis in children. Insect venoms, drugs and latex are other causes.
- Peanut, tree nuts, fish, shellfish, cow's milk, soya and egg are the most common food in anaphylaxis.
- Drugs – Ensure potential drug allergies are explained to the patient, and documented in the medical records with appropriate details.
Advise patients to avoid potential triggers identified in the history pending further investigations.
Prescribe 4 self-injectable adrenaline devices (should have two on the patient at all times, and two at school) with appropriate training to patients with:
- Anaphylaxis (see definition above)
- Also those with less severe allergic reaction but have pre-existing asthma
- Provoking allergen may be accidentally encountered again e.g. stings (or idiopathic)
All patients must have appropriate training in use of self-injectable adrenaline (links below to formulary choices) and provide a written and verbal emergency treatment plan for future anaphylactic reactions (see bsaci - Allergy Action plans for Children)
Video how to use Emerade adrenaline auto-injector
See Formulary section 3.4 Antihistamines, hyposensitisation, and allergic emergencies
Referral Criteria
Refer all cases to Paediatric Allergy Clinic
Referral Instructions
Refer via DRSS
e-Referral Service Selection
- Specialty: Children & Adolescents
- Clinic Type: Allergy
- Service: DRSS-Western-Child&Adolescent-Devon ICB-15N
Referral Forms
Patient Information
GP Information
NICE Anaphylaxis: assessment and referral after emergency treatment
Resuscitation Council (UK) - Anaphylaxis
NICE Angio-oedema and anaphylaxis
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: January 2017
