This page was printed from the Northern & Eastern Devon Formulary and Referral site at
Please ensure you are using the current version of this document
Anaphylaxis is an acute severe systemic reaction which is most often allergic (but can be non-allergic, previously called anaphylactoid). It is commonly associated with urticaria and angioedema and occurs within minutes (typically less than 1 hour) of a trigger (e.g. food/ drug/ sting). Anaphylaxis is characterised by one or more of:
NICE guidance is that patients with a history of anaphylaxis should be referred to a specialist allergy clinic, and according to the specialist services national definition set 17 for allergy, "patients with anaphylaxis must be seen in a specialist allergy centre and not managed in the community".
For guidelines describing the management of urticaria and angioedema in the absence of systemic features see guidance for spontaneous urticaria and angioedema
Stings: check specific IgE to bee and wasp venom and mast cell tryptase.
Foods: check specific IgE to specific suspect foods 4 weeks after index reaction. There is no need to investigate foods which have been tolerated since the reaction as these are not the trigger.
Drugs: Ensure potential drug allergies are explained to the patient, and documented in the medical records with appropriate details.
If there is a clear history consider identification jewellery.
All patients must have appropriate training in use of self-injectable adrenaline: How to use your EpiPen
Drug reactions are not an indication for self-injectable adrenaline, as drugs can usually be avoided unless there is altered consciousness.
Include details of index reaction with copy of appropriate correspondence (e.g.ED discharge summary) and suspected triggers.
Consider referral of patients with anaphylaxis, particularly for patients with
Patients with an obvious food trigger and no cofactors need not be referred
Refer via DRSS for NEW Devon CCG patients
Refer using e-Referral Service
This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.
Publication date: March 2016