Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction which is likely when both of the following criteria are met:

  1. Sudden onset and rapid progression of symptoms
  2. 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

How to use Epipen information

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-Eastern-Paediatrics- Devon CCG-15N

Referral Forms

DRSS referral form

​Supporting Information

Patient Information

NHS Choices Anaphylaxis

Anaphylaxis Campaign

Allergy UK

Medic Alert

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 by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: 6 July 2016


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