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Referral
Anaphylaxis (Adults)
Key Messages
- For efficiency and to minimise returned referrals, use of the referral form is recommended.
- Please include details of index reaction with copy of appropriate correspondence (e.g., ED discharge summary) and suspected triggers.
- Referrals not on the referral form will be accepted as long as all the essential information is included in a referral letter.
- Please prescribe appropriate emergency management plan with self-injectable adrenaline autoinjectors and antihistamine for type one allergy reactions (quick onset reaction with cardiorespiratory symptoms)
- See here to find the latest information for GPs regarding Immunology and Allergy
Scope
• Diagnosis and management of anaphylaxis in adults (16 years and over)
Out of Scope
- See the following pathways for other allergic or atopic conditions:
Introduction
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:
i) Airway – tongue/throat swelling, difficulty talking/hoarse voice
ii) Breathing – shortness of breath, wheeze, persistent cough
iii) Circulation – persistent dizziness or collapse, loss of consciousness
iv) Neurological – sense of impending doom, visual changes
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 here.
1. Anaphylaxis should be treated immediately according to Resuscitation Council guidelines and the patient referred to hospital for acute measurement of mast cell tryptase and further management.
2. Identify any potential triggers (eg foods, drugs, stings, exercise) in the 4 hours before the reaction.
3. Advise patients to avoid potential triggers identified in the history pending further investigations. If a suspected trigger has been tolerated since the reaction it is excluded as a cause.
4. All patients should be provided with an emergency plan:
- GPinformation-AnaphylaxisactionplanWITHadrenaline.pdf
- GPinformation-AnaphylaxisactionplanWITHOUTadrenaline.pdf
a. Self-injectable adrenaline should be prescribed:
i. Where there were features of anaphylaxis (airway, breathing, circulation, or neurological),
ii. For all patients with food allergy and a history of asthma
iii. For patients where access to emergency services might be delayed (e.g., living in a rural location, travelling to remote area with limited access to healthcare)
5. All patients prescribed self-injectable adrenaline must have appropriate training in their use.
Please also see 3.4.3 Allergic emergencies for Formulary Guidance on prescribing.
a. Adrenaline should be co-prescribed for patients with cardiovascular disease on betablockers and/or ACE inhibitors with caution.
b. Asthma care should be optimised.
c. Any patient with a tendency to angioedema should avoid ACE-I.
6. The use of unorthodox methods of diagnosis (e.g. naturopathy, food-specific IgG testing, vega testing, kinesiology, pulse testing, hair analysis) or treatment (e.g. homeopathy, acupuncture, reflexology, chiropractic therapy, or osteopathy) has no evidence and should not be used.
Drug reactions are not an indication for self-injectable adrenaline, as drugs can usually be avoided unless there is altered consciousness.
Ensure primary care record is updated if suspected drug allergy and patient is advised to obtain medic alert jewellery. Adrenaline Auto-injectors (AAI) may be considered if there is uncertainty about whether another likely allergen was responsible.
- No investigations in primary care are required prior to referral.
- If anaphylaxis has been recurrent with no clear trigger, a baseline MCT would be helpfu
The information essential for clinical triage is outlined on the referral form.
Please include details of index reaction with copy of appropriate correspondence (e.g., ED discharge summary) and suspected triggers.
For efficiency and to minimise returned referrals, use of the referral form is recommended.
Referrals not on the referral form will be accepted as long as all the essential information is included in a referral letter.
Referral Criteria
Refer all adults (16 years and over) with suspected anaphylaxis
Referral Instructions
Refer to Peninsula Immunology and Allergy Service
Refer via DRSS for NHS Devon patients
e-Referrals Selection
- Specialty: Allergy
- Clinic type: Allergy
- Service: DRSS-Northern-Allergy & Immunology-Devon ICB-15N
Referral Form
GP Information
NICE Guideline (CG134) - Anaphylaxis
Resuscitation Council guidelines - Emergency treatment of anaphylactic reactions
Specialised Services National Definition Set: 17 Specialised services for allergy (all ages)
World Allergy Organization anaphylaxis guidelines
Patient Information
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: March 2016
Updated: December 2024
