New NICE guideline published on anaphylactic episode
NICE, the healthcare guidance body, has today (14 December) published a new guideline on the initial assessment and referral following emergency treatment for a suspected anaphylactic episode.
An anaphylactic episode (sometimes called an anaphylactic shock) is a severe allergic response that is a generalised or systemic hypersensitivity reaction that is characterised by life-threatening airway, breathing and/or circulation problems. Common causes of anaphylactic reaction, especially in children, includefoods such as peanuts, nuts, eggs, shellfish, milk, fish, and some seeds such as sesame. Non-food causes include wasp or bee stings, natural latex (rubber), and penicillin. A significant proportion of anaphylaxis is classified as idiopathic, in which there are significant clinical effects but no identifiable stimulus.
Because of inconsistencies in reporting anaphylaxis, and because it is often misdiagnosed, there is no overall figure for the frequency of anaphylaxis from all causes in the UK. However, available UK estimates suggest that approximately 1 in 1,300 of the population of England has experienced anaphylaxis at some point in their lives. There has also been a dramatic rise in the rate of hospital admissions for anaphylaxis. Between 1990 and 2004 they increased from 0.5 admissions per 100,000 to 3.6 per 100,000 - an increase of 700% - and there are now around 20 deaths each year in the UK from anaphylaxis (although this may be a substantial underestimate). In addition, there is considerable geographic variation in both practice and service provision, specifically in assessment after the event to confirm an anaphylactic episode or on the decision to refer after emergency treatmenti.
Recommendations from the new guideline include:
- Record the circumstances immediately before the onset of the reaction to help to identify the possible trigger.
- Children younger than 16 years who have had emergency treatment for suspected anaphylaxis should be admitted to hospital under the care of a paediatric medical team.
- After emergency treatment for suspected anaphylaxis, offer people (or, as appropriate, their parent and/or carer) an appropriate adrenalineii injector as an interim measure before the specialist allergy service appointment.
- Each hospital trust providing emergency treatment for suspected anaphylaxis should have separate referral pathways for suspected anaphylaxis in adults (and young people) and children.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said:
“After an anaphylactic episode, there is often a risk of it happening again. Further investigation is therefore needed in all cases to try to identify the cause and assess the risk of the person having another anaphylactic reaction. Unfortunately people who have an acute episode of anaphylaxis often do not have their condition managed appropriately once the acute episode has been treated. The reasons for this include anaphylaxis not being recognised, or not being differentiated from less severe reactions. Also, people may not be referred to a specialist. This can reduce the likelihood of the person receiving a definitive diagnosis and can lead to anxiety, inappropriate management and recurrent episodes. It can also result in avoidable costs for the NHS and increase the need for acute care. This new guideline, the first on this topic from NICE, will help ensure that the thousands of people who experience anaphylaxis every year in England and Wales receive proper assessment to confirm an anaphylactic episode and that they are referred appropriately to a specialist allergy service after emergency treatment.”
Mandy East, National Coordinator at the Anaphylaxis Campaign and Patient/Carer Representative, Guideline Development Group said:
"We welcome this NICE guideline which gives clear recommendations on what to do following emergency treatment for a suspected anaphylactic episode. For the patient, an anaphylactic reaction is extremely worrying and it is essential that specialist care is offered in order for a diagnosis to be confirmed and for the risk of recurrent episodes to be reduced. I am sure the new guideline will be welcomed by all those involved in the treatment of this condition."
Notes to Editors
About the guidance
1. The NICE short clinical guideline, Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode will be available from Wednesday 14 December.
2. The guideline covers adults, young people and children who receive emergency treatment for suspected anaphylaxis.
ii. Adrenaline (also known as epinephrine) acts quickly to constrict blood vessels, relax muscles in the lungs to improve breathing, stimulate the heartbeat and helps to stop swelling around the face and lips.
1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
2. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
3. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.
4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 14 December 2011