Anaphylaxis: assessment and referral after emergency treatment

  • NICE guideline
  • NG258
  • Published: 
Download (PDF)

2026 exceptional surveillance of anaphylaxis: assessment and referral after emergency treatment (NICE guideline CG134)

Surveillance proposal

The topic areas considered in this surveillance were:

  • Number and timing of blood samples for measurement of mast cell tryptase levels following successful emergency treatment of suspected anaphylaxis.

  • Duration of the post-anaphylaxis observation period.

Following consultation with topic experts we propose to:

  • replace recommendations about post-anaphylaxis observation periods in adults aged 16 years and older and children, with the Resuscitation Council UK's (RCUKs) recommendations about a risk-stratified approach to the length of in-hospital observation following anaphylaxis

  • not update recommendations about the timing and frequency of blood sampling.

Trigger for the exceptional review

We were contacted by a member of the RCUK to say that their Emergency treatment of anaphylactic reactions: Guidelines for healthcare providers was updated in 2021. It was suggested that NICE's guideline on anaphylaxis needed updating as it now does not align with the RCUK guidance.

Context

The scopes of the 2 guidelines

NICE's guideline is intended to complement the RCUK's guidance and cross references it. The aim of NICE's guideline is to improve identification, diagnosis and referral of anaphylaxis following emergency treatment. Initial assessment, diagnosis of anaphylactic episode before emergency treatment and emergency treatment are out of scope.

The RCUK guideline is for healthcare providers who are expected to treat anaphylaxis during their usual clinical role (for example, doctors, nurses, and paramedics) in hospital or out-of-hospital settings. It provides recommendations and care algorithms about the recognition and emergency treatment of anaphylaxis and refractory anaphylaxis.

Overlap between both guidelines

There is overlap between some recommendations in NICE's guideline and section 7 on investigations in the RCUK guideline. There are now notable differences which are based on evidence not considered during the development of NICE's guideline and that add to evidence identified during 2016 surveillance.

RCUK guideline methodology

The methodology underpinning the update of the RCUK guideline is detailed in Dodd et al. (2021). Development consisted of using the GRADE evidence to decision (EtD) framework, also known as recommendation adoption, adaption or development (for example, GRADE-ADOLOPMENT). This comprised:

  • Identifying systematic reviews and international guidelines (including NICE's guideline on anaphylaxis) published or updated after the last RCUK guideline.

  • Completing an EtD table using the GRADE EtD framework for each research question underpinning the extant RCUK 2012 guideline.

  • Convening a working Group (numbering 16 medical and healthcare professionals and 1 patient advocate), who reviewed the EtD tables, considered the new evidence, and reached a consensus as to:

    • the certainty of the available evidence;

    • whether it still supported the previous recommendation (if yes, the recommendation was adopted) or

    • whether it indicated a need to update the recommendation (if yes, the recommendation was adapted) or

    • whether development of an entirely new recommendation was warranted (a new recommendation was developed).

This page was last updated: