Quality statement 1: Referral to specialist allergy services after emergency treatment

Quality statement

People who have emergency treatment for suspected anaphylaxis are referred to a specialist allergy service.

Rationale

Specialist allergy services can provide a definitive diagnosis and identify the cause of an anaphylactic reaction. Referral to these services after emergency treatment for suspected anaphylaxis will ensure that people receive the correct advice and treatment. If people are not referred to a specialist allergy service their safety might be compromised and they may receive inappropriate management, have an increased risk of recurrent anaphylactic reactions and feel anxious about possible recurrence.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that people who have emergency treatment for suspected anaphylaxis are referred to a specialist allergy service.

Data source: Local data collection.

Process

Proportion of cases of emergency treatment for suspected anaphylaxis that are followed by referral to a specialist allergy service.

Numerator – the number in the denominator that are followed by referral to a specialist allergy service.

Denominator – the number of cases of emergency treatment for suspected anaphylaxis.

Data source: Local data collection.

Outcome

People who are vulnerable to anaphylaxis feel able to manage their condition.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as primary care providers, emergency departments, paediatric services) ensure that people who have had emergency treatment for suspected anaphylaxis are referred to a specialist allergy service.

Healthcare professionals (such as GPs, emergency department staff, members of paediatric and adult medical teams) refer people who have had emergency treatment for suspected anaphylaxis to a specialist allergy service. The referral can be made by the person's GP, for example, after initial treatment in an emergency department or by hospital staff.

Commissioners (clinical commissioning groups and NHS England) commission local specialist allergy services and agree pathways for referral to specialist allergy services for people who have had emergency treatment for suspected anaphylaxis.

What the quality statement means for patients, service users and carers

People who have had emergency treatment for suspected anaphylaxis (a severe, life‑threatening allergic reaction) are offered an appointment at a specialist allergy service. This is to find out the cause of the reaction and to get advice on what to do in the future.

Source guidance

Definitions of terms used in this quality statement

Suspected anaphylaxis

A person who presents with the signs and symptoms of anaphylaxis may be classified as having a 'severe allergic' reaction rather than an 'anaphylactic' reaction. The NICE guideline on anaphylaxis: assessment and referral after emergency treatment and the Royal College of Physicians' concise guideline on emergency treatment of anaphylaxis in adults give details of clinical features that suggest anaphylactic reaction. Anyone who presents with such signs and symptoms should be diagnosed as having 'suspected anaphylaxis'.

[Adapted from Anaphylaxis: assessment and referral after emergency treatment (NICE guideline CG134)]

Specialist allergy service

A service consisting of healthcare professionals with the skills and competencies needed to accurately investigate, diagnose, monitor and provide ongoing management of, and patient education about, suspected anaphylaxis. The service should be age‑appropriate if possible.

[Anaphylaxis: assessment and referral after emergency treatment (NICE guideline CG134) recommendation 1.1.9]

Details of local allergy services are available from the British Society for Allergy and Clinical Immunology (BSACI) including information on services with expertise in particular allergies such as food, drug or venom allergies or from NHS Choices. The BSACI website can also be used to find allergy services with appropriate expertise to deal with a particular allergy (for example food, drug, venom allergy).

[Expert opinion]

Equality and diversity considerations

When referring people to a specialist allergy service, any potential difficulties in access such as travelling distance, disability or financial barriers should be taken into account.