Quality statement 3: Referral to specialist drug allergy services

Quality statement

People with a suspected or confirmed anaphylactic reaction, or severe non‑immediate cutaneous reaction to a drug, or reaction to a general anaesthetic are referred to a specialist drug allergy service.

Rationale

It is important to ensure appropriate referral to specialist drug allergy services so that all people with drug allergy receive the care they need. Expert clinical opinion suggests that some people who are currently referred do not need specialist services whereas others need specialist referral but this is not offered.

Quality measures

Structure

Evidence of local arrangements to ensure that people with a suspected or confirmed anaphylactic reaction, or severe non‑immediate cutaneous reaction to a drug, or reaction to a general anaesthetic are referred to a specialist drug allergy service.

Data source: Local data collection.

Process

a) Proportion of people with a suspected or confirmed anaphylactic reaction to a drug who are referred to a specialist drug allergy service.

Numerator – the number in the denominator who are referred to a specialist drug allergy service.

Denominator – the number of people with a suspected or confirmed anaphylactic reaction to a drug.

Data source: Local data collection.

b) Proportion of people with a severe non‑immediate cutaneous reaction to a drug who are referred to a specialist drug allergy service.

Numerator – the number in the denominator who are referred to a specialist drug allergy service.

Denominator – the number of people with a severe non‑immediate cutaneous reaction to a drug.

Data source: Local data collection.

c) Proportion of people with a reaction to a general anaesthetic who are referred to a specialist drug allergy service.

Numerator – the number in the denominator who are referred to a specialist drug allergy service.

Denominator – the number of people with a reaction to a general anaesthetic.

Data source: Local data collection.

Outcome

a) Mortality.

Data source: Local data collection.

b) Number of repeat allergic drug reactions.

Data source: Local data collection.

c) Length of hospital stay.

Data source: Local data collection.

d) Inappropriate avoidance of drugs.

Data source: Local data collection.

e) Further anaesthetics without problems.

Data source: Local data collection.

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

Service providers (GP, A&E departments, dentists and secondary care services) ensure that people with a suspected or confirmed anaphylactic reaction, or severe non‑immediate cutaneous reaction to a drug, or reaction to a general anaesthetic are referred to a specialist drug allergy service.

Healthcare professionals refer people with a suspected or confirmed anaphylactic reaction, or severe non‑immediate cutaneous reaction to a drug, or reaction to a general anaesthetic to a specialist drug allergy service.

Commissioners (NHS England area teams and clinical commissioning groups) commission local specialist drug allergy services for people with suspected or confirmed anaphylactic reactions, or severe non‑immediate cutaneous reactions to a drug, or reactions to general anaesthetics.

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

People are referred to a specialist drug allergy service for advice if they have a severe 'shock‑like' reaction straight after taking a drug, or if they have a severe skin reaction that develops later, or if they have a reaction to a general anaesthetic.

Source guidance

  • Drug allergy (2014) NICE guideline CG183, recommendations 1.4.2, 1.4.8 (key priority for implementation), 1.4.10 and 1.4.11 (key priority for implementation).

  • Anaphylaxis (2011) NICE guideline CG134, recommendation 1.1.9.