NICE guideline on anaphylaxis

During 2011, the National Institute of Clinical Excellence developed a new Guideline for medical practitioners on what to do in the event of a serious allergic reaction – or suspected anaphylaxis.  The InsectStings founder David Glaser sat as a patient expert on the NICE guidelines committee and hopefully the new Guideline offers a helpful support to both patients and doctors in the event of an anaphylactic shock.  And it could be the result of a bee or a wasp sting so it is very relevant to readers of this website.

The Guideline distinguishes between a mild allergic reaction and anaphylaxis by using the following definition:

It is characterised by rapidly developing, life-threatening problems involving: the airway (pharyngeal or laryngeal oedema) and/or breathing (bronchospasm with tachypnoea) and/or circulation (hypotension and/or tachycardia). In most cases, there are associated skin and mucosal changes

In short, hives and itching is not covered by the guideline but airway swelling, breathing problems, low blood presure and systemic response that is life threatening most definitely is covered.

The guideline recommends that the victim remains under the care of the medical practitioner for 6 to 12 hours because there is always the possibility of a secondary reaction following the first reaction.  When it is time for the patient to go, the Guideline recommends a number of actions by the discharging practitioner including:

1)  Training and prescribing on the use of an adrenaline injector such as Epipen, Jext or Anapen

2)   Referral to  a suitable clinician such as an allergy consultant or allergy clinic  for ongoing advice and management.

3)   Advice on the possibility of a delayed reaction

Other helpful suggestions are made too – including the recommendation of taking a tryptase test after the allergic reaction to assist in the diagnosis at a later date.

This guideline is very well worth reading if you are concerned about your own recent allergic reaction.