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NICE yesterday (11 July) published a draft guideline on the initial assessment and referral following emergency treatment for a suspected anaphylactic episode or a severe allergic reaction.

An anaphylactic episode (sometimes called an anaphylactic shock) is an allergic response that is a severe, generalised or systemic hypersensitivity reaction that can lead to potentially life-threatening airway, breathing and/or circulation problems. Foods, such as peanuts, nuts, eggs, shellfish, milk, fish, and some seeds such as sesame, are a particularly common cause of anaphylactic reaction, especially in children. Non-food causes include wasp or bee stings, natural latex (rubber), penicillin or any other drug or injection. Medicinal products are much more common triggers of anaphylactic reaction in older people. A significant proportion of anaphylaxis is classified as idiopathic, in which there are significant clinical effects but no known cause.

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 1,333 of the population of England has experienced anaphylaxis at some point in their lives. What is clear is that there has 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% - resulting in approximately 20 deaths each year in the UK (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.

Draft recommendations include:

• Record the circumstances immediately before the onset of the reaction to help to identify the possible trigger.
• All children given emergency treatment for a first suspected anaphylactic episode should be admitted to hospital under the care of a paediatric specialist team.
• Following emergency treatment, all patients who have been referred following a suspected anaphylactic episode (and, if appropriate their carer and/or family) should be given an adrenalineⁱⁱ injector as an interim measure pending the referral appointment.
• Each primary care organisation and hospital should have a referral pathway for patients who have received emergency treatment for a suspected anaphylactic episode.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said:

“Anaphylaxis is a very serious, potentially life-threatening reaction. Unfortunately, there is often a lack of understanding of the condition on the part of healthcare professionals both when making a diagnosis and of when or where to refer patients who have had a suspected anaphylaxis. This can affect the likelihood of the person receiving a definitive diagnosis, which can lead to anxiety, inappropriate management and recurrent episodes. It can also give rise to avoidable costs for the NHS and increase the need for acute care. This guideline, the first of its type from NICE, will help healthcare professionals who care for those who experience this extreme response. I would recommend all those who are registered as stakeholders in the development of this guideline to submit their comments via the NICE website.”

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Notes to Editors

About the guidance

1. The draft NICE short clinical guideline, Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode is available from Monday 11 July until 5.00pm, Monday 8 August at: http://guidance.nice.org.uk/CG/Wave23/8

2. The guideline covers adults, young people and children who receive emergency treatment for suspected anaphylaxis.

3. Read more information on developing NICE short clinical guidelines.

References

i. NICE short clinical guideline scope, Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode.

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.

About NICE

1. The National Institute for Health and Clinical 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. ICE 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.