Children at risk of Anaphylaxis (under 18) Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • The treatment of children under 18 at risk of anaphylaxis due to a confirmed allergy

This guidance does not cover:

  • The treatment of anaphylaxis in adults

Assessment

Signs and Symptoms

Anaphlaxis is a severe, life threatening, generalised or systemic hypersensitivity reaction which is likely when both of the following criteria are met:

  • Sudden onset and rapid progression of symptoms
  • Life­threatening airway and/or breathing and/or circulation problems

+/­ Skin and/or mucosal changes (flushing, urticaria, angioedema) can also occur, but are absent in a significant proportion of cases.

Anaphylaxis is characterised by one or more of:

  • Airway – tightness or lump in the throat, swollen tongue, hoarse voice, hacking cough
  • Breathing – shortness of breath, wheeze, persistent cough, unable to speak in full sentences, noisy breathing
  • Circulation – feeling faint, weakness, floppiness, glazed expression, collapse
  • Neurological – sense of impending doom, visual changes
  • Other - Skin and/or mucosal changes (flushing, urticaria, angioedema)
  • GI symptoms - Vomiting, abdominal pain, and incontinence

History and Examination

  • Anaphylaxis should be treated according to Resuscitation Council guidelines
  • Acute measurement of mast cell tryptase (immediately and 2 hours after the onset of symptoms) should be performed
  • Identify any potential triggers (e.g. foods, drugs, stings, exercise) in the 4 hours before the reaction if at all possible

Investigations

Undertake the following to aid diagnosis, inform management or prior to referral:

  • Anaphylaxis may be immunologically mediated, non-immunologically mediated or idiopathic. Food is the commonest trigger for anaphylaxis in children. Insect venoms, drugs and latex are other causes.
  • Peanut, tree nuts, fish, shellfish, cow's milk, soya and egg are the most common food in anaphylaxis.
  • Drugs – Ensure potential drug allergies are explained to the patient, and documented in the medical records with appropriate details.

Management

Advise patients to avoid potential triggers identified in the history pending further investigations.

Prescribe 4 self-injectable adrenaline devices (should have two on the patient at all times, and two at school) with appropriate training to patients with:

  • Anaphylaxis (see definition above)
  • Also those with less severe allergic reaction but have pre-existing asthma
  • Provoking allergen may be accidentally encountered again e.g. stings (or idiopathic)

All patients must have appropriate training in use of self-injectable adrenaline (links below to formulary choices) and provide a written and verbal emergency treatment plan for future anaphylactic reactions see:


Referral

Referral Instructions

  • e-Consultation is available for this specialty
  • Referrals should be made via ICG to TRISH (if training has been undertaken) - See user guides (EMIS & S1) for further information.
  • For those Practices who have not received ICG training referrals to the Paediatric Allergy Clinic via eRS
  • Please identify speciality and clinic type
  • Urgent same day referrals should be made to the Childrens Assessment Unit (CAU) supported by referral letter
  • 01924 543995 - Operations Centre at Mid York's to speak to the paediatrician on call

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Evidence/Additional Information

Assurance & Governance

  • This guidance was developed on: 03.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 03.2019
  • Ref No: AL3 - 03.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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