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Within this Document
• Acute Management
• Long-term Management
• Adrenaline Auto-injectors
• Action Plans
• Patient/Family Education
• Resources for Health Professionals
• Resources for Patients, Families and Caregivers
Anaphylaxis is the most severe form of allergic reaction, usually occurring within 20 minutes of exposure to the trigger, and is potentially life threatening.
It must be treated as a medical emergency, with the administration of intramuscular adrenaline as the first line treatment.
The most common trigger in infants, children and young people is food allergy; other triggers include allergy to insect venom (bee or wasp), drugs (e.g. penicillin), and latex.
Any acute onset illness with typical skin features (urticarial
rash or erythema/flushing, and/or angioedema), PLUS involvement of
respiratory and/or cardiovascular and/or persistent severe
Any acute onset of hypotension or bronchospasm or upper airway obstruction where anaphylaxis is considered possible, even if typical skin features are not present. (ASCIA)
Signs and symptoms that an allergic reaction is anaphylaxis include:
Swelling of tongue
Swelling/tightness in throat
Difficulty talking and/or hoarse voice
Wheeze or persistent cough
|Cardiovascular||Loss of consciousness
Palor and floppiness (in young children)
There is a Starship Clinical Guideline on the Management and Treatment of Anaphylaxis.
The New Zealand and Australian Resuscitation Councils published
guidelines for First Aid Management of Anaphylaxis in 2016:
Long-term management of anaphylaxis includes:
- Confirmation of triggering allergens
- Allergen avoidance measures
- Prescription for adrenaline auto-injector
- Provision of Anaphylaxis Action Plan
- Identification of risk factors
- Patient education on all of the above
- Venom immunotherapy/drug desensitisation if relevant.
For infants, children and young people who have had anaphylaxis, referral should be made to the local Paediatric Outpatient Service (or Paediatric Allergy/Immunology Service if available). In the interim, General Practitioners (GPs) should ensure the family has been provided with an Anaphylaxis Action Plan and adrenaline autoinjector ordering information. EpiPen®s are currently the only adrenaline auto-injector available in New Zealand. They are not funded by PHARMAC*.
*ACC provides cover for anaphylaxis as a personal injury caused by accident (PICBA). To make a claim, the patient will need to identify the trigger, the means by which it contacted the body (e.g. ingestion or injection), and confirmation of the injury (anaphylaxis). A GP can assist with the completion of an ACC form, so the family can claim the cost of the ambulance and reimbursement for the cost of the autoinjector (if used in the emergency treatment of their anaphylaxis). More information is available from Allergy New Zealand
Be mindful that autoinjectors come in different doses.
Recommendations from ASCIA (Australasian Society for Clinical Immunology & Allergy) are as follows:
- EpiPen® Adult for children >20kg (package insert says over 30kg)
- Epipen® Jnr for children 10-20kg (package insert says 15-30kg)
- Recommendation of an EpiPen® to a child weighing <10kg should be discussed with senior medical staff
An EpiPen® is appropriate for those:
- with anaphylaxis to non-avoidable triggers eg. bee stings and most food
- with less severe allergic reaction (i.e. not anaphylaxis) but with other risk factors for anaphylaxis eg. asthma, living in remote locations, peanut or tree nut allergy. This decision can generally be made at the Outpatient Clinic.
See information sheet on Adrenaline autoinjector ordering
Individual Anaphylaxis Action Plan forms are available from the ASCIA website: http://www.allergy.org.au/health-professionals/anaphylaxis-resources/ascia-action-plan-for-anaphylaxis. There is a separate version for Allergic Reactions (personal) for use when no adrenaline autoinjector has been prescribed. The patient's details, other medications to be used etc should be filled in online, printed and then signed and dated by the prescribing doctor.
GPs should ensure that family/carers know when and how to use an auto-injector. GPs and other health professionals can obtain a free EpiPen® training kit by logging in to http://www.count2.co.nz. This includes a 'trainer pen' which the patient/family can practice with. Families should also be encouraged to register with www.epiclub.co.nz in order to receive their own trainer pen, and reminders when their EpiPen® is due to expire. There is also a free e-anaphylaxis training module for carers/community on the ASCIA website. See Resources for Patients, Families and Carers below for more information.
The Australasian Society of Clinical Immunology and Allergy (ASCIA) has a range of resources including Anaphylaxis Action Plans, a GP Checklist and free online training. A full list is available at http://www.allergy.org.au/health-professionals/anaphylaxis-resources.
The 'Anaphylaxis Clinical Update' complements the ASCIA anaphylaxis e-training for health professionals. The main purpose of this document is to provide an evidence-based, 'quick reference guide' to assist primary health care physicians including general practitioners, paediatricians and nurses in the management of patients with allergy who are at risk of anaphylaxis.
An 'Anaphylaxis Checklist for Pharmacists' is also available.
Ensure that the family obtains and is instructed in the use of an autoinjector. Currently only EpiPen®s are available in NZ. See adrenaline autoinjector ordering information.
Advise the family in respect to ACC claims for anaphylaxis. Refer to Allergy New Zealand for more information.
Free anaphylaxis e-training for patients, families and the community is available from the Australasian Society of Clinical Immunology (ASCIA): http://www.allergy.org.au/patients/anaphylaxis-e-training-first-aid-community
ASCIA also has a checklist for patients transitioning from
paediatrics to adult care:
Document last reviewed: April 2017
More From Starship
Information about the Paediatric Society of New Zealand