Menu Search Donate

Anaphylaxis

This site does not accept referrals or provide clinical advice in response to questions. If you are a New Zealand health professional seeking clinical advice, please use your local clinical pathway. If you are a New Zealand child patient, parent or caregiver seeking clinical advice, please contact your usual doctor. You can read the full site disclaimer here.

Within this Document

•  Introduction
•  Definition
•  Acute Management
•  Long-term Management
•  Adrenaline Auto-injectors
•  Action Plans
•  Patient/Family Education
•  Resources for Health Professionals
•  Resources for Patients, Families and Caregivers

Introduction

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.

Definition

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 gastrointestinal symptoms.
OR
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:

Respiratory Difficulty/noisy breathing
Swelling of tongue
Swelling/tightness in throat
Difficulty talking and/or hoarse voice
Wheeze or persistent cough
Cardiovascular Loss of consciousness
Collapse
Palor and floppiness (in young children)
Hypotension

Acute Management

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:
http://www.nzrc.org.nz/assets/Guidelines/First-Aid/ANZCOR-Guideline-9-2-7-Anaphylaxis-Aug16.pdf

Long-term Management

Long-term management of anaphylaxis includes:

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 

Adrenaline Autoinjectors

Be mindful that autoinjectors come in different doses.

Recommendations from ASCIA (Australasian Society for Clinical Immunology & Allergy) are as follows:

An EpiPen® is appropriate for those:

 See information sheet on Adrenaline autoinjector ordering

Action Plans

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.

Patient/Family Education

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.

Update July 2017 

  • A reduction in the injection time for EpiPen®s from 10 to 3 seconds has been approved for New Zealand and Australia.
  • EpiPen®s with the 10 second label can continue to be used and should not be replaced unless they have been used, are just about to expire or have expired.
  • All  EpiPen®s should now be held in place for 3 seconds,  regardless of the instruction on the label. However if they are held in place longer eg. 10 seconds, it will not affect the way the adrenaline works.
  • Removal of massage step after the injection - this has been found to reduce the risk of tissue irritation.

Resources for Health Professionals

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.

Resources for Patients, Families and Carers

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:
http://www.allergy.org.au/images/stories/anaphylaxis/lists/ASCIA_PCC_Anaphylaxis_Checklist_Transitioning_paed_adult_care_2015.pdf

Document last reviewed: July 2017

More From Starship