Assessment and referral after emergency treatment of a suspected anaphylactic episode: summary of NICE guidance

Anaphylaxis is a severe, life threatening, generalised or systemic hypersensitivity reaction. 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.1 UK estimates suggest that about 1 in 1333 of the population in England has experienced anaphylaxis.2 A common trigger of anaphylaxis in children is food and in older people is medication.3 About 20 deaths from anaphylaxis are reported each year in the United Kingdom, of which about half are known to be iatrogenic,4 although this may be a substantial underestimate. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on assessment to confirm an anaphylactic reaction and on the decision to refer a patient after emergency treatment for a suspected anaphylactic reaction.5 NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Duration of observation after suspected anaphylactic reaction