Shock tactics

New guidance could help people at risk of anaphylaxis, says Fiona Rayner.

Many patients at risk of anaphylaxis still do not receive an appropriate diagnosis or management. The British Society for Allergy and Clinical Immunology recently published guidance about prescribing an adrenaline auto injector, aimed at improving the management of those at risk.
The guideline provides advice to doctors about when an adrenaline auto-injector (AAI) should be prescribed to improve patient safety.
There are a number of important steps in managing severe allergy. These include identifying triggers, careful avoidance of triggers and an assessment of risk, which should be done in an allergy service.
The guidance recommends that those who are at risk of anaphylaxis should be prescribed an AAI. It recommends that the auto-injector should be part of the overall management of allergy care, aimed at ensuring the safety of patients requiring it. 
In most cases, the guidance says, one AAI is sufficient for those at risk of anaphylaxis. This is in line with the national and European guidelines and 
In some cases, it is appropriate for the individual to carry more than one AAI and guidance about when this is necessary is provided. In addition, most children require a second auto-injector for school. 
Some patients do not receive an auto-injector after an anaphylaxis attack – the guideline recommends this is prescribed immediately or as soon as possible afterwards.
Conversely, many patients who are prescribed an AAI have never suffered anaphylaxis but are considered to be at risk. For this reason the new guidance offers information on how to make a risk assessment.  
The guidance also highlights the importance of training and retraining in the use of adrenaline auto-injectors. This is because a significant number of patients, for whom auto-injectors are prescribed, are either unable to use them, are afraid to use them or don’t carry them.
If you have a concern about the recommendations, seek advice from your local allergy service.
  • Fiona Rayner is chief executive, the British Society for Allergy and Clinical Immunology
Fiona Rayner is chief executive, the British Society for Allergy and Clinical Immunology

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