The Australian Commission on Safety and Quality in Health Care has released its first guidelines on anaphylaxis, aiming to improve the speed and continuity of treatment for those who experience the condition.
Under the guidelines, patients at risk of anaphylactic shock will have access to their adrenaline medication at all times, a departure from typical hospital processes, but one that is necessary, Associate Professor Amanda Walker, the Commission’s Clinical Director and clinical lead for the new guidelines, said.
“What is new in the national standard is a requirement for patients at risk of anaphylaxis to have access to their prescribed adrenaline injector at all times. In hospital and healthcare settings, patients do not usually have access to their own medicines,” Associate Professor Walker explained.
“This is one important exception, to ensure the adrenaline injector is with the patient wherever they are, so they can use it if needed.”
Associate Professor Walker also added that while hospital practices have received an update to reflect this, there is also additional guidance for managing those who have left the hospital and are receiving care from GPs and immunologists.
“Adrenaline is the first-line treatment for anaphylaxis and should be administered promptly… But a person who has experienced anaphylaxis remains vulnerable in the community after discharge. There needs to be a safe discharge and clear handover of care to the patient’s GP and immunologist.”
The new guidelines have received endorsement from more than 15 professional groups, spanning medical, nursing and other healthcare areas, while the National Allergy Strategy (NAS) has also endorsed the new guidelines.
“The new standard highlights the importance of safe practices – such as ensuring a person with anaphylaxis does not stand up or walk, even after they have had adrenaline – a critical issue that is often overlooked when managing anaphylaxis,” NAS Co-Chair Dr Preeti Joshi said.
“Having or witnessing anaphylaxis can be frightening, as symptoms can go from bad to worse very quickly. If it is not recognised and treated immediately, it can result in serious complications and can even be fatal.”
Anaphylaxis, described as “the most severe form of allergic reaction” by the Commission, was the cause of slightly more than half of emergency department visits in the five years leading up to 2019-20.
While one in five Australians experience allergies, spanning four million people across the country, one in four of those who presented with symptoms of anaphylaxis in emergency departments don’t receive the necessary adrenaline injections in a “timely” manner, the Commission reported.
The new guidelines were launched with a webcast that will be streamed at the Commission’s website, with Associate Professor Walker and Dr Joshi among the experts who will speak about the new guidelines.
Resources for clinicians are also available on the Commission’s website including an anaphylaxis discharge checklist and discussion guide and a clinician’s fact sheet to help improve the recognition of anaphylaxis and the provision of appropriate treatment and follow-up care.
The clinician’s fact sheet includes the following:
1 Prompt recognition of anaphylaxis
A patient with acute-onset clinical deterioration with signs or symptoms of an allergic response is rapidly assessed for anaphylaxis, especially in the presence of an allergic trigger or a history of allergy.
2 Immediate injection of intramuscular adrenaline
A patient with anaphylaxis, or suspected anaphylaxis, is administered adrenaline intramuscularly without delay, before any other treatment including asthma medicines. Corticosteroids and antihistamines are not first line treatment for anaphylaxis.
3 Correct patient positioning
A patient experiencing anaphylaxis is laid flat, or allowed to sit with legs extended if breathing is difficult. An infant is held or laid horizontally. The patient is not allowed to stand or walk during, or immediately after the event until they are assessed as safe to do so, even if they appear to have recovered.
4 Access to a personal adrenaline injector in all healthcare settings
A patient who has an adrenaline injector has access to it for self-administration during all healthcare encounters. This includes patients keeping their adrenaline injector safely at their bedside during a hospital admission.
5 Observation time following anaphylaxis
A patient treated for anaphylaxis remains under clinical observation for at least four hours after their last dose of adrenaline, or overnight as appropriate according to the current Australasian Society of Clinical Immunology and Allergy Acute Management of Anaphylaxis guidelines. Observation timeframes are determined based on assessment and risk appraisal after initial treatment.
6 Discharge management and documentation
Before a patient leaves a healthcare facility after having anaphylaxis, they are advised about the suspected allergen, allergen avoidance strategies and post‑discharge care. The discharge care plan is tailored to the allergen and includes details of the suspected allergen, the appropriate ASCIA Action Plan, and the need for prompt follow-up with a general practitioner and clinical immunology/allergy specialist review. Where there is a risk of re-exposure, the patient is prescribed a personal adrenaline injector and is trained in its use. Details of the allergen, the anaphylactic reaction and discharge care arrangements are documented in the patient’s healthcare record.