Clinical

Anaphylaxis SOP

Document Control Summary

Replacement.
Status:
Supersedes: Resuscitation Policy C-YEl-cm-03
v1.0 Date: 07/12/15
Version:
Diane Hughes - Senior Nurse Resuscitation Lead and
Author/Title:
Phlebotomy Manager

Kenny Laing - Deputy Director of Nursing

Owner/Title:

Policy and Procedures Committee Date: 17/12/15

Approved by:
Policy and Procedures Committee Date: 17/12/15
Ratified:
Related Trust Strategy
and/or Strategic Aims
December 2015
Implementation Date:
December 2018
Review Date:
Anaphylaxis, anaphylactic, shock, Adrenaline
Key Words:
Resuscitation Policy
Associated Policy or
Resuscitation – BLS & AED SOP
Standard Operating
Administration of Oxygen SOP
Procedures

Contents

1. Introduction .............................................................................................................. 2
2. Purpose ..................................................................................................................... 2
3. Scope ........................................................................................................................ 2
4. Recognition of Anaphylaxis .................................................................................... 3
5. Treatment .................................................................................................................. 3
6. Training ..................................................................................................................... 4
7. Resources ................................................................................................................. 5
8. Process For Monitoring Compliance And Effectiveness ....................................... 5
9. References ................................................................................................................ 5
 Anaphylaxis SOP December 2015

Change Control – Amendment History

Version Dates Amendments

1. Introduction

The UK incidence of anaphylactic reactions is increasing. Patients who have an anaphylactic

reaction have life-threatening airway and/or breathing and/or circulation problems usually
associated with skin and mucosal changes. Patients having an anaphylactic reaction should
be recognised and treated using the Airway, Breathing, Circulation, Disability, Exposure
(ABCDE) approach.

Whilst anaphylactic reactions are rare, there are still currently 20+ deaths a year across the
UK attributed to anaphylaxis, but this is considered to be a gross under-estimation.

2. Purpose

This SOP is designed to instruct staff of the action to take when anaphylaxis suspected and
what training and resources are required.

3. Scope

This SOP is applicable to all Trust staff, but particularly the qualified nurses, who would
usually be the person expected to deliver the treatment.

The Resuscitation Council (UK) state Patients having an anaphylactic reaction in any setting
should expect the following as a minimum:

• Recognition that they are seriously unwell.

• An early call for help.

• Initial assessment and treatments based on an ABCDE* approach.

• Adrenaline therapy if indicated.

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 Anaphylaxis SOP December 2015

4. Recognition of Anaphylaxis

A diagnosis of anaphylactic reaction is likely if a patient who is exposed to a trigger

(allergen) develops a sudden illness (usually within minutes of exposure) with
rapidly progressing skin changes and life-threatening airway and/or breathing and/or
circulation problems. The reaction is usually unexpected.

There is a range of signs and symptoms, none of which are entirely specific for an
anaphylactic reaction; however, certain combinations of signs make the diagnosis of an
anaphylactic reaction more likely. When recognising and treating any acutely ill
patient, a rational ABCDE approach must be followed and life-threatening problems
treated as they are recognised (see Appendix 1 for more information about the
ABCDE approach).

Anaphylaxis is likely when all of the following 3 criteria are met:

• Sudden onset and rapid progression of symptoms

• Life-threatening Airway and/or Breathing and/or Circulation problems
• Skin and/or mucosal changes (flushing, urticaria, angioedema)

The following supports the diagnosis:

• Exposure to a known allergen for the patient

Remember:

• Skin or mucosal changes alone are not a sign of an anaphylactic reaction

• Skin and mucosal changes can be subtle or absent in up to 20% of reactions (some
patients can have only a decrease in blood pressure, i.e., a Circulation problem)
• There can also be gastrointestinal symptoms (e.g. vomiting, abdominal pain,
incontinence)

5. Treatment

Immediately summon emergency medical assistance appropriate to the setting i.e. medical
emergency bleep and/or 999.
If available, administer 12-15l/min oxygen via high concentration non-rebreathe mask
(emergency oxygen may be administered without prescription via PGD).
If available, administer IM Adrenaline as per guidelines below.
If no treatment is available, monitor and reassure patient until help arrives and if deteriorates
to cardiac arrest commence immediate BLS.
Ensure all appropriate documentation is completed.
The subcutaneous or inhaled routes for adrenaline are not recommended for the
treatment of an anaphylactic reaction because they are less effective.

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 Anaphylaxis SOP December 2015

Adrenaline IM dose – adults

0.5 mg IM (= 500 micrograms = 0.5 mL of 1:1000) adrenaline
Adrenaline IM dose – children
The scientific basis for the recommended doses is weak. The recommended doses
are based on what is considered to be safe and practical to draw up and inject in an
emergency.
(The equivalent volume of 1:1000 adrenaline is shown in brackets)
> 12 years: 500 micrograms IM (0.5 mL) i.e. same as adult dose
> 6 – 12 years: 300 micrograms IM (0.3 mL)
> 6 months – 6 years: 150 micrograms IM (0.15 mL)
< 6 months: 150 micrograms IM (0.15 mL)
Repeat the IM adrenaline dose if there is no improvement in the patient’s condition.
Further doses can be given at about 5-minute intervals according to the patient’s
response.

The Medicines, Ethics and Practice guide for pharmacists and pharmacy technicians, issued
by the Royal Pharmaceutical Society of Great Britain (updated July 2007),
www.rpsgb.org.uk), states that intramuscular adrenaline injection (1 in 1000) is exempt from
requiring a prescription when given for the purpose of saving a life in an emergency. This is
based on article 7 of the prescription-only medicines (POM) order.

This means that any nurse, teacher, parent, carer etc. may administer adrenaline if the
purpose is to save life, without needing permission from an authorised prescriber. If they do
this, they will not commit an unlawful act under the Medicines Act 1968.

Therefore, whilst ideally Adrenaline will be administered by a doctor or a qualified nurse, the
trust recognises that this is an imminently fatal situation and as such, where there are no
suitably qualified persons available, but Adrenaline is available, this may be administered by
other staff groups as a last resort in an attempt to save a life, in accordance with the above
guidance.

6. Training

All in-patient staff will receive annual face to face anaphylaxis training as part of the DMI
training 5 day course and 2 day updates.

Other clinical staff will access e-learning as required. All qualified nurses will need to
complete this training annually as part of their mandatory training to comply with the
requirements for using PGDs

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 Anaphylaxis SOP December 2015

7. Resources

It is a requirement that anyone administering any form of injection must have an

anaphylactic shock pack immediately available to them. Therefore the requirements are:

All in-patient areas and clinic bases must hold an anaphylactic shock pack.

All community teams that administer injections must also hold anaphylactic shock packs.

Any staff that hold temporary clinics, for example flu vaccination clinics, must also have
anaphylactic shock packs available, whether the clinic is in a fixed location or mobile.

It is the clinicians responsibility to ensure that the pack is available and in date BEFORE
they administer any injections.

8. Process For Monitoring Compliance And Effectiveness

Will be included in the trust audit programme.

9. References

Emergency Treatment of Anaphylactic Reactions – Resuscitation Council (UK), edited 2012

The Medicines, Ethics and Practice guide for pharmacists and pharmacy technicians, issued
by the Royal Pharmaceutical Society of Great Britain (updated July 2007)

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