Anaphylaxis – 1.

31

SECTION: 1 – PATIENT CARE including Physical Healthcare

POLICY/PROCEDURE NO: 1.31

NATURE AND SCOPE: POLICY - TRUST WIDE

SUBJECT: ANAPHYLAXIS

This policy clarifies roles and responsibilities in relation to the recognition and
management of an anaphylactic emergency within Trust premises or in the Community

DATE OF LATEST RATIFICATION: APRIL 2017

RATIFIED BY: EXECUTIVE LEADERSHIP TEAM

IMPLEMENTATION DATE: MAY 2017

REVIEW DATE: APRIL 2020

ASSOCIATED TRUST POLICIES

& PROCEDURES: Medical Emergency - 1.06
Resuscitation, Recognition of Physical Health Deterioration
and Emergency Oxygen Use - 1.20
Privacy, Dignity and Compassionate Care - 1.27
Reporting of Accidents Untoward Incidents and Near Miss
Situations - 15.01
Being Open/Duty of Candour Policy - 15.11
First Aid - 16.02
Prevention & Management of Natural Rubber Latex Allergy –
16.15
Supply and Administration of Medicines by Registered
Health Care Professionals under Patient Group Directives
(PGDs) - 19.06
Safe Use of Injectable Medicines - 19.09
Procedure for Nurses Adrenaline 1:1000 Injection, Local
Partnerships - Mental Health Services

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NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST

ANAPHYLAXIS POLICY

CONTENTS

1.0 Introduction
2.0 Scope of the Policy
3.0 Duties
4.0 Recognition of Anaphylaxis
5.0 Management of an Anaphylactic Emergency
6.0 The Anaphylaxis Shock Pack
7.0 Further Treatment and Aftercare
8.0 Storage of Adrenaline
9.0 Reporting of Adverse Reactions
10.0 Immunisation
11.0 Differential Diagnosis
12.0 Training
13.0 Relevant Trust Policies
14.0 Target Audience
15.0 Monitoring Compliance
16.0 Equality Impact Assessment Review
17.0 Review Date
18.0 Consultation
19.0 Legislation Compliance
20.0 Reference/Source Documents
21.0 Champion and Expert Writer

Appendix 1 Anaphylactic Reactions – Initial Treatment Algorithm and Anaphylaxis Algorithm

Appendix 2 Definitions that apply to this Procedure
Appendix 3 Equality Impact Assessment Screening Tool
Appendix 4 Record of Changes

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NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST

ANAPHYLAXIS POLICY

1.0 INTRODUCTION

1.1 Anaphylaxis is the term used to describe a severe, life-threatening, generalised or systemic
hypersensitivity reaction (anaphylactic reaction). This is characterised by rapidly
developing, life-threatening airway and/or breathing and/or circulation problems usually
associated with skin and mucosal changes.

1.2 Anaphylaxis has a broad range of triggers but those most commonly identified include a
reaction to:

 Drugs:

o Vaccines
o Antibiotics
o Aspirin
o Non-steroidal anti-inflammatory drugs
o Heparin
o Blood products
o Anaesthetic drugs
o Local anaesthetics – particularly Mepivacaine (brand name Scandonest),
Lignocaine, Benzocaine, Procaine and Tetracaine Contrast
media
 Foodstuffs – commonly peanut and tree nuts
 Insect stings
 Latex

1.3 Age is an important consideration with food products being more common triggers in
children, and drugs more commonly associated with older age groups. However, there is no
guarantee and virtually any food or medication can be implicated. In many cases, no
significant cause can be identified.

1.4 Direct care staff must be aware that anaphylaxis can occur and that in the United Kingdom
incidents of anaphylactic reactions are rising. This is an emergency situation which can, in
severe cases, cause rapid deterioration and death, therefore first aid treatment must be
given without delay.

2.0 SCOPE OF THE POLICY

2.1 This Policy applies to all practitioners, (including agency and bank staff), employed by
Nottinghamshire Healthcare NHS Foundation Trust (the Trust) who have face-to-face
contact with patients and clients, particularly those involved in clinical procedures such as
vaccination, steroid injections, acupuncture and local anaesthesia.

2.2 Unregistered clinical support staff and first aiders have a responsibility to be able to
recognise the signs of possible anaphylaxis to enable them to summon help from other
clinical staff and/or call ‘999’ in the event of a person collapsing. This is to maximise the
earliest possible response form the registered practitioner and/or ambulance service.

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3.0 DUTIES

3.1 Non-Clinical Staff have responsibility to summon help from clinical staff and/or dial ‘999’ in
the event of a person collapsing.

3.2 Medicines legislation restricts the administration of injectable medicines. Unless self
administered, they may only be administered by or in accordance with the instructions of
Independent Prescribers eg a nurse. However, in the case of adrenaline there is an
exemption to this restriction which means:

 Any person can administer adrenaline that is prescribed for a specific person
 Any person can administer adrenaline to an unknown person in a life saving situation
 If the person administering the adrenaline is a registered practitioner then they must
work in accordance with their governing body standards
 Prescription Only Medicine restriction does not apply to the intramuscular administration
of up to 1mg of adrenaline injection 1 in 1000 (1mg/mL) for the emergency treatment of
anaphylaxis

4.0 RECOGNITION OF ANAPHYLAXIS

4.1 An anaphylactic reaction is expected and likely to occur if a patient is exposed to a trigger.
Usually within minutes of exposure, the individual will develop a sudden illness
characterised by rapidly progressing skin changes and/or life threatening airway/breathing
and/or circulation problems.

4.2 There is no single set of criteria or symptoms to identify an anaphylactic reaction but a
range of signs and symptoms that in certain combinations make a diagnosis more likely. An
ABCDE approach must be followed when recognising and treating any acutely ill
individuals:

Airway, Breathing, Circulation, Disability, Exposure

4.3 Anaphylaxis is likely when all of the following three 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, urticarial, angioedema)

4.4 Individuals may experience any combination of these A, B, C, problems. The following
signs and symptoms may help to support diagnosis:

Airway Problems: Throat and tongue swelling, difficulty swallowing and breathing, hoarse
voice, stridor

Breathing Problems: Shortness of breath, increased respiratory rate, wheeze, confusion

caused by hypoxia, cyanosis (usually a late sign), and respiratory arrest

Circulation Problems: Signs of shock (pale, clammy), tachycardia, hypotension (feeling

faint, dizziness, collapse), decreased or loss of consciousness, cardiac arrest

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Disability Problems: Altered neurological status due to decreased brain perfusion. May be
confusion, agitation, feeling of impending doom and loss of consciousness. May have
abdominal pain, incontinence, vomiting

Exposure: Skin and/or mucosal changes, urticarial (hives, nettle rash, wheals, welts),
erythema, angioedema (commonly eyelids, lips and sometimes mouth and throat).
NB Skin changes alone do not signify an anaphylactic reaction

Infants and some other vulnerable individuals may not themselves be able to
describe subjective symptoms eg feeling of warmth, weakness, anxiety, fright. Signs
of persistent crying may be difficult to interpret.

5.0 MANAGEMENT OF AN ANAPHYLACTIC EMERGENCY

5.1 Anaphylaxis is always an emergency situation requiring immediate action. These

treatment guidelines are based on the recommendations of the Resuscitation Council (UK)
(2008) annotated with links to NICE Guidance July 2012, and are summarised in the
algorithm in Appendix 1.

5.2 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

5.2.1 Sudden onset and rapid progression of symptoms

 The patient will feel and look unwell.

 Most reactions occur over several minutes. Rarely, reactions may be slower in
onset.
 The time of onset of an anaphylactic reaction depends on the type of trigger.
An intravenous trigger will cause a more rapid onset of reaction than stings
which, in turn, tend to cause a more rapid onset than orally ingested triggers.
 The patient is usually anxious and can experience a “sense of impending
doom”.
 Life-threatening Airway and/or Breathing and/or Circulation problems.
Patients can have either an A or B or C problem or any combination. Use the
ABCDE approach to recognise these.

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5.2.2 Patients having an anaphylactic reaction in any setting should expect the following
as a minimum:

1. Recognition that they are seriously unwell.

2. An early call for help/ambulance (state the case is suspected Anaphylaxis).
3. Initial assessment and treatments based on an ABCDE approach.
4. Adrenaline therapy if indicated.
5. Investigation and follow-up by an allergy specialist.

NB If you are on your own, administer the adrenaline prior to dialling ‘999’. If
the person affected is a child, state clearly to the ambulance service.

5.2.3 The following intra-muscular (IM) dose of adrenaline should be administered

without delay. NB the volume shown in brackets refers to adrenaline ampoule
1:1000 strength (1mg/1ml)

Age Dose of adrenaline

ADULT 500 micrograms IM (0.5ml)
Over 12 years (same as adult dose) 500 micrograms IM (0.5ml)
6 to 12 years 300 micrograms IM (0.3ml)
Over 6 months but under 6 years 150 micrograms IM (0.15ml)

 If there is no improvement in the patient’s condition, repeat the same dose at

five minute intervals or as the patient’s symptoms dictate until the ambulance
arrives, monitor pulse and respirations and blood pressure, if machine
available
 The above doses can be repeated as necessary, based on the clinical
assessment of the patient (in the absence of improvement or actual
deterioration between doses)
NOTE: There is no upper limit to the number of doses that can be
administered

 After the administration of adrenaline, patients who are breathing but

unconscious can be placed in a lateral position, ensuring the airway is open. If
the patient is pregnant, she should be placed in a left lateral position to
prevent inferior vena cava compression (pressure on a major blood vessel)
 If cardio-respiratory arrest occurs after an anaphylactic reaction, start CPR
immediately, according to the Trust Resuscitation, Recognition of Physical
Health Deterioration and Emergency Oxygen Use Policy 1.20
 Always record the time of the onset of the reaction and the time of the
administration of the drug and rationale for administering the next dose, if
required
 If appropriate, inform the patient/parent or carer that a blood sample may be
required at follow up at the specialist allergy service
 Because of the possibility of delayed reactions, all individuals who have had
an anaphylactic reaction must be transferred immediately to secondary care,
even if they may appear to have made a full recovery

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Antihistamines and/hydrocortisone are not recommended as first line management

of anaphylaxis in primary care.

6.0 THE ANAPHYLAXIS SHOCK PACK

6.1 Adrenaline is the most important drug for the treatment of an anaphylactic reaction; there is
consistent anecdotal evidence supporting its use to ease breathing difficulty and restore
adequate cardiac output. It reverses peripheral vasodilation and reduces oedema, dilates
the bronchial airways, increases the force of myocardial contraction and suppresses
histamine release.

6.2 An anaphylaxis shock packs contain the following:

 Local Partnerships In-patient Wards and Community: 10 ampoules of Adrenaline

1:1000 1ml, 5 x 1ml syringe, 10 x 23G Safety Needles, 10 x 21G Safety needles, 1
Anaphylactic Reaction card, 1 Resuscitation face shield

 Rampton Hospital In Patient Areas: Red Emergency Pouches inside emergency bag
(rucksack) – 10 x Adrenaline 1:1000, 3 x Adrenaline 1 in 10000. Safety syringes are
separate in the main part of the emergency bag (rucksack)

6.3 Chlorphenamine (chlorpheniramine) and hydrocortisone are second-line treatments not

included in the pack.

6.4 Adrenaline (epinephrine) is a prescription only medicine (POM). However, the Medicines
Act 1968 states that adrenaline can be administered for the purpose of saving lives in an
emergency without prescription. This means that in an emergency situation, where the
Registered Practitioner recognises the signs and symptoms of Anaphylaxis and is
competent to administer an Intra-Muscular Adrenaline Injection, an Adrenaline Injection can
be administered without a prescription and without the Practitioner being signed off to work
under a Patient Group Directive (PGD).

7.0 FURTHER TREATMENT AND AFTERCARE

7.1 Following an anaphylactic reaction, the individual must be taken by ambulance to an

Emergency Department for assessment and observation even if their symptoms have
subsided following immediate treatment as delayed or rebound reactions may occur.

7.2 Details of the incident must accompany the patient, including the following information:

 Probable cause of the anaphylactic reaction if known or suspected

 Action taken, doses of adrenaline and other medicines given and the times
administered
 List of medication the patient is known to be taking

7.3 All actions taken must be recorded in the patient’s notes and their GP informed. An alert
should be placed in the patients notes.

7.4 If the anaphylaxis was thought to be caused by a medicine, report the event to the
Medicines Healthcare Products Regulatory Agency (MHRA) via the Yellow Card reporting
scheme found in the BNF or at www.mhra.gov.uk or www.yellowcard.gov.uk

7.5 The patient/service user should be warned of the possibility of the recurrence of symptoms.
In-patients should be kept under observations for 8-24 hours and the GP notified of the

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incident on discharge. The Resuscitation Council (UK) advises that the service user is
referred by the GP for investigation and follow-up by an allergy specialist.

8.0 STORAGE OF ADRENALINE

8.1 Adrenaline is a Prescription Only Medicine (POM) and therefore must be stored securely at
all times.

8.2 Only sealed packs of adrenaline should be used. If the seal is broken discard.

8.3 As adrenaline has a limited shelf-life, it is the responsibility of all Trust practitioners to
ensure that the adrenaline available is in date and is kept in an environment that complies
with the Safe use of Injectable Medicines Policy 19.09 and Manufacturer’s instructions.

8.4 If there is any pink or brown colour present, the ampoules should be replaced even if they
have not reached the expiry date.

8.5 Inpatient Units – Adrenaline must be easily accessible in the appropriate designated place
for universal access.

8.6 Spare Stock Adrenaline – Stock adrenaline must kept in its original packaging (or the
packaging that was provided by Pharmacy) to ensure that it is not subject to light and is
protected from physical damage. It should be stored in an appropriate medicines cupboard
as set down in the Medicines Code at room temperatures below 25°C but not allowed to
freeze and not subjected to light. Due to the infrequency of adrenaline usage, it is vital that
systems are in place to regularly check and record expiry dates and stock levels.

8.7 Community Staff – When staff are on duty, adrenaline must be carried with them or be
readily at hand to be easily accessible. At the end of the shift, the adrenaline must be
stored securely either at the individual member of staff’s home or, if feasible, at their base.

8.8 Safe Transport of Adrenaline - During transport, adrenaline must be stored in a locked
receptacle or locked boot of the vehicle for safety reasons. Care must be taken to ensure
that it is not subjected to high temperatures (over 25°C) or allowed to freeze.

8.9 Safe Disposal of Adrenaline - Small quantities of adrenaline (i.e. 5 ampoules/auto-

injectors or less at a time) that require disposal should be disposed of by dropping into a
leak-resistant sharps bin. Further advice regarding pharmacy waste procedures can be
obtained from the appropriate Pharmacy department.

9.0 REPORTING OF ADVERSE REACTIONS

9.1 Adverse drug reactions that include an anaphylactic reaction should be reported to the
Medicine and Healthcare Products Regulatory Agency (MHRA) using the yellow card
scheme (www.mhra.gov.uk).

9.2 All adverse reactions must be reported in accordance with the Trust’s Reporting of
Accidents Untoward Incidents and Near Miss Situations Policy 15.01.

10.0 IMMUNISATION

10.1 Immunisation must not be undertaken unless a stock of adrenaline 1 in 1000 for
intramuscular injection is available. An anaphylaxis kit, including adrenaline 1 in 1000 for
intramuscular injection, needles for intramuscular injection, graduated 1ml syringe and a
pocket mask must be available at all immunisation sessions. Packs should be checked
regularly to ensure contents are within their expiry dates.

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10.2 Practitioners who undertake immunisations must know the dosage of adrenaline
appropriate for their client group.

10.3 Where an immunisation is to be administered, in addition to the individual prescription of a

vaccine, the practitioner must have adrenaline 500 micrograms IM (0.5mL 1:1000 solution)
easily accessible for intra muscular injection for use in the event of anaphylactic shock.

10.4 Whilst anaphylaxis after immunisation is rare (Resuscitation Council, 2008), fainting and
panic attacks associated with Immunisations are not. Practitioners involved in vaccination
programmes must be able to deal with these and recognise the difference between
anaphylaxis and fainting.

10.5 True anaphylaxis is most likely to occur within ten minutes following vaccination and the
majority of adverse reactions to vaccination occur within two minutes.

10.6 It is considered that, by the time the practitioner has checked the site for bleeding, the
patient has replaced clothing and the ‘patient records’ have been completed, any immediate
problems should have become apparent (Vaccine Administration Taskforce, 2001). In the
absence of any scientific evidence, best practice would dictate that once the documentation
is completed and providing the patient has been assessed to be feeling well before leaving,
is to be considered an adequate observation period.

10.7 It is further recommended that patients be given instructions, preferably written, regarding
observation for the post vaccination possible side effects and after care. The same advice
and considerations should be given to all patients undergoing a local anaesthetic or
receiving antibiotic cover.

10.8 Consideration should be given to ensure prevention where possible. Emphasis should be
given to the checking and recording of an adequate and thorough medical history
particularly allergies.

11.0 DIFFERENTIAL DIAGNOSIS

11.1 Practitioners should be able to distinguish between an anaphylactic reaction, fainting

(syncope) and panic attacks. Fainting is relatively common in adults and adolescents, but
infants and children rarely faint. Sudden loss of consciousness in young children should be
presumed to be an anaphylactic reaction, particularly if a strong central pulse is absent. A
strong central pulse persists during a faint or seizure. Following the ABCDE approach will
support a differential diagnosis.

11.2 Panic attacks should be distinguished from anaphylaxis. Symptoms include hyperventilation
that may lead to paraesthesiae (numbness and tingling) in the arms and legs. There may
be an erythematous rash associated with anxiety, although hypotension and pallor,
wheezing will not be present.

11.3 If the diagnosis is unclear, anaphylaxis should be presumed and appropriate management
given.

11.4 Clinical Features of Fainting and Anaphylaxis:

Symptoms and/or Fainting Anaphylaxis

signs
Onset following Before, during or within Usually within 5 minutes, but can
injected medication minutes of vaccine occur within hours of vaccine
such as vaccine administration administration
administration

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Symptoms and/or Fainting Anaphylaxis

signs
Skin Generalised pallor, cold
clammy skin
Respiration Normal respiration – may
be shallow but not
laboured
Cardiovascular Bradycardia, but with
strong central pulse,
hypotension – usually
transient and corrects in
supine position
Neurological Sense – light-headedness,
loss of consciousness –
improves once supine or
head down position,
transient jerking of limbs
and eye-rolling which may
be confused with a
seizure, incontinence
Skin itchiness, pallor or flushing of
skin, red or pale urticarial (wheals)
or angioedema
Cough, wheeze, stridor, or signs of
respiratory distress (tachypnoea,
cyanosis, rib recession)
Tachycardia, with weak/absent
central pulse, hypotension-sustained
Sense of severe anxiety and
distress, loss of consciousness – no
improvement once supine or head
down position

Taken from Chapter 8 Immunisation against infectious disease: Green Book November 2013

12.0 TRAINING

12.1 All clinical staff will attend annual anaphylaxis awareness training as part of life support
training.

12.2 All staff that administer vaccines and injections are required to attend annual anaphylaxis
training in and recognition of anaphylaxis and the administration of adrenaline to save life
following an anaphylactic reaction. They will then be covered to administer adrenaline
under the appropriate local guidance and standing operating procedures.

12.3 It is the responsibility of operational managers to ensure that all practitioners are trained to
recognise the signs and symptoms of an anaphylactic reaction and are competent in the
management of anaphylaxis.

12.4 It is the responsibility of operational managers to hold a record of staff training and to
update the training records on a regular basis to ensure compliance with this policy.

13.0 RELEVANT TRUST POLICIES

 Medical Emergency 1.06

 Resuscitation, Recognition of Physical Health Deterioration and Emergency Oxygen
Use Policy 1.20
 Privacy, Dignity and Compassionate Care Policy 1.27
 Reporting of Accidents Untoward Incidents and Near Miss Situations 15.01
 Being Open/Duty of Candour Policy - 15.11
 First Aid 16.02
 Prevention & Management of Natural Rubber Latex Allergy 16.15

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 Supply and Administration of Medicines by Registered Health Care Professionals under

Patient Group Directives (PGDs) 19.06
 Safe use of Injectable Medicines Policy 19.09
 Protocol for the Administration of Intramuscular Adrenaline (Epinephrine) 1mg/1ml
(1:1000) Injection for Adults and Children over 13 years for Anaphylaxis, Local
Partnerships Mental Health Services
 Trust Mass Vaccination Plan

14.0 TARGET AUDIENCE

14.1 The target audience for this policy is all employees of the Trust.

15.0 MONITORING COMPLIANCE

15.1 Following any anaphylactic reaction requiring the administration of adrenaline, the
practitioner must report and record the episode in accordance with the Reporting of
Accidents Untoward Incidents and Near Miss Situations 15.01. Incidents should be
recorded in Ulysses as Incident Care Group Clinical/Missing, Incident Group Clinical Care,
Type – Allergic Reaction.

16.0 EQUALITY IMPACT ASSESSMENT REVIEW

16.1 This policy has been assessed using the Trust Equality Impact Assessment (EIA)
Screening Tool (attached at Appendix 3) which concluded that a full EIA is not necessary.
The Policy has a positive impact on all patients, inclusive of protected characteristics, by
ensuring that best practice will always meet national guidelines. The purpose of the Policy
is to save life following an anaphylactic reaction for all patients by appropriately trained
staff. All care will be provided in line with the Trust’s Privacy, Dignity and Compassionate
Care Policy. Specific guidance is provided within the Anaphylaxis Policy regarding the care
of pregnant women following an anaphylactic reaction. Furthermore, the appropriate
dosage of adrenaline to be administered to patients is clearly specified based on the
patient’s age.

16.2 Two of the core Trust values are to respect individuals and deliver effective communication.
The Trust will ensure that all staff embrace these values when working with service users
and help make a difference to their lives. The Trust is committed to treating every individual
fairly and will not discriminate against any individuals or groups of people because of their
race, gender, disability, age, religion or belief, sexual orientation, gender identity,
marriage/civil partnership status or pregnancy and maternity status.

17.0 REVIEW DATE

17.1 This policy will be reviewed every three years, following its activation or on receipt of new
guidance from the Department of Health or the Resuscitation Council UK.

18.0 CONSULTATION

18.1 This policy has been written after consultation with the Medical Director, Chief Pharmacist,
Physical Healthcare Infection Prevent & Control Lead (Local Partnerships Division),
Resuscitation Officer (Local Partnerships Division), Learning & Development Facilitator/
Trust Resuscitation Lead and the Leadership Council.

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19.0 LEGISLATION COMPLIANCE

19.1 Health & Safety etc Act 1974.

20.0 REFERENCE/SOURCE DOCUMENTS

 British National Formulary (2017) BNF: number 72, BMJ and RS, London
 British Formulary for Children 2017, London
 National Institute for Health And Clinical Excellence: CG134 Anaphylaxis: Initial
Assessment and Referral following emergency treatment for an anaphylactic episode.
July 2012, NICE Clinical Guideline, London
 Resuscitation Council UK (2008) Emergency Treatment of anaphylactic reactions:
Guidelines for Healthcare Providers – annotated with NICE guidelines July 2012
(Available in full on the Resuscitation Council UK website, http://www.resus.org.uk
 Resuscitation Council UK (2015). Advanced Life Support

21.1 CHAMPION AND EXPERT WRITER

21.1 The Champion of this policy is Julie Hankin, Medical Director. The Expert Writer is Caroline
Brookes, Head of Emergency Preparedness, Resilience & Response.

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APPENDIX 1

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APPENDIX 2

DEFINITIONS THAT APPLY TO THIS PROCEDURE

Adrenaline Injectable drug used for emergency treatment of severe allergic reaction,
(epinephrine) including anaphylaxis. (Epinephrine is the man made chemical version of the
hormone)
Anaphylactic reaction The life-threatening signs and symptoms caused by anaphylaxis

Anaphylactic shock Compromise of the circulation and poor perfusion of the body’s vital organs
caused by an anaphylactic reaction
Anaphylaxis Is the process which leads to an anaphylactic reaction – severe, life-
threatening, generalised or systemic hypersensitivity reaction
Angioedema Swelling in the deeper layer of the skin, often affecting eyelids, lips, mouth
Antibody (also known as immunoglobulin) a protein manufactured by lymphocytes – a
type of white blood cell, in response to the presence of an antigen, or foreign
protein, in the body
Antigen A substance, usually a protein that the body recognises as foreign and that
can induce an immune response
Caval compression Pressure on the vena cava impeding venous return

Immunoglobulin E Antibody causing anaphylaxis

Urticaria Skin rash, notable for dark red, raised, itchy bumps

Yellow card scheme UK system for collecting information on suspected adverse drug reactions to
medicines
ABCDE Airway, Breathing, Circulation, Disability, Exposure

BNF British National Formulary

CPR Cardio Pulmonary Resuscitation

IgE Immunoglobulin E

IM Intramuscular

MHRA Medicines and Healthcare products Regulatory Agency

Due Regard Having due regard for advancing equality involves:

 Removing or minimising disadvantages suffered by people due to their

protected characteristics
 Taking steps to meet the needs of people from protected groups where
these are different from the needs of other people
 Encouraging people from protected groups to participate in public life or in
other activities where their participation is disproportionately low.

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APPENDIX 3
EQUALITY IMPACT ASSESSMENT (EIA) SCREENING TOOL

Name of policy/procedure/strategy/plan/function etc Anaphylaxis 1.31

being assessed:

This policy clarifies roles and responsibilities in relation to the recognition and management of
Brief description of policy/procedure/strategy/plan/ an anaphylactic emergency within Trust premises or in the Community
function etc and reason for EIA:

Caroline Brookes, Head of Emergency Preparedness, Resilience & Response (EPRR)

Names and designations of EIA group members: Catherine Conchar, Head of Equality & Diversity
Julie Gardner, Associate Director for Safeguarding and Social Care
Leadership Council
List of key groups/organisations consulted Equality and Diversity Subcommittee

Health & Safety at Work etc Act

Data, Intelligence and Evidence used to conduct the Resuscitation Council UK
screening exercise

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Equality Strand Does the proposed Are there any changes Have any mitigating Areas for Review/Actions
policy/procedure/ strategy/ which could be made to the circumstances been Taken (with timescales
plan/ function etc have a proposals which would identified? Please and name of responsible
positive or negative (adverse) minimise any adverse describe officer)
impact on people from these impact identified? What
key equality groups? Please changes can be made to the
describe proposals to ensure that a
positive impact is achieved?
Please describe
A positive impact has been n/a n/a Author to review in 3 years
Race identified as the policy ensures or sooner in light of new
best practice will always meet guidance from the
national guidelines and will Department of Health or
benefit all patient groups. The Resuscitation Council UK
purpose of the Policy is to save
life following an anaphylactic
reaction for all patients,
inclusive of protected
characteristics, delivered by
appropriately trained staff. All
care will be provided in line with
the Trust’s Privacy, Dignity and
Compassionate Care Policy.
As Race. Specific guidance is n/a n/a As above
Gender provided within the Policy
Incl. Transgender regarding the care of pregnant
women following an
anaphylactic reaction.
As Race n/a n/a As above
Disability
Incl. Mental Health and LD
As Race n/a n/a As above
Religion/Belief
As Race n/a n/a As above
Sexual Orientation
As Race. The appropriate n/a n/a As above
Age dosage of adrenaline is clearly

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 Anaphylaxis – 1.31

specified in the Policy based on

the patient’s age.
n/a n/a n/a As above
Social Inclusion*1
n/a n/a n/a As above
Community
Cohesion*2
As Race n/a n/a As above
Human Rights *3

*1 for Social Inclusion please consider any issues which contribute to or act as barriers, resulting in people being excluded from society e.g. homelessness, unemployment, poor
educational outcomes, health inequalities, poverty etc
*2 Community Cohesion essentially means ensuring that people from different groups and communities interact with each other and do not exclusively live parallel lives. Actions
which you may consider, where appropriate, could include ensuring that people with disabilities and non-disabled people interact, or that people from different areas of the City or
County have the chance to meet, discuss issues and are given the opportunity to learn from and understand each other.
*3 The Human Rights Act 1998 prevents discrimination in the enjoyment of a set of fundamental human rights including: The right to a fair trial, Freedom of thought, conscience and
Religion, Freedom of expression, Freedom of assembly and association and the right to education

Conclusions and Further Action (including whether a
full EIA is deemed necessary and agreed date for
completion)
Screening Tool Consultation End Date
Following completion of the Equality Impact Assessment (EIA) Screening Tool it has been
determined that a full EIA is not necessary. The Policy has a positive impact on all
patients, inclusive of protected characteristics, by ensuring that best practice will always
meet national guidelines. The purpose of the Policy is to save life following an
anaphylactic reaction for all patients by appropriately trained staff. All care will be provided
in line with the Trust’s Privacy, Dignity and Compassionate Care Policy. Specific guidance
is provided within the Anaphylaxis Policy regarding the care of pregnant women following
an anaphylactic reaction. Furthermore, the appropriate dosage of adrenaline to be
administered to patients is clearly specified based on their age.
5:00pm on Wednesday 22 March 2017

Name of Equality and Diversity (E&D) Group Equality and Diversity Sub-Committee of the Board of Directors
Approving EIA (i.e. Directorate E&D Group,
Divisional E&D Forum or Trustwide E&D Steering
Group)

Name of Responsible Officer Name and Contact Caroline Brookes

Details (tel. e-mail, postal) Head of Emergency Preparedness, Resilience & Response
caroline.brookes@nottshc.nhs.uk

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 Anaphylaxis 1.31

APPENDIX 4

The Policy/Procedure for: Anaphylaxis

Issue: 04

Status: APPROVED

Author Name and Title: Caroline Brookes, Head of Emergency Preparedness,

Resilience & Response (EPRR)

Issue Date: 02 MAY 2017

Review Date: APRIL 2020

Approved by: EXECUTIVE LEADERSHIP TEAM (26/04/2017)

Distribution/Access: Normal

RECORD OF CHANGES

DATE AUTHOR POLICY DETAILS OF CHANGE

1.31
11.14 C Brookes Minor amendments to 6.2, 8.6, 8.8 and 10.3
(Issue 2)
1.31
02.17 C Brookes Minor Amendments throughout policy
(Issue 3)

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