Care you should expect if you experience anaphylaxis

Anaphylaxis should always be treated as a medical emergency. This means that immediate treatment must be given and triple zero (000) should be called. The medication used to treat a severe allergic reaction (anaphylaxis) is called adrenaline (EpiPen®, Anapen®). Research has shown that fatalities occur more often by either delaying or not using adrenaline. In Australia, 1 in 4 people presenting to emergency departments with anaphylaxis were not given adrenaline. This is not acceptable and places those experiencing anaphylaxis at an increased risk of a more severe outcome.

To help those at risk of anaphylaxis to feel safe, and reduce the number of preventable deaths, the Acute Anaphylaxis Clinical Care Standard was established. This Clinical Care Standard defines the level of care that you should receive from paramedics, nurses, and doctors in a healthcare setting if you experience or are at risk of anaphylaxis. The standard is made up of 6 statements that explain the importance of recognising and treating anaphylaxis in a timely manner. In other words, ‘if you think you may be looking at anaphylaxis, do not delay: act now’.

The information below details the six Quality Statements and what each of them means for someone who is at risk of anaphylaxis.

1) Prompt recognition of anaphylaxis

What the standard says:

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.

What this means for you:

If you have symptoms that could mean you are having an allergic reaction, you will be assessed to see if you are experiencing anaphylaxis. These symptoms could include sudden difficulty breathing, swelling of your face, tightness in your throat, persistent dizziness or hives. Abdominal pain with or without vomiting can also be a sign of anaphylaxis, usually for people allergic to insect bites or stings.

If you have an allergy or have had anaphylaxis before, it’s important to let your nurse or doctor know.

2) Immediate injection of intramuscular adrenaline

What the standard says:

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.

What this means for you:

If a nurse or doctor believes you are experiencing anaphylaxis, they will immediately give you an injection of adrenaline into your thigh muscle.

If you recognise the signs of anaphylaxis yourself, use your adrenaline injector (if prescribed) without delay into your outer mid-thigh and call for help immediately. If you’re not sure, it’s safer to use adrenaline than to wait for symptoms to get worse.

The adrenaline should work within 5 minutes. If you don’t start to feel better after 5 minutes, use a second adrenaline injector, if you have one.

3) Correct patient positioning

What the standard says:

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.

What this means for you:

When you are experiencing anaphylaxis, you will be advised to lie flat. If breathing is difficult, you may sit with your legs outstretched. If you feel faint, your legs may be elevated. If you’re pregnant, you should lie on your left side to ensure continued blood circulation to your body. An infant should be held horizontally across your body. Do not hold an infant upright or over your shoulder.

If you have had adrenaline, do not stand or walk anywhere, even to the bathroom, ambulance or emergency department, until a nurse or doctor has said it’s safe for you to do so. This is usually a minimum of one hour after one dose of adrenaline or 4 hours if more than one dose is given.

4) Access to a personal adrenaline injector in all healthcare settings

What the standard says:

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.

What this means for you:

If you have a personal adrenaline injector (such as an Anapen® or EpiPen®) and know how to use it, you should:
• Keep your adrenaline injector close by while you’re being treated in a health service, hospital, ambulance, or clinic. For example, if you’re admitted to hospital, keep it at your bedside for you or staff to use if necessary.

Tell your healthcare team that you have an adrenaline injector and arrange with them to keep it near you during your care.
Keep the adrenaline injector with your ASCIA Action Plan for Anaphylaxis in an unlocked location that you can easily reach.

If you believe you are having an allergic reaction and experience symptoms such as breathing difficulties, faintness, swelling of your tongue or tightness in your throat while in a healthcare service, lie down (or sit with your legs outstretched if breathing is difficult), use your adrenaline injector as soon as possible and alert a staff member immediately.

5) Observation time following anaphylaxis

What the standard says:

A patient treated for anaphylaxis remains under clinical observation for at least 4 hours after their last dose of adrenaline, or overnight as appropriate, according to the 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.

What this means for you:

When you have been treated for anaphylaxis with adrenaline you will be kept under clinical observation for at least 4 hours after the last injection of adrenaline.

In some cases, you may need to be admitted overnight for observation after having anaphylaxis.

6) Discharge management and documentation

What the standard says:

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.

What this means for you:

Before you leave hospital, your nurse or doctor will speak to you about how you can manage your allergy and reduce your future risk of anaphylaxis in the community. They will also make sure you know what to do to stay safe when you go home.
Before you are discharged from a hospital or healthcare service, it is important you receive:

information about your allergic trigger (allergen) and how to avoid it
an ASCIA Action Plan that includes information about:
- how to recognise the symptoms of an allergic reaction, including anaphylaxis
- how to use the adrenaline injector, if prescribed.
advice to see your general practitioner (GP) within one week
information on how to arrange an appointment with a clinical immunology/allergy specialist. If this is your first anaphylaxis event, the specialist will help to confirm the cause of your anaphylaxis and advise you about how to manage your allergy. If you already have a regular specialist, arrange to see them for follow-up.
advice about wearing special jewellery to identify that you have an allergy.

If you’re at risk of re-exposure to the allergen trigger, you will also be given a personal adrenaline injector or a prescription for this medicine. If you’re given a prescription, go to a pharmacy to get the adrenaline injector as soon as possible. The adrenaline injector should be always kept on you or your carer.