Anaphylaxis: assessment and referral after emergency treatment

National Institute for Health and Care Excellence


List of all recommendations

  • Document the acute clinical features of the suspected anaphylactic reaction (rapidly developing, life-threatening problems involving the airway [pharyngeal or laryngeal oedema] and/or breathing [bronchospasm with tachypnoea] and/or circulation [hypotension and/or tachycardia] and, in most cases, associated skin and mucosal changes)
  • Record the time of onset of the reaction
  • Record the circumstances immediately before the onset of symptoms to help to identify the possible trigger
  • After a suspected anaphylactic reaction in adults or young people aged 16 years or older, take timed blood samples for mast cell tryptase testing as follows:
    • a sample as soon as possible after emergency treatment has started
    • a second sample ideally within 1–2 hours (but no later than 4 hours) from the onset of symptoms
  • After a suspected anaphylactic reaction in children younger than 16 years, consider taking blood samples for mast cell tryptase testing as follows if the cause is thought to be venom-related, drug-related or idiopathic:
    • a sample as soon as possible after emergency treatment has started
    • a second sample ideally within 1–2 hours (but no later than 4 hours) from the onset of symptoms
  • . . .

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