New national standard of care for anaphylaxis

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The first national standard of care for patients with anaphylaxis released this week emphasises the need for prompt treatment and continuity of patient care between acute and general practice healthcare settings.

Anaphylaxis is a severe allergic reaction that requires medical treatment and given a rising rate of visits to hospital emergency departments nationwide for this potentially fatal condition, the release of the new standards appear to be timely.

The new Acute Anaphylaxis Clinical Care Standard, developed by the Australian Commission on Safety and Quality in Health Care (the Commission), describes the optimal standard of clinical care for patients experiencing anaphylaxis, recommending priority areas for clinicians managing treatment.

Each year up to 20 Australians die from anaphylaxis. Australia has one of the highest documented rates of hospital anaphylaxis admissions in the developed world.

Anaphylaxis occurs when our immune system overreacts to an allergen or allergy trigger. Common triggers are foods such as nuts, milk, fish, shellfish and eggs. Up to 10% of infants and 2% of adults have food allergies.  Other common triggers are insect venoms such as wasp and bee stings, and some medicines.

Clinical lead for the new standard, Associate Professor Amanda Walker, Clinical Director at the Commission, reaffirmed the goal as safer care for all anaphylaxis patients.

“The standard addresses gaps in existing guidelines for patient care, such as ensuring timely treatment with adrenaline and strengthening the process for handover of care along the patient journey,” she says.

“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 clinical care standard is also important for families and carers of people at risk, as well as for the individual themselves.

“It is vital for people at risk of anaphylaxis to know how to manage their allergy, how to recognise symptoms and how to correctly use a personal adrenaline injector if needed,” Associate Professor Walker explains.

“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. This is one important exception, to ensure the adrenaline injector is with the patient wherever they are, so they can use it if needed.”

Dr Preeti Joshi, Co-chair of the National Allergy Strategy and paediatric clinical immunology/allergy specialist, says the standard would help avoid dangerous mistakes.

“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.

“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,” says Dr Joshi.