Published guidelines in reverse order of publication are listed in the table below. Some guidelines are open access and available from the website of the publishing Journal. All the guidelines are available for download in the Guidelines section of the  BSACI members only website .

Summaries of all guidelines can be found at the bottom of this page.

BSACI Published Guidelines

Guidelines in Consultation

There are presently no guidelines in consultation, but future guidelines will be posted on the BSACI website as soon as a draft has been finalised by the BSACI Standards of Care Committee. The BSACI is very happy to draw on the expertise of all members as well as specialists in areas related to allergy. Members will be alerted if and when a guideline draft is added to the BSACI website for consultation and are strongly encouraged to contribute to the consultation. All comments will be considered carefully by the Standards of Care Committee and a revised version will be prepared before submission for publication.

BSACI Guideline Development Scheme

Guidelines by the Paediatric Allergy Group of the BSACI (PAG)

eGuidelines (Primary Care) prepared by the BSACI:

(http://www.eguidelines.co.uk/index.htm)

• Management of chronic urticaria and angio-oedema

• Rhinitis management guidelines.

The BSACI algorithm for the management of patients with rhinitis in primary care: Primary Care Rhinitis Algorithm

Guidelines in Preparation

• Egg allergy

• Immunotherapy for Allergic Rhinitis 

• Adrenaline auto injector

Planned Guidelines

• Nut allergy

• Beta lactam allergy

• Vaccine allergy

SUMMARIES OF THE GUIDELINES 

BSACI/SOCC Guidelines 

1. BSACI guidelines for the management of drug allergy
R. Mirakian, P. W. Ewan, S. R. Durham, L. J. F. Youlten, P. Dugu´e, P. S. Friedmann, J. S. English, P. A. J. Huber and S. M. Nasser.
These guidelines have been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and are intended for allergists and others with a special interest in allergy. As routine or validated tests are not available for the majority of drugs, considerable experience is required for the investigation of allergic drug reactions and to undertake specific drug challenge. A missed or incorrect diagnosis of drug allergy can have serious consequences. Therefore, investigation and management of drug allergy is best carried out in specialist centres with large patient numbers and adequate competence and resources to manage complex cases. The recommendations are evidence based but where evidence was lacking consensus was reached by the panel of specialists on the committee. The document encompasses epidemiology, risk factors, clinical patterns of drug allergy, diagnosis and treatment procedures. In order to achieve a correct diagnosis we have placed particular emphasis on obtaining an accurate clinical history and on the physical examination, as these are critical to the choice of skin tests and subsequent drug provocation. After the diagnosis of drug allergy has been established, communication of results and patient education are vital components of overall patient management. Full guideline...

2.  BSACI guidelines for the management of rhinosinusitis and nasal polyposis

GK Scadding; SR Durham; R Mirakian; NS Jones; AB Drake-Lee; D Ryan; TA Dixon; PAJ Huber and SM Nasser.

This guidance for the management of patients’ rhinosinusitis and nasal polyposis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The recommendations are based on evidence and expert opinion and are evidence graded.  These guidelines are for the benefit of both adult physicians and paediatricians treating allergic conditions. Rhinosinusitis implies inflammation of the nose and sinuses which may or may not have an infective component and includes nasal polyposis. Acute rhinosinusitis lasts up to 12 weeks and resolves completely. Chronic rhinosinusitis persists over 12 weeks and may involve acute exacerbations. Rhinosinusitis is common, affecting around 15% of the population and causes significant reduction in quality of life. The diagnosis is based largely on symptoms with confirmation by nasendoscopy. Computerized tomography scans and magnetic resonance imaging are abnormal in approximately one third of the population so are not recommended for routine diagnosis but should be reserved for those with acute complications, diagnostic uncertainty or failed medical therapy. Underlying conditions such as immune deficiency, Wegener’s granulomatosis, Churg-Strauss syndrome, aspirin hypersensitivity and allergic fungal sinusitis may present as rhinosinusitis. There are few good quality trials in this area but the available evidence suggests that treatment is primarily medical, involving douching, corticosteroids, antibiotics, anti-leukotrienes, and anti-histamines. Endoscopic sinus surgery should be considered for complications, anatomical variations causing local obstruction, allergic fungal disease or patients who remain very symptomatic despite medical treatment. Further well conducted trials in clearly defined patient groups are needed to improve management. Full guideline ......

3. BSACI guidelines for the management of allergic and non-allergic rhinitis

GK Scadding; SR Durham; R Mirakian; NS Jones; SC Leech; S Farooque; A Simpson; D Ryan; SM Walker; AT Clark;  TA Dixon; SRA Jolles; N Siddique; P Cullinan; PH Howarth; SM Nasser.

This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the Standards of Care Committee. Where evidence was lacking consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy.  There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research. Full guideline ......

4. Emergency treatment of anaphylactic reactions

Executive Summary:

• 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.
• Anaphylactic reactions are not easy to study with randomised controlled trials. There are, however, systematic reviews of the available evidence and a wealth of clinical experience to help formulate guidelines.
• The exact treatment will depend on the patient’s location, the equipment and drugs available, and the skills of those treating the anaphylactic reaction.
• Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction.
• Despite previous guidelines, there is still confusion about the indications, dose and route of adrenaline.
• Intravenous adrenaline must only be used in certain specialist settings and only by those skilled and experienced in its use.
• All those who are suspected of having had an anaphylactic reaction should be referred to a specialist in allergy.
• Individuals who are at high risk of an anaphylactic reaction should carry an adrenaline auto-injector and receive training and support in its use.

• There is a need for further research about the diagnosis, treatment and prevention of anaphylactic reactions.  Full guideline ......

5. BSACI guidelines for the management of chronic urticaria and angio-oedema

RJ Powell; GL Du Toit; N Siddique; SC Leech; TA Dixon; AT Clark; R Mirakian; SM Walker; PAJ Huber; SM Nasser.

This guidance for the management of patients with chronic urticaria and angio-oedema has been prepared by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is aimed at both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the Standards of Care Committee. Where evidence was lacking a consensus was reached by the experts on the committee. Included in this guideline are clinical classification, aetiology, diagnosis, investigations, treatment guidance with special sections on children with urticaria, and the use of antihistamines in women who are pregnant or breast feeding. Finally, we have made recommendations for potential areas of future research. Full guideline .....

6. Protocol for personnel performing sub-cutaneous immunotherapy using Alutard(TM) and Aquagen(TM) vaccines

SM Walker; SR Durham

Introduction: The aim of this protocol is to provide documented information on the treatment performed by personnel performing immunotherapy within the department of Upper Respiratory Medicine. It should be used as a guide and reference. In order to work by this protocol, personnel should have successfully completed the appropriate training and education (Appendix 1) and be deemed competent.

Immunotherapy, or desensitisation, is a treatment used for preventing allergic reactions to specific allergens. Conventional treatment involves weekly administration of incremental doses of the identified allergen (wasp/bee venom or grass pollen) over 12 weeks and then monthly injections for 3 years. An abridged updosing schedule is available for venom sensitive patients in certain circumstances. Treatment must be in hospital with full cardio-respiratory resuscitation equipment to hand. Patients must be carefully observed for 1 hour after each treatment. All immunotherapy is performed in the presence of a physician. Full guideline .....

7. Suspected Anaphylactic reactions associated with anaesthesia

Walter S Nimmo; David G Bogod; L Roderick McNicol; Amanda Vipond; Richard Foxell; Pamela Ewan; Lawrence Youlten

Executive Summary

1.1 Anaphylactic reactions are rare during anaesthesia but may be increasing in frequency. 

1.2 There are no clinical trial data and therefore no evidence base is available or likely to become available. Recommendations follow analysis of case reports and summaries of experience.

1.3 Guidelines about the treatment of a patient with suspected anaphylaxis during anaesthesia must take into account the inevitability of some diagnostic errors and an emphasis on the safety of any recommended therapy. 

1.4 Even severe reactions show a prompt and successful response to appropriate treatment in most patients.

1.5 Treatment normally should include epinephrine (adrenaline) at an early stage. A model operating procedure for management of patients with suspected anaphylaxis is included. 

1.6 Any patient who has a suspected anaphylactic reaction associated with anaesthesia should be investigated fully. The anaesthetist who administered the drugs is responsible for ensuring that this is done.

1.7 Immediate blood tests to confirm diagnosis and recommendations for skin testing to identify the causative agent are described. A list of allergists with experience in skin prick testing for anaesthetic drugs is included.

1.8 All suspected adverse reactions should be reported to the Medicines and Healthcare Products Regulatory Agency.

1.9 There is no valid predictor of drug anaphylaxis at present. Claims that any form of screening will predict anaphylaxis are without foundation. Link to AAGBI site with guideline access .

8. Latex allergy. A position paper of the British Society of Allergy and Clinical Immunology

P Cullinan; R Brown; A Filed; J Hourihane; M Mones; R Kekwick; R Rycroft; R Stenz; S Williams; C Woodhouse.

9. Position paper on allergen immunotherapy.

Paediatric Allergy Group (PAG)

Guidelines for the administration of Influenza vaccine in children with egg allergy. 2008.