BSACI Guideline to improve the management of those at risk of Anaphylaxis


The British Society for Allergy and Clinical Immunology (BSACI) recently published guidance on the ‘Prescribing an Adrenaline Auto Injector’. This was developed to improve the management of those at risk of anaphylaxis.  

Many patients at risk of anaphylaxis still do not receive an appropriate diagnosis or management. The BSACI guideline provides guidance to doctors about when an adrenaline auto-injector (AAI) should be prescribed to improve patient safety. 

Important steps in the management of severe allergy are identifying triggers, careful avoidance of triggers and an assessment of risk, which should be undertaken in an allergy service. The guidance recommends that those who are at risk of anaphylaxis should be prescribed an adrenaline auto-injector. It recommends that the adrenaline auto-injector should be part of the overall management of allergy care, aimed at ensuring that those patients who require it are safe. In most cases one adrenaline auto-injector is sufficient. This is in line with the NICE Quality Standards for Anaphylaxis and the European (EAACI) anaphylaxis guidelines. Most children require a second auto-injector for school. There are some individuals at risk of anaphylaxis for whom it is appropriate to carry more than one AAI and guidance about when this is necessary is provided. Some patients do not receive an adrenaline auto-injector after an attack of anaphylaxis and the guideline recommends this is prescribed immediately or as soon as possible afterwards.

Assessment of patients who have never suffered anaphylaxis, but are considered to be at risk of anaphylaxis, requires clinical expertise. Many patients who are prescribed an adrenaline auto-injector fall into this category, therefore new guidance on how to make a risk assessment is given.

The guidance also highlights the importance of training and re-training in the use of adrenaline auto-injectors, as a significant number of patients, for whom adrenaline auto-injectors are prescribed, are either unable to use them, are afraid to use them or don’t carry them. If you have any concerns regarding the recommendations in the BSACI guideline ‘Prescribing of an Adrenaline Auto Injector’, we suggest that you seek advice from your local allergy service.


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