Patients at risk from anaphylaxis to benefit from new GP guidance - BSACI

Patients at risk from anaphylaxis to benefit from new GP guidance

15 June 2023

The British Society for Allergy and Clinical Immunology (BSACI) has announced the publication of the Adrenaline auto-injector prescription for patients at risk of anaphylaxis: BSACI guidance for primary care.

Anaphylaxis, also called allergic or anaphylactic shock, is a sudden, severe and life-threatening allergic reaction that involves the whole body. The reaction is marked by constriction of the airways, leading to difficulty breathing. Swelling of the throat may block the airway in severe cases.

The Adrenaline auto-injector prescription for patients at risk of anaphylaxis: BSACI guidance for primary care written by the BSACI, is for primary care healthcare professionals managing patients who have either experienced anaphylaxis or may be at risk of anaphylaxis. This is important guidance as primary care is often the first place where advice and guidance is sought from patients.

The guidance has been informed by current practice and addresses key primary care clinical questions and known gaps in care from reported fatalities.

The guidance recommends GPs to provide two adrenaline auto injectors for those at significant risk of anaphylaxis and to always carry them. Where the healthcare professional is uncertain about the risk of anaphylaxis, prescribing adrenaline would be a safety net, pending review in a specialist allergy clinic. Patients who are prescribed an AAI or considered at risk of anaphylaxis must then be referred on to be reviewed by an allergy specialist.

The guidance emphasises the need to train the patient on how to use each device and how the specialist and primary care teams should work together to avoid gaps in care.

The guidance aims to simplify the understanding and practice of prescribing auto-injectors for health professionals for the benefit of patients. It also signposts other helpful resources in this area including the recent MHRA Public Assessment Report of the Commission on Human Medicines’ AAI Expert working group: Recommendations to support the effective and safe use of adrenaline auto-injectors.

This new BSACI guidance has been led by GPs Dr Elizabeth Angier and Dr Deepa Choudhury. Dr Angier explains “This guidance has been created to support primary care workers in this important topic of adrenaline prescribing for patients at risk of anaphylaxis. Our aim is to assist health care workers with information illustrated by case histories, and to improve the patient journey and their families whilst waiting for specialist review or for their ingoing care across the health system.”

The guideline has been endorsed by patient charities. Simon Williams Chief Executive of Anaphylaxis UK says “Anaphylaxis UK welcomes the BSACI AAI guidance that provides clear evidence-based information to primary care teams to enable them to support their seriously allergic patients. Learning from Prevention of Future Death Reports highlights the importance of prescribing two AAIs and ensuring the patient knows how and when to use them. Onward referral to allergy clinics is important for those patients who require specialist advice.”

Amena Warner, Head of Clinical Services at Allergy UK says “Adrenaline is the first line treatment of Anaphylaxis. All those at risk should have access to it, in a way that can be given in the community. Adrenaline by autoinjector is this way and the new BSACI guidance for primary care outlines the prescribing detail. No one should die of Allergy and every bit of protection we can give to those at risk is a step forward to achieving this. Allergy UK welcomes this guidance and will work with the BSACI and primary care for implementation.”

Click here to access the guidance.

The AAI research letter in Clinical & Experimental Allergy journal can be accessed at