Anaphylaxis: ED visits up by 51%, new care standard released

The Australian Commission on Safety and Quality in Health Care (the Commission) has released the first national standard of care for patients with anaphylaxis.

Australia has one of the highest documented rates of hospital anaphylaxis admissions in the developed worldⁱ, with up to 20 deaths from anaphylaxis each year and one in four ED patients not receiving timely adrenaline injections.

Anaphylaxis presentations to emergency departments in public hospitals rose by 51% to 11,594 in the five years to 2019–20. Given a rising rate of visits to hospital emergency departments nationwide for this potentially fatal condition, the release is timely.

The new standard emphasises the need for prompt treatment and continuity of patient care between acute and general practice healthcare settings. It describes the optimal standard of clinical care for patients experiencing anaphylaxis, recommending priority areas for clinicians managing treatment.

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

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 said.

“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,” A/Professor Walker explained.

“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, paediatric clinical immunology/allergy specialist and Co-chair of the National Allergy Strategy, said 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,” Dr Joshi said.

The new clinical care standard is supported and endorsed by the National Allergy Strategy, a partnership between the Australasian Society of Clinical Immunology and Allergy (ASCIA) and consumer group Allergy & Anaphylaxis Australia (A&AA).

^{i Mullins RJ, Wainstein BK, Barnes EH, Liew WK, Campbell DE. Increases in anaphylaxis fatalities in Australia from 1997 to 2013. Clinical & Experimental Allergy 2016;46;1099–1110. https://onlinelibrary.wiley.com/doi/10.1111/cea.12748}

^{ii Australasian Society of Clinical Immunology and Allergy. Food allergy [Internet]. 2019 [cited 2020 Aug 3]. Available from: https://www.allergy.org.au/patients/food-allergy/food-allergy}

Image caption: Associate Professor Amanda Walker — Clinical Director, ACSQHC. Image courtesy of ACSQHC.