Acute Anaphylaxis Clinical Care Standard

Anaphylaxis is the most severe form of allergic reaction, and is potentially life threatening if not treated immediately. The recognition of acute anaphylaxis and the provision of appropriate treatment and follow-up care are essential for improved outcomes.

Introduction 

Over four million Australians live with allergies.1 For example, food allergy occurs in around 10% of infants, 4-8% of children, and 2% of adults in Australia.2

Anaphylaxis is the most severe form of allergic reaction, and is potentially life threatening if not treated immediately.

Recent studies show increasing incidence of all-cause anaphylaxis in Australia, the United Kingdom and the United States.3 Anaphylaxis hospital admissions in Australia increased by 46% over 5 years from 8,098 in 2014-15 to 11,856 in 2018-19.4 Anaphylaxis presentations to emergency departments in public hospitals in the same 5 year period grew by 58%, to over 10,940 in 2018-19.5

There were 324 anaphylaxis fatalities recorded by the Australian Bureau of Statistics between 1997-2013.3 Analysis of these fatalities has highlighted some gaps between guideline recommendations and patient care, such as delayed treatment with adrenaline.

The Commission is developing a national clinical care standard to describe and promote good practice for the acute management of anaphylaxis in adults and children. Relevant guidance includes the Australasian Society of Clinical Immunology and Allergy (ASCIA) guideline: Acute Management of Anaphylaxis (2019) and the Safer Care Victoria Anaphylaxis clinical care standard (2019).

Development of a clinical care standard

The clinical care standard aims to reduce the variation in care experienced by people who have an anaphylactic reaction. It provides guidance for use by health services aiming to provide high quality care and to meet their obligations under the NSQHS Standards and other standards and regulations appropriate to their health care settings.

The Commission has established an Acute Anaphylaxis Clinical Care Standard Topic Working Group (TWG) with expertise from relevant organisations and clinical specialities including immunology, general practice, emergency medicine and intensive care from states and territories around Australia.

All topic working group members are required to disclose financial, personal and professional interests that could, or could be perceived to, influence a decision made, or advice given to the Commission. Disclosures are managed in line with the Commission’s Policy on Disclosure of Interests.

Next Steps

The draft clinical care standard will be developed based on review of the guidelines and literature and advice from the topic working group. 

Public consultation on the draft clinical care standard is planned for late 2020. Following public consultation, the Commission will review all comments and use this analysis to finalise the clinical care standard by June 2021.

References

1. House of Representatives Standing Committee on Health, Aged Care and Sport. Walking the allergy tightrope. Canberra (ACT): Commonwealth of Australia; 2020 May [cited 2020 Aug 3]. 156p. Available from: https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/Allergiesandanaphylaxis/Report

2. 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

3. 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.

4. Australian Commission on Safety and Quality in Health Care, analysis of Admitted Patient Care National Minimum Data Set (APC NMDS), 2014-15 to 2018-19. Sydney: ACSQHC (unpublished)

5. Australian Commission on Safety and Quality in Health Care, analysis of the Non-admitted Patient Emergency Department National Minimum Data Set (NAPED NMDS), 2014-15 to 2018-19. Sydney: ACSQHC (unpublished)