For further information see NICE guideline CG134



Asevere allergic reaction with airway and/or breathing and/or circulation problems.


Causes can be –


  • Food (commonest cause in children)


  • Latex


  • Exercise (ask if wheat or fish eaten just prior to exercise, as very rarely can be food – induced exercise anaphylaxis)


  • Drugs  (no need to refer if single drug and alternative available eg penicillin allergy)


  • Venom induced (most commonly bee or wasp)


Refer all cases to Paediatric Allergy Clinic (Consultant led)


Adrenaline Auto – injectors


In most cases where provoking allergen may be accidentally encountered again (or idiopathic), prescribe an adrenaline autoinjector when referring, due to small risk of recurrence in intervening wait for appointment. All makes of auto-injector are acceptable.


Use the excellent information sheet at http://www.medicinesforchildren.org.uk/search-for-a-leaflet/adrenaline-for-anapylaxis/


Demonstrate with 'dummy' pen if available


Doses (BNFc, ALSG)


If < 30kg 0.15 mg

(If child < 15kg discuss with Allergy Consultant before prescribing)


If > 30kg 0.3mg


If > 50kg and particularly if obese consider Emerade 0.5 mg pen, which has a longer needle as well as providing higher dose




Guideline updated by Simon Bedwani, Consultant Paediatrician, Royal Cornwall Hospital, November 2018.


Date Reviewed                                 14/08/2019

Next Review Date                           14/08/2020

GP Sifter                                              Dr Rebecca Harling


Version No.        1.1