Barts and The London NHS Trust ALLERGIC REACTION

Date ________ Time _______ ED admitting consultant _____________ Tick / Cross ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬

Inclusion Criteria • Allergic reaction • Treatment initiated in the ED • Symptoms stabilised or improving • Requiring further observation • Likely to be discharged within 12 hrs • CDU transfer form filled out Exclusion Criteria • Unstable vital signs • Anaphylaxis with major cardiovascular compromise • Actual or potential airway compromise • Ongoing requirement for adrenaline • Persistent pulmonary complications with oxygen sats < 93% room air • Major co-morbidity requiring in-patient admission Investigations (only if clinically indicated)

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Management • Antihistamines as charted Chlorpheniramine Other antihistamines (consider H1 antagonists) • Steroids as charted • IV cannula to be left in-situ if patient required adrenaline prior • To be reviewed by Dr ____________ at _________hrs • Notify Medical Staff if:
o o o o o o

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Worsening of symptoms (rash, DIB, vomiting / abdo pain) HR < 60 or > 120 bpm Systolic BP < 100 or > 160 mmHg RR < 8 or > 24 / min Oxygen sats < 93% on room air or ongoing oxygen or salbutamol requirement Drop in GCS by 1 point

Discharge only if: • Symptoms resolving / stabilised


• • • • • • • • • Normal vital signs Can eat / drink normally Normal mobility IV cannula removed (if previously inserted) Adequate home supports Advice about delayed symptoms Discharge medications arranged Discharge letter completed Out-patient referral completed (if appropriate) ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ Referral / Consultation In-patient team: Team _________________________ Time referred _________ Reason for referral: Bleep ___________ Time seen __________ Fast Response Team: • Social Work • Physiotherapy • Occupational Therapy Time referred _________ ‫ٱ‬ ‫ٱ‬ ‫ٱ‬ Time seen __________ Refer to Allergy Clinic if: ‫ٱ‬ • Anaphylaxis • Angioedema / Urticaria > 3 months duration OR assoc with DIB / syncope • Require confirmation of allergy to specific foods • Allergy to insect venom • Suspected drug allergy Created by Ling Tan Last modified on 4/1/06 .

ROYAL LONDON HOSPITAL CLINICAL DECISION UNIT ALLERGIC REACTION DISCHARGE SUMMARY Pt Sticker Date ___________ Dear Dr _____________ Your patient was admitted into the Clinical Decision Unit following a presentation to the Emergency Department with an allergic reaction Tick as appropriate: Your patient had the following investigations (if any): Your patient had the following management whilst in the ED / CDU: ‫ٱ‬ IM Adrenaline ‫ٱ‬ Oral / IV antihistamines ‫ٱ‬ Bronchodilators (salbutamol) ‫ٱ‬ Steroids (prednisolone) Your patient was observed in the CDU and discharged with the following: ‫ٱ‬ TTA medications: ‫ٱ‬ Antihistamines prn ‫ٱ‬ Prednisolone 40 mg for 3 days ‫ٱ‬ Advice about avoiding the offending agent (if known) ‫ٱ‬ Advice about the possibility of a delayed reaction ‫ٱ‬ Advice about the use of an EpiPen and / or a new epipen dispensed ‫ٱ‬ To be reviewed by yourself within _________ ‫ٱ‬ Out-patient referral to the _______________ team (Your patient will be contacted by the Out-Patient Department) ‫ٱ‬ Advice to contact yourself or the Emergency Department should there be any further problems .

Thank you Signed _________________ Name ______________ Grade ___________ .

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