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Barts and The London NHS Trust ALLERGIC REACTION

Date ________ Time _______ ED admitting consultant _____________ Tick / Cross

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)

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

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)

Referral / Consultation In-patient team: Team _________________________ Time referred _________ Reason for referral: Bleep ___________ Time seen __________

Fast Response Team: Social Work Physiotherapy Occupational Therapy Time referred _________

Time seen __________

Refer to Allergy Clinic if: 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

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: IM Adrenaline Oral / IV antihistamines Bronchodilators (salbutamol) Steroids (prednisolone)

Your patient was observed in the CDU and discharged with the following: TTA medications: Antihistamines prn Prednisolone 40 mg for 3 days Advice about avoiding the offending agent (if known) Advice about the possibility of a delayed reaction Advice about the use of an EpiPen and / or a new epipen dispensed To be reviewed by yourself within _________ Out-patient referral to the _______________ team (Your patient will be contacted by the Out-Patient Department) Advice to contact yourself or the Emergency Department should there be any further problems

Thank you Signed _________________ Name ______________ Grade ___________